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$7 Million Needed To Help Children With Psychiatric Emergencies

By Gregory B. Hladky

Money, other issues delay efforts to provide emergency care for kids with psychiatric problems.

HARTFORD — State officials are looking for $7 million needed to pay for two key elements of Gov. Dannel P. Malloy's plan to prevent children with psychiatric behavioral problems from having to resort to hospital emergency rooms or getting stuck there for hours awaiting treatment.

Other parts of the governor's 11-point "immediate action plan," such as providing 70 beds for young people in need of residential psychiatric care and support, aren't likely to go into effect until March, a state official said Wednesday.

In October, Malloy announced his proposals for addressing what health officials say has been a long-running and worsening crisis in dealing with the psychiatric needs of children with behavioral, developmental and autism-related problems.

Anne Foley, a top planning official with the state Office of Policy and Management, reported to the administration's Health Care Cabinet this week that progress was being made on implementing much of Malloy's plan. But she acknowledged that administrative concerns, such as requesting bids for specialized services and drawing up contracts, is "a process that takes a few months."

"For those of us on the front lines, we'd like to see all of those plans happening yesterday," said Dr. Lisa Namerow, director of child psychiatry consultation services at the Connecticut Children's Medical Center in Hartford. "We called this a crisis a decade ago."

Foley said that funding for such reforms as posting psychiatric teams in emergency rooms and increasing Medicaid payments for psychiatric residential facilities has been found through grants or shifting state funds. Those parts of the governor's action plan have already been put into effect, Foley said.

But creation of a new state "behavioral health assessment center" as an alternative to emergency rooms for young people facing psychiatric and autism spectrum disorder problems would need an estimated $4 million in new money. Foley said that funding isn't currently available.

State officials are also looking for another $3 million to pay for additional staff and expanded working hours for teams of mobile emergency psychiatric experts to offer families in-home assistance in crises. The proposal calls for extending the current 11-hours-per-day availability of such teams to 18 hours per day.

The search for money to pay for Malloy's plan comes at a time when the governor has ordered a freeze on state spending to deal with projected deficits.

"There are a couple of ways we could do it," Foley said. She said the additional funding could be included as part of the governor's new budget that will be presented to the General Assembly in 2015. Another funding source could come from "lapses" in the current state budget — money that agencies aren't expecting to spend during the current fiscal year for various reasons, she said.

Connecticut emergency rooms have had a steady increase in the number of young people with psychiatric and autism-related behavioral troubles coming in for treatment, according to state reports.

Psychiatric visits to the emergency room at Connecticut Children's Medical Center in Hartford in 2000 were averaging fewer than 55 per month. In 2013, that average rose to 207 per month. In May of this year, the center's emergency room recorded a high of 367 psychiatric visits. State officials say that other emergency rooms are reporting similar increases.

Namerow said that winter is when emergency rooms generally face the highest influx of young people in need of crisis care for psychiatric and autism-related problems.

A lack of available beds in facilities equipped to provide psychiatric care for children with serious behavioral problems is one reason some end up stuck in hospital emergency rooms for more than eight hours. State records show that some end up being sent home and waiting days for help.

A long-term plan for the state Department of Children and Families to "meet the mental, emotional and behavioral health needs of all children in the state" was mandated by the legislature in 2013. That plan was completed in October, the same month that Malloy issued his action plan for shorter-term solutions to deal with children seeking treatment for serious psychiatric problems in emergency rooms.

One planned reform is to provide 70 beds in residential care facilities or group homes, beds that are currently restricted for use by abused or neglected children in the custody of DCF. Changes in DCF policies have led to high vacancy rates for many of those facilities, in part because more abused or neglected children are being placed in foster homes.

Foley said that DCF officials are currently preparing new contracts that will allow beds in those facilities to be used for young people with psychiatric problems. She said those beds should be available by March 1.

Another of Malloy's proposals would offer expanded in-home psychiatric services for families. Foley said that state officials are now preparing requests for proposals to send to service providers, and that those new programs should be available beginning in March.