news While ER waits days, Massachusetts turns to home care for children’s mental health

Around 2 am on October 24th, a mother named Carmen realized that her 12-year-old daughter was in danger and needed help. Haley was neither in her room nor anywhere else in her house. Carmen uses an app on her phone to find Hayley. She was moving down Maine her streets in a community in Central Massachusetts. Her Carmen’s mind jumped at the terrifying possibility.

“She doesn’t know the dangers out there,” Carmen choked with tears. She said, “When she’s walking in the middle of the night, anything can happen to her. She wanted to see her again.”

Carmen picked up Haley unharmed. But that early morning, Carmen learned about more potentially dangerous behavior: a provocative photo sent by a 12-year-old boy and plans to meet with an older boy. Remembering a few years ago, he told Carmen that he wanted to die.

Worried that her daughter might harm herself, Carmen took Haley to the UMass Memorial emergency room.

“So we went to the hospital because she had suicidal thoughts too. A lot,” Carmen said.

Haley ended up on a stretcher in the hallway with other young people. Carmen had to go home from time to time to take care of Haley’s brother.

“Go away [her] It was terrifying for me to be there for days and see all those kids,” Carmen said.

And also for Hailey.

“I wasn’t sure if they were going to just take me home or put me in a really weird place,” she said.

That week, Haley was one of 115 children and teens who came to a hospital emergency room with a mental health crisis and were stuck there. I waited for weeks. This problem, known as boarding, has been on the rise for over a decade. Some hospitals reported record numbers during the pandemic.

In Massachusetts, new attempts are being made to speed up the transition to mental health care and reduce the burden on the ER. The state has contracts with four agencies to provide intensive counseling at home as an alternative to psychiatric hospitalization. This approach is called emergency department diversion.

To understand what is best for each child, the hospital begins with a psychological evaluation. Haley had one of hers on her second day at UMass ER. Her DeAnna Pedro, UMass’ pediatric and psychiatric liaison, reviewed Haley’s report and considered recommending time in a psychiatric ward.

“She was doing a lot of risky things,” Pedro said. “So there’s been a lot of thought about whether we need to do something as extreme as her psychiatric admission to keep her in her place.”

But Pedro and Haley’s parents were worried about this option. For her 12-year-old girl, whose only experience in mental health care was with a school counselor, it would be a dramatic change.

“Put her in an inpatient psych ward with kids who could be going through a lot of other things,” Pedro said, then paused. That is.”

So Pedro contacted Youth Villages, one of the youth diversion agencies Massachusetts has hired during the pandemic. Costs are covered by the state, and a typical course of care costs him $8,522 on average. At Youth Villages, he has 45-60 minute counseling sessions three times a week for three months.

Savings are important. In one study, the cost of a pediatric hospital stay was calculated at $219 per hour, or $5,256 for the day alone. This does not include costs associated with treatment in a psychiatric ward.

Haley’s family met the Youth Village Supervisor at UMass ER. The first home visit the next day included a safety sweep.

Counselor Laura Polizotti, who has worked on Haley’s case, said: “I had the children hide objects in the soil of the plants.”

Haley had to let go of her phone. So cleaning included making sure they weren’t hiding anything old, and Youth Villages provided window and door alarms that Haley’s parents could activate at night. The program also provides lockboxes for medicines and sharp objects that the family would like to keep out of reach, if needed.Counseling for Haley and her parents began immediately.

The main goal was to understand why Hayley was sneaking out at night and taking sexually inappropriate photos. focused on.

“Have you ever done an emotion thermometer?” Polizotti asked, placing an oversized photograph on a table in a private room at the local library. The photo had blank lines for his five emotions ranging from cool to hot.

“It helps you know where your feelings are,” Polizotti explained.

In the blank next to the bottom of the thermometer, Haley wrote “Cold”. In the red zone at the top, she wrote “Furious.”

“Furious, that’s a good word,” Polizotti said. “So how do you think you feel physically when you’re enraged? What do you notice?”

Hailey told Polizoti that her palms would become sweaty, she would stop talking, and she would have a “weird face.” Haley shrugged his nose and frowned. Polyzoti laughed.

As practice progressed, Polyzoti asked Haley to think of ways to calm herself before her irritation turned to anger. I suggested that I stay alone.

“This is a good trampoline,” Polizotti said. “Can I think of another one?”

“I was able to talk to your mom,” Haley said, raising her voice as if asking a question.

“Amazing,” said Polizotti.

Haley often finds herself in the red zone when fighting with her mother. It might be because Haley left dirty dishes behind or didn’t clean his room. From her Haley point of view, her mom is too impatient.

“Sometimes I wish my mother would ask me. [to do chores] Instead of yelling at me,” Haley said.

Two worksheets for Youth Villages counselors to use when working with patients. (Image provided by: Youth Village)

Polizoti pulled out another chart that helped Haley understand the relationships between thoughts, feelings, and actions. This is known in therapy as the cognitive triangle. Understanding these connections may change how Haley and her mother react when they fight.

Haley gets furious when her mom yells at her. She told Polyzoti that it made her more disrespectful.

“So the act of sneaking out?” asked Polyzoti. Yes, Haley nodded.

Polyzoti also leads sessions with Haley and Carmen, often around the kitchen table or in the living room. Polizoti proposed a technique called collaborative problem solving for resolving cleaning disputes. The first step is to show empathy. That’s difficult for Carmen. She likes a clean house. Carmen didn’t have a problem with her having too many clothes and toys when she was Haley’s age.

“I’m trying to give my children something better,” Carmen said, with emotion in her voice.

Haley suggested another dresser for her room. Carmen suggests giving Haley clothes she doesn’t wear often. As the hour ended, it became clear that cleaning would be the topic of future sessions. But overall, Carmen said counseling is helping Haley. She started smoking e-cigarettes, but she doesn’t leave her house at night.

“Honestly, she’s been good since you guys got here,” Carmen told Polizotti.

The Emergency Department Youth Diversion Program has grown rapidly from a pilot in March 2021 to 37 participating hospitals today. As of early December, her 470 young people between the ages of 4 and 18 were working at any of her four agencies, according to the state’s Department of Mental Health. The majority, 83%, have not returned to the emergency room for mental health issues. Overall, 91% of his adolescents met treatment goals or were referred to additional treatment services.

Advocates for parents of children with mental health problems say the main complaint they hear is that hospitals don’t offer home care programs quickly enough, and when they do, there is often a wait. is.

Meri Viano, Associate Director of Parent Professional Advocacy League, said: “We’re looking at the data and hearing from families that this is a great program to help children heal faster in:”

Some families are hesitant to try distractions if their child is on, or needs to start taking, psychiatric medications. Children who need medication should be seen by a psychiatrist or family doctor outside the program.

Diversion programs appear to offer some relief to overburdened hospitals and staff. More hospitals are referring families to one of their stay-at-home options, according to a Massachusetts Health and Hospital Associations report. It has been shown that the number of young people boarding has decreased as they have started to Demand for mental health care varies seasonally, but the numbers are expected, according to the MHA.

“Without these programs, I think things would be much worse,” said Leigh Simons Youmans, senior director of health policy at the MHA. “They help hospitals manage capacity” and help children get out of chaotic emergency rooms.

It is not clear how many children and adolescents who go to hospital emergency rooms for mental health care can be treated at home rather than in a psychiatric ward. But Matthew Stone, Youth He Village Director for Massachusetts and New Hampshire, said home care could be the best option otherwise.

“Many of the mental health challenges these children face are caused by factors in the natural environment, such as schools, neighborhoods, and peer systems,” Stone said. , it is really impossible to address these factors in a placed child.”

Psychiatric ward clinicians work with family and social issues and sometimes bring families to the hospital for sessions. No data yet to compare results.

Massachusetts is unusual in using diversion as a way to mitigate mental health boarding for children and teens. I have.

“It worked,” said former Health and Human Services Secretary Marilou Sudders, who is now an adviser to the Healy administration. But Sudders calls the diversion “first aid to meet the urgency of what the emergency department is experiencing.”

Sudders argues that the need for a diversion will wane as states begin multiyear plans to improve mental health care. line, more community mental health centers, and more urgent mental health alternatives. Proponents are asking whether these services can help patients treat mental health problems early, before they escalate to the need for emergency room visits.

But for the time being, Carmen and other parents dealing with their first mental health crisis are likely headed to the hospital’s ER. She doesn’t like having people “in her own business,” but Carmen wanted to share this experience, she said.

“Many parents don’t know what their children are going through because they don’t want to accept that their children really need help.” Hopefully this can help another family.”

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