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CT parents can lose track of the number of kids’ mental health ER visits. Can the system be repaired?

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The Simsbury mother felt like she had exhausted all the options.

They’d tried repeated psychiatric hospitalizations to help her adopted daughter. They’d tried a wide variety of therapy methods. They’d lost track of the number of emergency room visits. And still, she feared her daughter, who had reported suicidal ideations, would end up dead.

When yet another inpatient facility sent the girl home, saying there wasn’t space available for the higher level of care she needed, her parents, fearing for her well-being, refused to take her, leaving the girl in the care of the state’s Department of Children and Families. They thought the state would get her treatment and that she would be safer with them.

DCF placed her daughter at a group home in Harwinton, one of the state’s Short Term Assessment and Respite homes, shelters that provide basic services and counseling and prepare youths for their next placement.

But the experience gave her family an up-close look at a mental health care system that experts say is struggling.

Connecticut’s mental health system for children is strained, they say, leaving the state without enough placements for kids with complicated therapeutic needs that can stem from traumatic life events and feelings of abandonment, among other issues. It has resulted in a situation where children aren’t getting the level of care they need, the state is struggling to figure out where the kids should go, and providers feel like they’re bearing the brunt of a crumbling system.

The Simsbury mother, whom the Connecticut Mirror is not identifying to protect her child’s privacy, believes myriad systemic problems led to her daughter’s stay at the Harwinton group home. In October, lawmakers held a hearing over allegations at the group home of physical and sexual abuse, a lack of supervision of kids and insufficient therapeutic care for children with traumatic histories.

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“I asked to testify because my daughter was a resident of this facility, and I thought it was important for the committee to understand why she was at the STAR home in the first place,” the mother wrote in testimony she handed to legislators.

The Harwinton home became the high-profile subject of accusations of abuse and neglect, four lawsuits — including one filed last week — and the legislative hearing. Since then, DCF has announced sweeping changes to the STAR home model, now called the Specialized, Trauma-Informed, Treatment, Assessment and Reunification homes, or STTAR.

The homes are intended to be short-term stays for kids whose complicated mental health needs have made it difficult to find them a place to stay. The homes started as shelters for kids, and officials say they’re now a place for children’s mental health to stabilize when they have nowhere else to go. Many of the children — most of them children of color — have had multiple foster care placements. Connecticut typically has 30 to 40 children in the homes at any time.

The accusations at the now-closed Harwinton facility have drawn debate and legislative proposals. Parents, advocates and service providers acknowledge that changes are needed. But they say the issue stretches far beyond the STTAR homes.

“I think we are at a point now where we really need to look at the system and look at: is this march away from congregate care, is it being effective? And ask those hard questions,” said Margaret Hann, executive director at The Bridge Family Center. The Bridge operated the Harwinton home and still runs three other STTAR homes.

What’s happened in Connecticut is difficult to understand because of the intertwined systems that have formed a cycle. Kids report more severe and complicated mental health needs, but the mental health system is experiencing a workforce shortage.

The shortage means that remaining providers get overworked and burnt out, further straining the system. As kids wait for services, mental health symptoms worsen, meaning they need higher levels of care. But the state has cut down on congregate care settings, and the number of foster homes dwindled during COVID-19, leaving fewer places for kids to stay.

Many of the children at the STTAR homes have exhausted other options. Their needs aren’t deemed severe enough for hospitalization but need more help than the homes can provide, said Sarah Eagan, the state’s child advocate.

“We have not adequately designed that part of our system,” Eagan said. “And that’s how you wind up with kids with significant treatment needs sitting in shelters. Because there are no other places for them to be.”

The issue grew nationally during the COVID-19 pandemic as children’s mental health issues worsened and the number of foster homes dropped. DCF officials have said the STTAR homes are one of the reasons Connecticut hasn’t resorted to measures that other states have taken, such as putting foster children in hotels or having them sleep in state offices.

The plan for the new STTAR homes model includes adding more staff and more frequent therapeutic services for kids. DCF officials are looking to open another STTAR home to fill the gap.

The state’s $1.2 million request for proposals on a new STTAR home went out in March.

Hann said she thinks Harwinton was the “sacrificial lamb” in a needed discussion about mental health care for children. The Bridge’s homes have served as a place for many children to stabilize before their next placement, she said.

But the Simsbury mother said her daughter needed intensive therapeutic services, not just the minimal, intermittent services Harwinton offered.

“She was running away, self-harming, attempting suicide, and putting our other children at risk,” the mother wrote in testimony to state lawmakers. “Her actions were terrifying.”

Finding the right place

The STTAR homes are often the only option for teenagers, like the Simsbury girl, who have run out of other options, said Michael Williams, DCF Deputy Commissioner of Operations.

“We fund those programs for those youth and children who we have no option for,” Williams said of the STTAR homes. “They are not diagnosed to the level to where they need inpatient therapeutic placements. They have not been delinquent enough to where they need to be in a locked facility. And they don’t stay in foster homes because they run and go AWOL routinely.”

Connecticut parents said they understand how someone could get so scared, so desperate that they think putting their child in DCF care is the only way to get them help.

Eagan said this isn’t an uncommon scenario.

Jennifer Fell of Wethersfield said she sometimes felt like she was in desperate need of support as she sought mental health care for her 9-year-old child and the foster children in her care.

Like many Connecticut families, Fell has spent years navigating a complicated mental health care system. Parents say getting care, especially for children with severe mental illnesses, can mean multiple trips to the emergency room, getting sent home with a child they fear will hurt themselves, or run-ins with the juvenile justice system.

Fell said she’s found an informal network of parents in the same situation. They give each other advice — which programs are best, or where you might find an opening.

“A lot of it has been a lot of trial and error, and it’s doing a lot of research on your own to find out what’s out there,” Fell said.

“You have to do a lot of networking because you can’t have a lot of faith in just getting access to a program, and the waitlists are very long,” she added. “So you also have to get on waitlists with as many places as you can and continue to call and follow up regularly to make sure that you’re not getting bumped off the list.”

Often, the same children with wide range of chronic mental health conditions such as depression, anxiety, substance abuse or eating disorders come to the hospital repeatedly, said Dr. Christin McDermott, division head of Pediatric Psychiatry at Connecticut Children’s Hospital. The hospital typically discharges them into community care or intermediate levels of care such as intensive day programs or multiple therapeutic visits per week.

“I think there’s often a waitlist for mental health, whether it’s inpatient, outpatient, in-home services,” McDermott said. “We’re often running up against wait times for these resources, and that can be frustrating to patients and families, and certainly to those who are providing the services. We want to help as many kids as we can.”

The Bridge, however, has a policy to avoid turning children away. They rarely have cases in which children are sent to different placements because they’re being forced to leave The Bridge facility.

“That rarely, if ever, happens here,” Hann said. “If we’ve exhausted everything we know how to do with a young man or woman, we may ask DCF to consider … we may start that process and say, ‘Listen, this kid, we’re unable to maintain their safety here.’ We have to work together with DCF.”

How the homes work

The Simsbury family spent years looking for ways to help their daughter, enduring dozens of violent outbursts before they concluded she wasn’t safe at home. They wanted her in a long-term inpatient facility.

DCF placed her at Harwinton, a program that wasn’t intended to be long-term or therapeutic.

“Our daughter worked so hard to be like her peers, but her mental health simply made this impossible,” the Simsbury mother’s testimony says.

Like the girl from Simsbury, kids at STTAR homes are typically adolescents, ranging in age from 12 to 18. At The Bridge’s home in Wolcott, they have their own bedrooms, where they can put up posters of their choosing and get privacy.

Meals are served family-style, and the kids split chores. Some of the chores, such as cooking, are used as opportunities to teach life skills. They go to school, and some have part-time jobs as well.

They also do restorative justice circles, a community-based method to work out differences. They go to group meetings, play games and sports, and they meet with staff clinicians.

“The boys are involved in cooking meals with the staff, and they have a life skills group that encompasses a curriculum that teaches things like hard and soft skills, how to negotiate differences with authority figures, how to apply for a job,” Hann said.

But despite the programs, children aren’t supposed to be living in STTAR homes indefinitely — and when their stays lengthen, problems occur.

Stays at STTAR homes are intended to be up to 90 days, but most kids are staying much longer. Eagan’s office put out a report that said the length of children’s stays are sometimes far longer than the ideal, ranging from five to 533 days.

In many instances, staff relied on police to deal with problems involving longer-term residents.

In Wolcott, for instance, the local police department has responded to more than 300 calls at the boys’ STTAR home since 2021, according to call log data, for reasons like breach of peace, children running away and medical emergencies.

“They do take up a lot of the Wolcott Police Department time and our functions,” Chief Edward Stephens said in a recent interview. “We are there constantly.”

Stephens said his police department has started meeting with representatives from The Bridge roughly every six months to discuss how they can collaborate to alleviate the problems and reduce the reliance on law enforcement.

A similar arrangement exists in West Hartford, where The Bridge runs a STTAR home serving girls. Since 2021, the police there have responded to more than 1,500 calls from The Bridge, the overwhelming majority of which have related to children who were missing or ran away.

Still, West Hartford Police Chief Vernon Riddick Jr. feels like the department has formed a good working relationship with The Bridge, with it largely being centered on how they can best assist each other.

“For law enforcement, DCF to a lesser extent, facilities like The Bridge, the problems are already there,” Riddick said. “We need to get back to the root of how these problems begin, directing resources to the beginning stages of this, correct that in the beginning stages of this, so we can mitigate the enormity of these problems later on.”

The problems are compounded by staffing shortages.

The Bridge, along with other service providers, has also struggled with staff turnover in recent years that has made it hard to provide care, Hann said. And they have contracted with an outside agency to help them improve staff retention.

“We take kids that a lot of people don’t want to take, and therefore that leaves us vulnerable too, and we have sometimes more police calls, sometimes we have more behavioral issues and our staff get maybe burned out a little bit quicker,” Hann said. “But we try to do everything that we can to support them. We really put in play a very robust professional development plan for our staff.”

A report from the Child Health Development Institute published earlier this year found that the need for intensive outpatient services is outpacing the state’s capacity to provide those services. Much of the problem, the report said, is driven by workforce shortages, particularly in what are called intermediate levels of care, which are for youths who need more care than traditional therapy but don’t require hospitalization. Intermediate care can also serve as a transition for kids out of residential placements.

Extended day treatment centers reported that they were short about 36% of their staff. Intensive outpatient programs were down 23%, and partial hospitalization programs were down about 37% of staff, according to the CHDI report.

“Essentially we see a cycle of rising acuity of children, more challenging, higher caseload of staff, especially at community services, burnout of those staff,” said Elise Kelly, a senior associate at CHDI. “Then you see staffing shortages. So then you have even higher case loads, then you have delays in care, children waiting to receive services with potentially their acuity increasing, then needing a higher level of care.”

Most programs reported a two- to six-week wait for services to start. The time between referral and start date was typically about 26 days, with longer waits for Black and Hispanic children.

The report says that wait lists for intermediate programs can mean delays in care at other levels. Connecticut is seeing a growing need for intermediate placements, the report says.

“Without long-term investments in the broader workforce needs, including issues related to the workforce pipeline, recruitment, retention, and diversity, improvements to ILC programs will be challenging to implement, if not impossible,” the CHDI report says.

Eagan said other services needed could include more therapeutic foster home placements, which are higher levels of care in foster homes that are designed for children who have experienced trauma that can range from domestic violence to neglect. Eagan said the state could also make it easier to access in-home services or intensive outpatient programs. She said the state needs more 24/7 therapeutic treatments for kids as well as a continuum of other services.

“There’s no silver bullet for these kids,” Eagan said. “And the state does need to have a continuum of services, which includes specialized 24/7 settings, and we need to pay more attention to the design of that and what we’re finding and what we’re funding than we are. And the reliance on STAR homes is … a strong sign that there’s a problem.”

Congregate care

Eagan has spoken often about the need for more mental health services for children in Connecticut. As the state has cut down on group home placements for foster kids, she said, they’re relying more on STTAR homes.

“I’ve seen kids with some really acute needs, and we aren’t going to have easy answers,” Eagan said. “But we definitely have to start with systems. If we know we’re using the STTAR homes to fill in gaps, we’ve really got to dig in on our continuum of care and where those gaps are in our continuum of care, and how we’ll address them.”

Child welfare advocates say that kids in the foster system have better outcomes when they’re not in congregate settings. Research shows it’s best to leave kids at home when possible, with relatives or in individual foster homes.

Systems across the United States have cut down on group home and congregate care placements over the years, which Eagan says is the right goal.

But many states ran into problems during the pandemic as families stopped fostering children. In 2019, there were about 219,000 licensed foster homes in the United States. By 2023, the number had dropped to about 186,000.

Connecticut gained foster homes between 2019 and 2021 but saw a drop of about 500 licensed foster homes after 2021. By last year, the number was at about 2,360.

Over the past few years, the state has also seen declines in the number of children in foster care. By 2022, the number had dropped by nearly a third from 2019, to about 3,000 children as the state has offered more services to keep families together.

Police records show that runaways are one of the most frequent calls for service from STTAR homes.

Often, they’re trying to return to the communities they came from, said Williams. He said many of the kids at STTAR homes have been “abandoned” at juvenile court or at a hospital. Their needs were high, and their parents felt they couldn’t keep them safe any more and left them in DCF custody, he said.

“The kids who are coming into care now, they still have relationships with their biological families,” Williams said. “Their parents aren’t saying ‘We don’t want to parent them any more.’ It’s not because of bad parenting, not because they’re abusive or anything like that. It’s because the child may have a severe mental illness or the child may have some significant delinquency pieces going on.

“Parents still want to be involved. They want to have custody, they don’t want to give up custody. They don’t want the kids to go into foster care. They just want them to go somewhere else out of their home, who could help them take care of them.”

That feeling of being rejected by a family is a common thread among kids, according to officials at The Bridge. Asked about what ties together kids who wind up at STTAR homes, four staff members answered nearly in unison:

“Trauma.”

Williams said that many of the children in the STTAR homes have had multiple foster care placements. The behaviors caused by mental health problems make it difficult to find a home for them.

At least two dozen other states have used nontraditional placements such as children sleeping in state offices or hotel rooms as they cope with the lack of foster homes. Connecticut’s alternative has been the STTAR homes, he said.

Since the pandemic began, parents and children have reported higher rates of mental health issues such as depression, anxiety, eating disorders and substance abuse. In 2021, the U.S. Surgeon General issued an advisory on a national youth mental health crisis exacerbated by the pandemic.

McDermott said the hospital is seeing more children with complex needs and trauma — often with multiple diagnoses such as chronic depression, anxiety and post traumatic stress disorder.

COVID put the spotlight on mental health.

Circumstances during the pandemic such as job loss, fear over physical health and disruption of day-to-day life exacerbated many of these conditions or brought them out in children that were already prone to developing mental illnesses, McDermott said.

“We had data well before the pandemic to show that we were seeing increasing rates of depression, anxiety, suicidality, and that we were seeing kids who were younger experiencing symptoms in a way that was really preventing their engagement with school and community and family,” McDermott said. “So COVID put the spotlight on mental health.”

Nadia Gerwell of Stamford got a crash course in those worsening symptoms when one of her triplets had her first panic attack. When the 10-year-old started complaining that she couldn’t breathe, Gerwell thought it was her asthma. She said her daughter had shown signs of anxiety before, but it had been manageable at home up until then.

After doctors determined it was a panic attack with shortness of breath, Gerwell put her daughter in therapy. But things escalated from there until Gerwell was hiding kitchen knives to keep her daughter safe.

“The suicidal ideations in her head were triggered by the OCD,” Gerwell said. “So they just kept swirling in her head over and over and over. And that would torture her all day.”

As her daughter had more emergency and longer-term placements at mental health facilities, Gerwell started meeting other parents and talking with them about the system. She recalls often having to wait for a bed while she worried about keeping her daughter alive.

“I don’t wish this upon my worst enemy,” Gerwell said. “I mean to have a child that every time I felt I was gonna lose her, it was beyond my being able to handle it.”

Gerwell said her daughter languished on many waitlists while she struggled at home to provide her care. Every day brought new fears, and Gerwell soon found herself exhausted, stressed and on the verge of a breakdown.

Changes to STTAR homes

Hann said she and her staff think of the STTAR homes as a good place for children’s behavior to stabilize.

“We have STTAR programs, and that has really served a huge role in preventing further traumatization of those children that have already been abused, abandoned and neglected,” Hann said. “Our kids sometimes really get bopped around like pingpong balls. And it’s difficult to go from lots of different foster care placements, kinship care placements, residential treatment, the hospital to a group home, and then back to a STTAR program.”

In March, DCF officials stood alongside key lawmakers to announce some broad changes to the way STTAR programs are run, a change that was spurred on by the allegations at Harwinton.

“We acknowledge that STTAR homes have experienced significant challenges in trying to meet the needs of youth in their care,” said DCF Commissioner Jodi Hill Lilly, at a press conference. “In many instances, those complex needs, particularly post pandemic, exceed what STTAR programs were originally intended and equipped to address.”

The state will establish two intensive transitional treatment centers that can each house eight children. Youth with more therapeutic needs than the group homes are equipped to handle will go to these centers. If children stabilize in the centers but can’t go home or into foster care, they’ll be moved to a therapeutic group home.

DCF also plans to offer youth in the STTAR homes priority access to three of the beds at Solnit South and Solnit North, two of the state-run psychiatric residential treatment facilities.

Under the plan, STTAR providers will add supervisory positions to improve monitoring of staff and kids, especially during late-night hours. Staff will also get more trauma-informed training.

The state will cut down on the number of kids in each home. DCF’s census in the homes is six, but as youth leave the homes, they’ll go down to five. The programs will also have more recreational activities to “channel their energy into positive activities, creating a sense of normalcy,” Hill-Lilly said.

The changes will cost about $6.2 million, DCF officials said. The money will come from within the department’s budget for congregate care. Use of congregate care has declined since 2019, which allows the agency to use the money for the new services.

“This is a very important step forward,” Eagan said, after DCF’s announcement about changes at the homes. “But it’s a piece of a much larger challenge that we have.”

Legislative response

Hann said more funding, particularly to increase wages for staff, would go a long way to ensuring there are sufficient and stable services for children in Connecticut. It would also help cut down on turnover, she added.

The legislature also recently passed a bill proposed by the Juvenile Justice Policy and Oversight Committee to establish a gender responsiveness subcommittee to recommend improvements to the continuum of care for justice-impacted youth, such as the children residing in STTAR homes.

But advocates say it’s unlikely the big problems in the children’s mental health system will be solved in one legislative session or without significant financial investments both in mental health care and in early prevention of serious mental health issues.

“It’s really, really important to make early interventions in home, school, and community settings as accessible as you possibly can, so that the kids can get the help that they need when they need it,” said Jeffrey Vanderploeg, president and chief executive officer at CHDI. “And when you do that, you’re going to find that fewer kids will show up to the emergency department in a significant crisis.”

And while there is some agreement that the problems with the STTAR homes are only one piece of the larger puzzle, advocates say it’s important that providers like The Bridge and legislators take responsibility and acknowledge where they may be falling short.

“It’s so important not to just pass the hot potato there or say ‘that’s not my issue’ or ‘it’d be unfair that you’re focused on me,’ because something did happen there,” said Christina Quaranta, executive director of the Connecticut Justice Alliance, which advocates for youth affected by the criminal legal system. “If we just all kind of wrapped around it, were accountable for our actions, took responsibility and moved on, I think that’d be so much more productive.”

Meanwhile, the Simsbury family is in a holding pattern, still seeking care for their daughter.

“When we adopted our daughter, we were aware that there were brewing mental health issues caused by early childhood neglect and trauma, but we were convinced that with stability and love, we could overcome the challenges,” the mother wrote in testimony.

“As it stands today, we were wrong.”

If you or a loved one has struggled with thoughts of suicide, help is available by calling 988.

Ginny Monk and Jaden Edison are reporters for the Connecticut Mirror. 

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