It’s a problem that legislators on the state House Health Committee have become all too familiar with: a child dealing with a mental health crisis is taken by their family or law enforcement to a local emergency department, only to stay in the ED for days or weeks on end with no real treatment plan.
While there is no physical ailment for which the adolescent can be admitted to the hospital, because of behavioral problems they cannot be safely released, either.
On Tuesday, leaders from the Carolina Complete Health Network in Charlotte presented lawmakers with results from a pilot program that has shown success in reducing the boarding time that children in crisis spend without treatment in emergency department settings.
Katie McKay, the senior director of clinical operations for CCHN, said the first step of the Crisis Intervention Therapy and Education (CITE) model is to have a dedicated behavioral health clinician stationed in the emergency department, devoted to at-risk children. That clinician is the point of contact for family members and identifies appropriate treatment options.
The clinician is also responsible for making a referral to a community-based provider. MORES, short for Mobile Outreach, Response, Engagement and Stabilization, is a mobile provider that can respond within an hour of a crisis.
The MORES team provides up to eight weeks of follow-up care. The program is publicly funded by the N.C. Department of Health and Human Services, but is not yet available in every county.
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The final step, said McKay, is family education provided by the MORES team on how to recognize crises, how to respond, and what resources are available other than simply returning to the emergency room.
Dr. Michael Utecht, chief medical director for Carolina Complete Health, said before this pilot at Novant Health Presbyterian Medical Center, some children in crisis were being boarded for 4-6 weeks. They were taking up significant bed space but not receiving behavioral health treatment or having any social interaction.
“One 13-year-old, he was there for seven months. He gained 100 pounds. These are horrific stories. But this is what happens because there’s not much else to offer,” said Utecht.
Since the pilot was implemented, the average length of stay for children in these “social holds” at Novant has been 3-4 days, according to Utecht.
Rep. Donna White (R-Johnston) said she’d like to see the program expanded. In her own district, she said the hospital is not well equipped to deal with every patient that may come through the doors.
“Our Department of Social Services has been a primary provider of these types of clients to the hospital,” said White. “They were not diagnosed necessarily with mental health issues. They were just foster children and people dropped the ball. They put them in the hospital and they stay there.”
Rep. Grant Campbell (R-Cabarrus) (Photo: NCGA livestream)Rep. Grant Campbell (R-Cabarrus), a medical doctor, said when he started practicing medicine, it was rare to see a behavioral health hold in the emergency department.
“Now, it’s not uncommon for a third of our bed-capacity in the emergency room to be filled up with those [patients],” said Campbell.
Campbell said every bed being used to board patients who could be better cared for elsewhere is a bed that’s not available for a patient needing acute medical care.
In the pilot, Carolina Complete Health Network paid $90,000 for the dedicated behavioral health clinician. The dedicated MORES team cost another $130,000 for the eight-week trial. McKay acknowledged that it could cost more to establish such a program in a rural area with fewer resources than Mecklenburg County.
“Money is precious. We’re struggling with that,” acknowledged Rep. Donny Lambeth (R-Forsyth), a senior budget chair in the N.C. House. “But the pilot had a good outcome that we can certainly build on.”
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