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Stuck kids: a
seasonal issue
(August/September
2008 Issue)
By Phyllis Hanlon
The issue of stuck kids has prompted the state of Massachusetts
to create several agencies, programs, projects and services intended
to alleviate the problem. A look into any hospital emergency room
at certain times of the year might indicate that these efforts are
failing. However, experts disagree, noting the seasonal ups and
downs of the issue.
According to Laura M. Prager, M.D., director of child psychiatry
emergency services at Massachusetts General Hospital (MGH), the
issue of stuck kids is "multi-factorial." She says, "It's so large,
it's hard to appreciate all the factors."
The emergency room at MGH sees between five to seven thousand patients
annually, ten percent of whom are children, Prager says. She says
the number rises and falls depending on the time of year. "Right
now, it's at a low. School's out and nobody is watching," she says.
"During the school year, there are more eyes on the kids. We usually
see a peak two to three weeks into school."
One major obstacle in moving children out of the hospital and into
less restrictive care involves insurers. "The state programs are
applicable only to patients on state insurance," says Prager. But
these individuals have more options today than in the past. Find
a Service Today (FAST), the Family Stability Team, (FST) and the
Supported Treatment and Resource Team (START) all work to identify
appropriate services, programs and, if necessary, placement for
children with urgent behavioral problems.
Other initiatives, including Community-Based Acute Treatment Services
(CBAT), Coordinated Family Focused Care (CFFC) and Mental Health
Special Programs for Youth (MHSPY), exist but may prove difficult
to access from the emergency room. "It's not always easy. There
is lag time in putting a team together, which causes problems,"
Prager says.
Prager points out that the implementation of resource specialists,
who help medical professionals communicate with insurers to find
beds around the state, has made the task a bit easier, but admits
there are still challenges. "You can't send a kid to just any bed,"
she says. "Even if there is a bed available in Amesbury, it doesn't
do the child any good if the parents can't get there."
Other insurance-related issues also present stumbling blocks, according
to Prager. "All insurers have different rules, restrictions and
contract payment rates," she says. "It's an incredibly lengthy process
to certify a child. To help the child, you have to spend 30 minutes
on the phone with a reviewer who is not medically trained."
One challenge that has been removed relates to after-hours certification.
Private and out-of-state insurers who used to close at five o'clock
now allow emergency rooms to "hospitalize patients with certification
for benefit done by the inpatient unit themselves," according to
Prager.
David Matteodo, executive director of Massachusetts Association
of Behavioral Health Systems, admits that at certain times beds
are difficult to access, but overall there has been a downward trend.
"In late winter/early spring beds are backed up," he says. "But
last summer, two child/adolescent units had no patients." He compares
the issue to a serious flu epidemic that causes a dramatic and sudden,
but short-term, increase in the hospital census.
Matteodo applauds the willingness of policymakers, state administrators
and the Executive Office of Health and Human Services to find solutions
to the problem of stuck kids. "You might think a simple solution
would be to add more beds," he says. "But we don't need them all
year. We're frustrated trying to come up with an answer."
While the problem continues on a reduced scale, Massachusetts is
not alone in its quest for solutions. "A Baltimore paper ran a story
on stuck kids a while back," says Prager.
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