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Wednesday, September 17, 2014

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Long ER stays for kids in crisis on the rise

Lisa Chedekel, New Canaan News
Published 11:26 am, Monday, July 14, 2014
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Pediatric emergency department visits are spiking at hospitals throughout the state, and some hospital officials said the culprit is a lack of other resources for children with mental health problems.

At Yale-New Haven Hospital, for example, there has been a 10 to 15 percent increase in ED visits this year, and in each of the past several years, said Dr. Andres Martin, medical director of children's psychiatric inpatient services. Hospital officials noted that the state Department of Children and Families has cut funding for congregate or group homes and is steering children to remain with families -- even when community-based support services are lacking, they said.

"The current DCF commissioner has been very opposed to congregate care, and wants to place children in home settings," Martin said. "It's well-intentioned, but in my opinion, the pendulum has swung too far."

Other hospitals have seen spikes as well, including Connecticut Children's Medical Center in Hartford. A report by the hospital, obtained by the Connecticut Health Investigative Team, projects that children with mental health problems will spend a total of 3,085 nights in the ED -- more than triple the number in 2010. The average stay is about 15 hours, with some children remaining in the ED for 10 days or more.

Martin said at Yale-New Haven, some children bounce back to the ED "five or six times" in a year because their families cannot cope with their problems.

"We do struggle with some kids for whom we just don't have an appropriate placement," Martin said. In other cases, placements are found, but the state will not authorize care.

DCF official Kristina Stevens, said the spike in longer ED stays is not related to the closing of group homes or a shortage of treatment programs, but instead mirrors a national trend driven by myriad factors. Stevens, DCF's administrator for clinical and community consultation and support, said the statewide average length of stay for children with psychiatric problems has remained relatively consistent, at 1.5 days.

Still, she acknowledged, "It was a big spike this year ... Nobody wants children sitting in the ED and not getting the services they need," she said. "We're doing a deep dive into the numbers to see who this population is" and how they might be diverted to other services.

Martin said ED visits climb during the school year, when school officials refer problem children, and then subside during the summer. At Yale-New Haven this school year, "We were bursting at the seams," Martin said.

Greater awareness about children's mental health and a "zero tolerance" policy in schools, especially after the Newtown school shootings, has contributed to the increase, they and others said.

As the hospitals grapple with the ED backlog, DCF is closing five group homes and reducing inpatient slots in other programs, including the Village for Families and Children in Hartford, which is losing funding for the residential component of its Intensive Community Program, touted as a model by DCF when it was launched in 2012. The five group homes that will close in August are located in Bridgeport, Bethlehem, Torrington and Lebanon, with a total of 27 beds.

Under DCF Commissioner Joette Katz, the agency has set as goals reducing the length of stay in residential treatment centers and dramatically limiting the number of children ages 12 and under who are served in non-family settings.

Stevens said the shift in Connecticut reflects a national move away from institutional care to family settings. But critics say the state does not have enough community services in place -- yet -- to support the policy shift to home-based care.

DCF in October will present a statewide plan for improving behavioral health services to children, under legislation passed in 2013, after the Newtown shootings.

Among ideas that have been proposed is an expansion of a statewide Emergency Mobile Psychiatric Services program, which has helped to divert ED calls from schools and families. Yale-New Haven and other hospitals are working with EMPS to assess children and direct families to care.

Nationally, pediatric psychiatric ED visits increased from an estimated 491,000 in 2001 to 619,000 in 2010, according to a recent report in the journal Academic Emergency Medicine. Teenagers and publicly insured patients were at increased risk of landing in the ED.

This story was reported under a partnership with the Connecticut Health I-Team (www.c-hit.org).