Sunday, April 2, 2023

State’s mental health facilities for children have collapsed

SEATTLE ( Associated Press) — The Tamarack Center website reads in capital letters “Does it work?”

“We answer that question with an enthusiastic ‘yes’,” the center says of its proposals: a children’s residential program in Spokane, where children with serious mental health conditions live and intensive for months at a time. receive psychiatric treatment.

For kids and teens at Tamarack, the promise of “works” is everything.

Tamarack is one of four Washington intensive inpatient facilities that serve as an ultimate last stop for youth with mental health problems so important they remain vulnerable at home. Some youth cycled to emergency departments and passed out after a mental health crisis; Others have bounced between foster homes, lived in juvenile detention or experienced long and unsuccessful trials with outpatient care. Many have a history of aggressive behavior, mood disorders, suicidal behavior, and trauma.

At a time when more children are needed than ever, Washington’s pediatric inpatient psychiatric facilities are grappling with chronic underfunding, a patchwork of laws that make expansion difficult, and a mental health workforce crisis that is fueled by high employee turnover and severe Understandably translated.

Washington currently funds 94 long-term inpatient beds serving the state’s 1.1 million children. Even though the state has injected more money to add additional long-term beds, providers say they are also struggling to keep their existing beds online because they can’t retain or hire enough staff. can. And while the state is trying to set up a new inpatient facility, not a single provider has applied to run it.

Pearl Youth Residence, a 27-bed pediatric facility in Tacoma, had a 50% staff turnover rate last year, said Chris Gleason, chief communications and community affairs officer for Comprehensive Life Resources, which oversees Pearl Youth. Because it didn’t have enough staff, Pearl Youth made the difficult decision in December to stop hiring new patients. Its census has since dropped to 17.

“Just trying to get a therapist?” To work at Pearl Youth, said Kim Doozal, the facility’s director. “I’m calling them unicorns now.”

As Washington faces a growing youth mental health crisis, places such as Pearl Youth and TAMARC have become central to debates over how to expand care for children experiencing serious mental illnesses or behavioral problems. Families who are fighting on one front – through lawsuits or determination – to tie together intensive outpatient services so their children can stay at home. On the other are families who have gone through a long odyssey of diagnosis and outpatient services and see no other option than housing their children in long-term, inpatient psychiatric care.

Many families begin to seek long-term care because they notice their child’s symptoms becoming progressively worse, even violent, at home. More and more, however, children are in such severe distress that they are taken to an emergency department – ​​and end up staying there for weeks or months as they wait longer stays in facilities such as Tamarack and Pearl Youth. Huh. ,

The Seattle Times recently reported that hundreds of Washington children each year end up in this holding pattern, known as “boarding.”

Long-term bed waits are longer than at any time in recent memory: Of the state’s waiting lists during the first quarter of 2022, children aged 6-13 waited an average of 144 days, and 14 Children aged -18 waited 96 days. And the number of admissions is historically high, a reflection of the need to crush both long-term care and rapid turnover at care facilities, experts say. For example, Tamarack admitted 47 children in 2021, its largest admission to date. But children are staying for shorter durations: the average is now 4.5 months, which is less than the typical stay of about 6 months.

“Our phone rings all day,” said Tim Davis, who has run the Tamarack Center for 34 years.

“Out of 10 phone calls from parents or people here to have a baby, we probably say no to nine. The phone rings constantly for those wanting to get some help to their kids. ,

To serve children with serious mental illnesses, Washington state contracts with three non-profit residential facilities: Tamarack, Pearl Youth, and a small facility in Yakima called Two Rivers Landing. Near Western State Hospital in Lakewood, the state runs a fourth facility, called the Child Study and Treatment Center.

Washington began funding the long-term pediatric psychiatric bed, now called the Children’s Long-Term Inpatient Program (CLIP), in the 1980s. Davis said the state envisioned small, home-grown facilities staffed by highly qualified physicians, nurses and teachers.

The Tamarack pretty much fits that model. Teens who live there have five hours of school on most days and spend the rest of their time in a mix of group therapy, individual therapy, family therapy, and recreational activities such as basketball, pool or video games.

Jason Longshore, who oversees the nursing department at Tamarack and has worked there for 26 years, said the biggest change he’s seen during his career is the length of time residents stay at the center. In their early years at Tamarack, the kids lived an average of 10-12 months, he said, and “they were in pretty good shape by the time they moved on.”

Now, “there are so many kids waiting to come in, whether it’s from home or the hospital, that there’s a push like, ‘We have people in line here, let’s go,'” he said.

There is also a financial incentive to get children out of hospitals and into long-term care: The daily cost of boarding in the ER can be upwards of $2,000, depending on the hospital. That’s less than half the rate the state pays for long-term care in Tamarack, which is $880 per day.

Some who manage CLIP facilities say there is not enough money to recruit and retain the highly trained staff needed for the job – especially when they have to compete for staffing with hospitals, which often do more. Can pay, and jobs that offer work from home or a more flexible working environment. And CLIP facility operators say state rates for long-term care do not cover the cost of care for many high-need youth.

Davis remembers only three meaningful increases in the state rate over the past 30 years, and the current rate doesn’t leave room for facilities to increase, he said. As part of a decades-long shift from institutionalisation, cultural and legal forces have focused on improving access to outpatient care rather than extended inpatient stays.

Davis said Tamarack survived because it accepts children with either public or private insurance. Private plans pay slightly more than state plans.

“The state is not happy with us at all as we call some of the clips children they refer to. I certainly understand his position on that,” Davis said, but, “it keeps us from hitting the iceberg.”

But many other residential facilities have closed or consolidated.

Seattle Children’s Home, which was established in 1884 and served youth before Washington was formally a state, merged with a provider called Navos in 2012. Then, Navos closed some of its programs: citing staffing shortages and care costs that exceeded the state rate. Reimbursable, Navos’ Sunstone program kicks off in the summer of 2021. Many therapeutic group homes, such as Ryther in Seattle and the Navos Ruth Dieckman Children’s Center in Burion, which provide less intensive services than CLIP, have also closed or shortened their residential rehabilitation programs.

Long-term care is just one part of a fragmented system that makes it difficult for children to return to stable homes, or from one point in the mental health system to another. From foster care to hospitals to therapeutic group homes, long wait times have created bottlenecks at almost every stage. For example, CLIP operators say they sometimes struggle to discharge youth into less intensive mental health settings because these services are full, leaving children in a CLIP bed that may need hospital or Another young man waiting at home.

For example, a 15-year-old man at Pearl Youth who met all of his treatment goals and was stable for five months was due to leave the facility in early May. But her parents said they were not ready to take her in, Dojal said. So Pearl Youth put her on hold for two additional weeks—and asked the state’s Department of Children, Youth, and Families to explore other options, such as foster care or group homes. But until last Monday—the date of the teen’s new vacation—nothing had been revealed.

Pearl Youth couldn’t hold the teen, and the facility didn’t even leave her homeless, so Doozle made every call she could think of: DCYF, law enforcement, child protective services. On that Monday afternoon, he decided to escort the boy to the door of DCYF.

“We get stuck in a situation where the progress the child has made has essentially been wiped out,” Dojal said. “It was really hard for the staff to wrap their heads around that we were dropping a baby and essentially walking away.”

State data shows that as of early May, eight Washington children aged 11 and younger, and 28 years of age and 12 years and older, were waiting for a CLIP bed.

To help speed more children and teens toward care, the Washington state health care authority, which oversees the CLIP program, recently built a new 12-bed facility and at least 35 additional beds, officials said. received money for

But problems persist.

In January, the agency solicited bids for a new 12-bed residential facility intended to serve youth with co-occurring mental health conditions and developmental or intellectual disabilities – populations with complex needs that are often denied placement in existing CLIP facilities. is done.

The state put in money to pay employees’ wages and other costs that go into caring for a child, but no capital dollars to build or renovate a facility. No one bid on the project.

“We were really hopeful that we would be bitten,” said Diana Cockerell, the behavioral health administrator at the Health Care Authority.

Davis and Pearl were not interested in Youth’s Dozzle: chronic staffing concerns at their facilities made it difficult to imagine employees trying new beds. And Washington is uniquely hard-pressed to attract new long-term inpatient providers, Davis said. This is because Washington youths 13 and older have the right to start and withdraw their mental health treatment without their parents’ consent. The law provides significant protections to youth, but also makes long-term care an uncertain business proposition.

“There are so many places for kids with varying degrees of psychiatry and many of them are profitable,” Davis said. “That being said, they stay as far away from Washington as possible because the kids can sign themselves out,” says Caring.

Juveniles can be placed involuntarily if a judge is involved: At Pearl Youth and Tamarack, anywhere from 30-45% of residents are under a court order, facility administrators said. However, young people often buy into their treatment as it progresses, Davis said, and end up living voluntarily.

Davis said he stays the course because, as Tamarack advertises on its website, long-term treatment may work.

“It’s like a slot machine. You can sit there playing all night and lose, but if you hit the jackpot you feel like a million dollars,” he said. “We’ll help a kid. And they’ll do great and get amazingly better here… you look around and say, ‘Okay, okay, we’ve got to keep doing this.'”

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