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Mobile units
an alternative to hospitals,
residential treatment
(October
2004 Issue)
By Phyllis Hanlon
Connecticut has a statewide network of 16 mobile crisis units to
alleviate the increase in pediatric psychiatric emergency room (ER)
admissions. The Connecticut Department of Children and Families
(DCF) and the Department of Social Services (DSS) in 2002 created
the measure through the state-funded Community KidCare project.
According to Ann Adams, MSW, project director for Exit/Outcome,
a federally mandated program to determine what services are available
for children, DCF was directed to provide mental health services
for children five years ago in addition to the protective measures
and welfare services it already offered.
The emergency mobile unit (EMU) was created in response to this
need, Adams notes. "Our goal is to keep kids out of the hospital
and residential treatment," she says. To date, the EMU has served
10,737 children. Approximately 72 percent of these cases have never
been known to DCF, according to Adams.
The EMU responds to crisis situation calls from parents, caregivers
and the school system with additional requests from the court, DCF
office and other social service agencies as well as from some hospitals
and ERs. A few healthcare facilities hesitate to utilize the mobile
unit due to liability issues, Adams says, "but some hospitals have
EMU doing evaluations."
The units provide face-to-face evaluation and support in a school
setting, the child's home, a shelter or other location. "We are
allowed six weeks of crisis stabilization," she says. She reports
that 34 percent of the cases continue to receive attention beyond
this period. "We are carrying some cases three and four months because
of gridlock." Adams says that 39 percent of the families prefer
that a child be seen outside in a venue other than the home. She
adds, though, that some families still bring children to the ER
out of habit.
According to Adams, the EMU is modeled after several different
programs throughout the country, in particular the wraparound programs
implemented in Ohio, Pennsylvania, Wisconsin and Michigan. Mobile
service starts responding to calls anywhere from 8 to 10 a.m. and
might continue until 7 p.m., with extra availability in the evening
and on weekends.
In order to "get the message out," the unit has done a significant
amount of outreach. "EMU is required to do community education so
we go to fairs and schools. As part of a support group, we've done
a lot of outreach," she says.
Before the program was implemented, the EMU anticipated serving
between 200 and 400 children annually. "In reality, it has been
more like 800 to 1,000 per year in some areas," she says. Adams
believes that children today deal earlier with adult issues and
increased stress.
J. Kevin Kinsella, Ph.D., vice president of Hartford Hospital,
points out that, although many pediatric cases might be diverted
into outpatient services, a significant number still present with
a level of illness that requires hospitalization. "The notion that
[EMU] would fix the problem in the ER was not a valid assumption,"
he says. "They do more case finding."
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