The state system that treats children with severe mental health issues is so stretched that it’s become dangerous, Colorado’s county human services directors charged in a fiery letter to state officials.
Previous efforts have failed to “shift the course of the emergency,” wrote the leaders of the Colorado Human Services Directors Association and Colorado Counties Inc. in a joint letter obtained by The Colorado Sun, 9News and the Colorado News Collaborative.
Child protection caseworkers are sometimes spending the night with children in hotels or county office buildings because they cannot find a bed for them at a treatment center. Caseworkers responsible for keeping kids safe spend hours and days on the phone attempting to locate an available bed, according to the letter, which was addressed to the executive directors of the Colorado Department of Human Services and the Department of Health Care Policy and Financing.
“Hours upon hours upon hours a day, they’re calling facilities trying desperately to find the appropriate placement they need,” Lexie Kuznick, director of the Colorado Human Services Directors Association, said in an interview. “That has been coming to a head for a while now.”
The lack of care available for acutely sick children and teens means that they are instead sitting in hospital emergency departments and are sometimes sent to foster homes or residential centers because no psychiatric treatment bed is available, the letter said. Also, kids from out of state are taking up slots that county leaders said should go to Colorado children.
A quick survey by the association of 36 county child welfare divisions, including the 11 largest in the state, revealed that 26 children and teens in county custody were in a hospital, 24 were in an out-of-state residential center and 91 were waiting for a treatment bed.
Even worse, 69 children and teens in the custody of one of those 36 counties were missing — on the run from a residential center, group home or foster home. The high number of runaways is a symptom of children not receiving the right placement for their behavioral health needs, Kuznick said.
The survey was taken by the county organizations just before the letter was sent Sept. 9.
“Even with all hands on deck across our organizations to match needs with existing treatment providers, the crisis persists,” the letter states. “The capacity to match the need simply doesn’t exist and more often than not the private provider refrain is that a child/youth is ‘too acute’ to meet admission criteria.”
The letter, copies of which were sent to Gov. Jared Polis and several lawmakers, is the latest evidence that the children’s mental health crisis is overwhelming workers across the state.
Colorado Sun/9News partnered for a joint series examining residential treatment centers where Colorado houses foster youth and kids with severe behavioral issues.
Earlier this month, a lawsuit filed on behalf of Colorado children and teens alleges the state has lapsed in its duty to provide mental health care for needy kids. The lawsuit includes three anonymous plaintiffs who for months or years have cycled in and out of hospital emergency rooms and psychiatric facilities without receiving step-down care needed to stabilize them. The children’s attorney is seeking class-action status.
And in May, Children’s Hospital Colorado declared a “pediatric mental health state of emergency” because its emergency rooms are filled with children who are suicidal. Children spend days or weeks in the hospital waiting for an available bed at a treatment center where they could receive round-the-clock supervision and intensive mental health therapy.
Suicide has been the leading cause of death for teenagers in Colorado for several years. Now, as the pandemic exacerbated children’s mental health problems, and as the number of beds for youth psychiatric care have declined, the system is overburdened.
The letter from county officials was drafted in part to make sure that kids in the child welfare system don’t get lost in the conversation about increasing mental health resources.
Children in the child welfare system who need psychological treatment because of past trauma — whether they are in residential facilities, foster homes or even adoptive families — compete for the same psychiatric beds as children who are suicidal and driven to an emergency room by their parents. At the same time, juvenile justice reform aims to send fewer kids to lockup and more kids to treatment centers.
From all ends, the system is stretched.
When children are in the custody of county child welfare departments, caseworkers compete for beds against those sought for children privately placed by their families.
“Met by denial after denial, these cases rarely find timely or local resolutions and as a result children bounce in and out of inappropriate types of care with changes to their medication and long waits for clinical evaluation and support,” the letter from county leaders said. “The delays and inefficiency resulting from a lack of bed space across multiple levels of care further adds to the trauma, destabilization and acuity of the child involved.”
The hardest placements to find are for young people who have a history of running away, physical aggression, self-harm and intensive mental health needs, county officials said.
The lack of beds in Colorado leads to “costly, out of state placements that are much farther away from a child’s family,” said the letter, signed by Archuleta County Human Services Director Matt Dodson, who is president of the association, and Prowers County Commissioner Wendy Buxton-Andrade, who is chair of Colorado Counties Inc.
State officials have not responded to the letter, but the state Human Services Department provided The Sun a copy of a memo that addressed many of the same concerns. The memo was drafted after an Aug. 27 meeting that included hospital officials, county human services directors and state leaders who discussed the children’s mental health crisis.
The department hopes to use federal coronavirus relief aid to fund 15-20 youth beds at various centers that will come available in November. Facilities that provide the beds will receive $650-$850 per day, and the state will manage admissions and discharges, moving kids who are stuck in emergency rooms into psychiatric treatment centers.
In addition, the state is doubling capacity for youth — from 10 beds to 20 — at the state mental health hospital in Pueblo. The increase is expected to happen within the next three to six months, according to the memo. And Colorado is expected to have an additional 70 psychiatric beds for youth this fall as three facilities are making plans to transition beds from residential placements to higher level psychiatric care.
Colorado also has increased the rates it pays to psychiatric residential treatment facilities for youth in an effort to encourage those centers to admit Colorado kids instead of youth from other states. Beginning in July, rates increased to $750 per day. This came after an internal review found that facilities were taking out-of-state kids because they would receive higher daily Medicaid rates.
In the memo to county officials and hospital workers, state Office of Children, Youth and Families Director Minna Castillo Cohen said she recognized the “significant frustration” from those advocating for youth. “Each of us, from hospital to county to state to provider, are all working collaboratively in many ways and in various settings daily to discuss options for residential placements that can treat the most acutely mentally and behaviorally ill and difficult to serve youth,” she wrote.
Still, county leaders felt compelled to write a formal letter advocating for foster kids.
Kuznick, with the county human services association, is grateful that Colorado policymakers are taking notice that youth are staying too long in emergency rooms because there is a shortage of psychiatric beds. But that is only part of the problem, she said.
“While I think it’s imperative that we put our resources to getting those children who are stuck in emergency room settings out of emergency rooms, we know that they are likely to go to the same residential beds that we are all competing for right now because we all have high-acuity youth and children who need those beds,” she said. “Sadly, those beds in hospitals will likely be filled by other youth who can’t get their needs met.
“The problem is bigger than solely focusing on moving those youth out.”
In the letter, county officials also called on the state — which licenses youth facilities — to require more transparency of the centers. They want to know admission rates and denials, as well as the number of children admitted from Colorado versus other states.
“Without significant and timely action, this crisis will only continue to intensify,” the letter says.
Rep. Dafna Michaelson Jenet, a Commerce City Democrat, is among the lawmakers on a committee working to improve Colorado’s behavioral system, which is poised to get $450 million in federal coronavirus relief money. Lawmakers also put $30 million into children’s mental health during the last legislative session.
“We are in a state of crisis,” she said. “And it has been building and building and building and COVID just knocked us out of the park. We know that anxiety has increased. We know that depression has increased. And we can see just by the number of kids who are lining up and waiting in our emergency departments for treatment, that we are in a crisis.”
9News reporter Jeremy Jojola contributed to this report.