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Philip G. Spiva, Ph.D., director of Valley View School in North Brookfield, Massachusetts, thinks that agencies must collaborate to meet the needs of every child and that each youngster requires individualized care. (photo by Kathryn Hardy) |
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By Phyllis Hanlon
Images of youngsters locked in psychiatric wards recall a darker time in our history when such situations were commonplace. And although times have changed, the issue of adequate, accessible and affordable mental health care for children still challenges state governments and citizens today. The way states utilize federal and human resources impacts the issue of “stuck kids.”
In Massachusetts, the number of children who remain “stuck” due to bureaucratic red tape, insufficient services and programs, lack of advocacy and misinformation continues to be significant, according to David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems (MABHS).
Matteodo defines “stuck” children as those who no longer need hospital level care but have no other place to go. Responsible for 13 child/adolescent inpatient units, Matteodo has seen many disturbing situations, including an incident of one child remaining “stuck” for one year in a locked psychiatric unit.
With an average 110 children stuck on any given day, the state pays a hefty price — $19 million annually, according to data collected by MABHS. Utilizing transitional or residential care, foster homes or other community programs would save the Commonwealth approximately $7 million, says Matteodo. In addition to enormous financial drain, the dilemma reflects inadequate clinical care. Matteodo says that keeping children hospitalized beyond an appropriate time frame because of inadequate community resources is not in the youths’ best interest. He adds that the use of the state’s funds is “misdirected” and could be better utilized by creating community-based programs.
Lisa Lambert, assistant director of the Parent/Professional Advocacy League (PAL), cites a survey the organization conducted recently that reveals alarming statistics. While some of the survey respondents benefited from support groups, educational advocates and attorneys, a large percentage reported gaps in the system that hinder efficient delivery of care.
According to the survey, 33 percent of parents waited more than one year before their child was given any treatment. More than half the children requiring hospitalization in a crisis situation waited from one to 12 hours for admission, while another 34 percent waited more than 13 hours. In addition to delayed admissions, children were often admitted to inappropriate units due to the unavailability of beds and also discharged too early. Of the 301 respondents, 77 percent reported that providers were not at all or only somewhat helpful in connecting them to appropriate resources.
Philip G. Spiva, Ph.D., a clinical psychologist, founder and director of Valley View School in North Brookfield, Mass. says, “if you scroll back through history, you will see horror stories.” He emphasizes the importance of agencies working with families to ensure a happier future for their children. “When a place feels services are no longer needed, they should have the ability to work with parents to find a transitional experience to allow the child to function in the world,” he says.
Spiva adds that each child requires individualized care. “When people evaluate what might be effective, they need to consider the dynamics of the family and who is involved in the process. There is no panacea, no one program that will meet all the needs.”
Based on these ideas of collaboration and family involvement, Massachusetts recently implemented programs to help children and families obtain necessary services. Anthony Irsfeld, Ph.D., clinical director of the grant-funded Worcester Communities of Care (WCC), believes that emotional disturbances can affect every domain of family life, not just the child’s, so the agency looks at a range of issues. “When children are ready to be discharged, we need to divert resources,” he says. In many cases, parents are willing to accept youngsters into the home again, but lack of social services and financial resources prevents that outcome from happening. Through a collaborative process of detailed service planning, the entire community – mental health, social and youth services, juvenile justice, local housing authorities, legal experts and community-based organizations – provides better support, says Irsfeld.
Maine has experienced considerable expansion and growth in resources, ameliorating the problem of stuck kids. Joan Smyrski, M.S., acting director, children’s services in the Department of Behavioral and Developmental Services, says, “In our state, the resources that have been allocated legislatively to children’s services that offer a variety of support have been dramatically increasing over the past few years.” In the last fiscal year, she reports that between 17,000 and 18,000 children received services ranging from case management and respite to in-home support.
Brenda Harvey, M.S.Ed., acting deputy commissioner, credits the collaborative efforts of several state agencies for the success they have achieved in working with children and families. “There’s great attention being paid to interdepartmental work that needs to be done and continues to happen. We think that’s had a pretty significant impact,” she says. “It certainly has impacted what happens to kids wherever it is they are getting stuck.”
Bruce Saunders, Ph.D., ABPP who practices in Bangor, Maine, grew up in a residential treatment center – his father ran the facility. A clinical and forensic psychologist now, his patients include individuals who, as children in the early to mid-1970s, lived in therapeutic situations. The transition to community living and outpatient services represents “enormous progress,” says Saunders. In the past, he notes, patients didn’t know who their caseworkers were. “Today there is face-to-face check-in with children,” he says. “A lot of positive changes have taken place.”
According to Diana L. Prescott, Ph.D., clinical psychologist at Acadia Hospital, the issue of stuck kids is less severe than it was 10 years ago due in part to shorter lengths of stay. “There are also more wraparound services, more expertise on the part of school personnel and more professionals available in the community to treat these children and adolescents,” she says. Prescott says, though, in her practice she still sees many youngsters who “fall through the cracks” and that abuse is often reported with indecisive results in terms of positive life changes for the children.
New Hampshire, too, has seen a decrease in the incidence of stuck kids during the last several years through its cooperative approach to mental health care. Joe Perry, administrator for Care NH, says previously various agencies such as juvenile justice, mental health, child protection, education and others have stymied children with intensive needs by providing only categorical services. “The goal of a system of care is to create a collaborative infrastructure at the local and state level of those agencies, so we can have families join that infrastructure and family advocacy agencies to change the culture of service delivery and streamline financing as it applies to this population,” he says.
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