Kids are waiting months for psychiatric beds. Why it's such a struggle to expand care in WA
Seattle TimesMay 21, 2022
May 21—On the website for Tamarack Center, big bold letters read "DOES IT WORK?"
"We answer that question with an enthusiastic 'Yes'," the center says of its offerings: a children's residential program in
For the children and teens at Tamarack, the promise of something that "works" means everything.
Tamarack is one of
At a moment when more children than ever are in need,
Pearl Youth Residence, a 27-bed pediatric facility in
"Just trying to get a therapist?" to work at Pearl Youth, said
As
Many families begin seeking out long-term care as they watch their child's symptoms become progressively worse, even violent, at home. More and more, though, children are in such a serious crisis that they're taken to an emergency department — and end up stuck living there for weeks or months as they wait to secure a long-term stay at facilities like Tamarack and
Hundreds of
Waits for a long-term bed are lengthier than at any time in recent memory: Of those on the state's waitlist during the first quarter of 2022, children ages 6-13 waited an average of 144 days, and those ages 14-18 waited 96 days. And the number of admissions is historically high, a reflection of both the crushing need for long-term care and faster turnover at care facilities, experts say. Tamarack, for instance, admitted 47 children in 2021, its highest admittance ever. But kids are staying for shorter periods: The average is now 4.5 months, down from a typical stay of about 6 months.
"Our phone rings all day," said
"Out of 10 phone calls from parents or folks to put a kid here we say no to probably nine. The phone just rings constantly for people wanting to get their kids some help."
The iceberg
To serve children with serious mental illnesses,
Tamarack largely fits that model. Teens who live there have school for five hours most days and spend the rest of their time in group therapy, individual therapy, family therapy and a mix of recreational activities like basketball, pool or video games.
Now, "there's been so many kids waiting to get in, whether it's from home or hospital, that there's a push, like 'We have people in line here, let's get going,'" he said.
There's also a financial incentive to get kids out of hospitals and into long-term care: The daily cost of boarding in an ER can top
Some who manage CLIP facilities say that's not enough money to recruit and retain the highly trained staff needed for this work — especially when they have to compete for staffing with hospitals, which can often pay more, and jobs that offer work-from-home or more flexible working environments. And CLIP facility operators say the state's rate for long-term care doesn't cover the cost of caring for many high-needs youth.
Davis remembers only three meaningful increases to the state's rate over the past 30 years, and the current rate doesn't leave room for facilities to scale up, he said. As part of the decades-long shift away from institutionalization, cultural and legal forces have focused on improving access to outpatient care rather than extended inpatient stays.
Tamarack has stayed afloat because it accepts children with public or private insurance, Davis said. Private plans tend to pay a little more than the state.
"The state is not happy with us at all because we say no to some of the CLIP kids they refer. I certainly understand their position on that," Davis said, but, "It's kept us from hitting the iceberg."
But several other residential facilities have closed or consolidated.
Seattle Children's Home, which was founded in 1884 and served youth before
Long-term care is just one part of a splintered system that makes it difficult for kids to get back to stable homes, or from one point in the mental health system to the next. From foster care to hospitals to therapeutic group homes, long waiting times have created bottlenecks at nearly every stop. For instance, CLIP operators say sometimes they struggle to discharge youths into less intensive mental health settings because these services are full, leaving kids in a CLIP bed that's needed by another youth waiting in a hospital or at home.
For instance, a 15-year-old at Pearl Youth who met all his treatment goals and had been stable for five months was supposed to leave the facility in early May. But his guardians said they weren't prepared to pick him up, Dozal said.
"We get stuck in this situation where all of this progress the kid has made is essentially wiped out," Dozal said. "It was really hard for staff to even wrap their head around that we are dropping a kid off and essentially walking away."
Problems persist
In early May, eight
To help speed more children and teenagers toward care,
But problems persist.
In January, the agency solicited bids for the new 12-bed residential facility, which is intended to serve youth with co-occuring mental health conditions and developmental or intellectual disabilities — a population with complex needs that's often denied placement at existing CLIP facilities.
The state put up the funding to pay staff salaries and other costs that go into caring for a child, but no capital dollars to construct or renovate a facility. No one bid on the project.
"We were really hopeful we would get a bite," said
Davis and
"There are lots of places for kids with varying degrees of psychiatric illness and many of them are profitable," Davis said. "With that being said, they stay away from
Teenagers can be held involuntarily if a judge gets involved: At Pearl Youth and Tamarack, anywhere from 30-45% of residents are there under a court order, the facility administrators said. However, youth often buy into their treatment as it progresses, Davis said, and end up staying voluntarily.
Davis said he stays the course because, like Tamarack advertises on its website, long-term treatment can work.
"It's kind of like a slot machine. You can sit there and play all night and lose, but every now and then if you hit the jackpot you feel like a million dollars," he said. "We'll help a kid and they'll do so well and get amazingly better here ... you look around and say, 'Well, OK, we've got to keep doing this.'"
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