The state’s dwindling number of psychiatric facilities for children has advocates and legislators concerned foster kids that need serious mental health care aren’t getting it.
Psychiatric residential treatment facilities provide intensive care for children with mental illnesses, substance abuse problems or severe emotional disturbances, including those in the foster care system, and discharge them back to parents or foster homes.
Sen. Laura Kelly, a Topeka Democrat, said she worked in a similar facility and kids may experience severe trauma after being neglected or abused at home, or removed and placed in the foster care system.
“They may well need months of safety, security and treatment to work through some of the issues that make it possible to put them back in either their biological family or back into a foster care system,” Kelly said.
Psychiatric residential beds, though, are sparse. Since 2011, capacity at those facilities has dropped 65 percent. Seventeen facilities held 780 beds in 2011. In August, the system had eight facilities with 272 beds, according to data released to the state’s Child Welfare Task Force on Tuesday. That means children in need of intensive psychiatric care may have to wait weeks or months to get it.
“It’s kind of like saying you need to go to the emergency room and you can’t go there for another 14 days,” said Christie, Appelhanz, executive director of the Children’s Alliance.
Kansas Department for Aging and Disability Services spokeswoman Angela de Rocha said in an email psychiatric residential treatment care was considered non-emergent.
Officials from Saint Francis Community Services and KVC Health Systems, the private companies that run foster care in Kansas, said losing those facilities can put a strain on kids, families and the child welfare system.
“When you don’t have the right care at the right time, it may ripple out through the system, so foster parents feel the strain of higher needs systems,” said Rachel Marsh, executive director of public policy for Saint Francis Community Services.
Cheryl Rathbun, chief clinical officer at Saint Francis, said there was an overcapacity of beds in 2011, so some providers naturally left the system.
“So the good news for children in foster care was there were a lot of choices and a lot of availability,” Rathbun said.
Rathbun said providers were then hit hard by a 4 percent cut by the Legislature to reimbursements they got from Medicaid and some struggled to stay in business. Medicaid pays for foster children’s medical care. The funds were restored earlier this year.
Appelhanz said psychiatric residential care is expensive to provide. One night in a facility can cost between $500 and $700, according to a report from Saint Francis to the child welfare task force.
Rathbun said part of the problem is that children are staying in facilities for fewer days on average. In 2011, foster children who got care in a facility stayed, on average, for 120 days. Now they stay for 45 days, according to Saint Francis.
“As we lowered the number of days, we had other people fall out because they were just frustrated with the lower number of days and not feeling effective, so they closed their (psychiatric residential treatment facility) beds,” Rathbun said.
Waiting for care
That reduction means children in need of care have to wait. According to the Kansas Department for Aging and Disability Services, 255 out of the state’s 279 beds were taken in September. Beds are often earmarked for certain groups of children, like boys or children with certain conditions.
Girls under KVC’s care may have to wait two weeks for admission to a psychiatric facility, while boys have to wait four or five weeks, said Vice President of Operations Lindsey Stephenson.
At Saint Francis, the wait can range from two weeks to two months depending on the child’s sex and level of need, Marsh said.
“Unfortunately, there are also more beds for the less high-acuity children, which means that there are longer wait times for the children who are most severely in need,” Marsh said.
Children who have been found in need of that level of psychiatric care can also be more difficult to place in a foster home in the mean time, advocates and officials said.
“When we’ve made a determination that a child can’t be safe at home, that’s a tough sell for a foster family,” Appelhanz said.
KVC told the task force last month some of its children in need of psychiatric care had spent nights in offices while they awaited placement in a facility or foster home. Saint Francis, too, had to keep kids in its offices while it sought placements.
Even when children have access to a psychiatric residential treatment facility, advocates said they may not be getting the care they need because of the shorter stays. Rathbun said child welfare officials had worked to reduce the amount of time children spend in psychiatric facilities and had good results when they averaged around 120 days.
“We just know that kids do better in small family-like settings, building permanent relationships for the rest of their life,” Rathbun said.
When kids were staying for about 120 days in 2011, they were getting treatment and being discharged to family-like settings 80 to 85 percent of the time and remaining there successfully, Rathbun said. Now, they’re only staying 45 days.
“Once we got past a certain point, it had a reverse trend,” Rathbun said.
Now, she said 80 percent of children are discharged to a group home, and many end up having to return to a psychiatric facility for more treatment. She said foster parents previously felt more confident that children discharged from psychiatric facilities could be successful and safe in a home environment.
“When they leave, they still has lots of behavior health needs that a foster parent may feel like they can’t meet,” Rathbun said.
De Rocha said those stays are determined by the private companies that administer Kansas’ Medicaid program based on children’s medical needs. Community mental health officials also play a role in the decision, she said.
Garrett Kasper, regional director of communications for UnitedHealthcare, said in a statement its members’ health was its top priority. UnitedHealthcare is one of three private companies that offer coverage in Kansas’ Medicaid program, KanCare.
“Every child’s health care and wellness needs are unique — and are addressed by their care providers in collaboration with family members and caregivers,” Kasper said. “Our members have access to all licensed psychiatric residential treatment facilities in Kansas, all of which are paid the state-determined Medicaid rate for care services.”
Appelhanz said the struggle for high-level services and fast-growing number of kids entering foster care combined to put a strain on the system.
“And because of that, we’re squeezing every single point in the middle,” Appelhanz said.