The state’s Department of Children and Families took custody of Beth Farrell’s 14-year-old child in February 2022, when the teenager was hospitalized after overdosing, Farrell said. While her child was in in the hospital, Farrell said, the teen developed a functional neurological disorder, which causes tremors and interferes with daily living.
As Farrell fights to regain custody, her child has spent most of the past year at Baystate Medical Center in Springfield. The teenager needs a rehabilitation center that provides physical, speech, and occupational therapy, and Farrell was told that DCF cannot find a residential placement that will accept a minor and has the medical staff to assist a child with a functional neurological disorder.
So her child has “been sitting in the hospital for months and months and months against medical advice,” Farrell said. “DCF has caused so much trauma for my child and my family that I don’t think we will ever recover from this, ever.”
A new report from the Massachusetts Health and Hospital Association, based on a December 2022 survey of 29 hospitals and five psychiatric facilities, identified 69 pediatric patients whose care involved a state agency and who were ready to be discharged but could not be, because the state had nowhere to put them.
There were 32 kids in inpatient psychiatric facilities, 28 in emergency departments, and nine in inpatient medical-surgical beds. Of 57 DCF-involved children, 25 had been waiting to be discharged for more than 10 days, including 10 who had been waiting at least 30 days.
The number is consistent with a similar MHA survey done in May 2022, when 41 facilities identified 78 state agency-involved children awaiting discharge.
If the state has custody of a child, because the child has been abused or neglected or for any other reason, it is obligated to meet that child’s needs in the most appropriate setting. Monthlong waits in a hospital are inexcusable. They are also impractical and expensive. When hospital beds are filled with children who don’t need to be there, it takes beds and staff away from patients who need them.
Workforce and capacity issues are plaguing the entire health care system. Massachusetts health officials have made extraordinary efforts to improve the mental health system. But there are needs that have not yet been addressed when it comes to state-involved children with complex medical and behavioral needs. Lawmakers in 2022 passed a mental health law that includes creation of an interagency review team to handle complex cases. This team must become fully operational. There also need to be resources put into creating more beds — or new models of care — that can handle children with unique needs.
Leigh Simons Youmans, senior director of health care policy for the MHA, said most of the children stuck in hospitals have complex medical needs. The report writes that a minor with insulin-dependent diabetes and a behavioral health issue cannot be placed in a traditional group home because of regulations related to who can administer insulin. There are only two units in the state that can handle children with both an eating disorder and a behavioral health issue. Transgender and non-binary children can have longer waits since they need a single room.
“The appropriate services just aren’t there,” said Nancy Allen Scannell, director of external affairs for the Massachusetts Society for the Prevention of Cruelty to Children.
State Senator Cindy Friedman, co-chair of the Joint Committee on Health Care Financing, said the intention of the 2022 mental health bill was to resolve situations where a child is getting services from multiple agencies that disagree where the child should be placed and which agency is responsible. “[Children] were sitting there because the adults couldn’t agree who should pay,” Friedman said.
The bill establishes an interagency team that is required to quickly review cases and decide where to send a child. The Executive Office of Health and Human Services is still finalizing regulations to create that team.
A bigger problem is a lack of services for high-needs children. When children in DCF custody require a higher level of behavioral health treatment than foster care can provide, DCF works with other state agencies to find appropriate placements. But those can be scarce.
Justin Precourt, chief nursing officer at UMass Memorial Medical Center, said children with chronic medical conditions like diabetes, asthma, or heart disease, as well as children who are aggressive or angry due to a behavioral health condition, do not need inpatient care, but require a high enough level of supervision that they can be hard to place in communities.
David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, said it is not uncommon for a child to get stuck in a psychiatric facility because they assaulted a staff member at their residence, and that place won’t take them back. “DCF needs to have some facilities that can care for kids who don’t need an inpatient locked unit, but they’re a higher level of acuity than the regular residential facility [can handle],” Matteodo said. “We’re not talking huge numbers, but when it happens it’s a problem.”
The MHA has argued for a systemwide review to determine what the needs are and whether there are alternative models of care to better serve children with complex or chronic medical needs. This makes sense.
The state already lets nonmedical group home workers become trained to administer insulin. There may be a need for more community-based service agencies to receive this training. Allen Scannell said Spring Harbor Hospital in Westbrook, Maine, could be a model. At that facility, when a child is hospitalized with both autism and another behavioral health condition, hospital staff prepare families and school districts to work with the child upon discharge.
Massachusetts has made major strides in improving mental health care. In January, the state launched a “front-door” hotline for patients seeking mental health treatment. The state added 248 licensed psychiatric beds this past year, 93 for children and adolescents. Since March 2021, the Department of Mental Health has been providing home-based mental health services. State officials also created a process to speed up psychiatric admissions for people in emergency departments.
But as the MHA report makes clear, more work needs to be done.
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