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Oct. 31, 2011
TOPEKA Several Kansas psychiatric facilities that specialize in treating severely disturbed children are closing their doors or scaling back operations in the wake of a new state policy aimed at cutting costs and limiting reliance on inpatient care.
A year ago in Kansas, there were about 500 children living in what are called psychiatric residential treatment facilities, or PRTFs.
Then in January, officials at the Kansas Department of Social and Rehabilitation Services ordered a major reduction in referrals to the facilities, citing both the need to cut spending and concerns that local community mental health centers had been too quick in referring children for inpatient care.
By July, fewer than 300 children were staying at the facilities.
Early last month, St. Francis Community Services announced it would close its 34-bed facility in Ellsworth within 60 days; its 33-bed PRTF in Salina will remain open.
“We had two campuses 30 miles apart from each other – both of them half-full,” said Cheryl Rathbun, vice president of clinical services at St. Francis. “It just didn’t make business sense to keep both of them open.”
United Methodist Youthville soon followed suit, announcing last week that it would close its 56-bed PRTF in Newton by the end of November. Its 44-bed facility in Dodge City will remain open.
“There’s been a significant reduction in referrals,” said Youthville Executive Director Shelley Duncan. “For a while I thought this might pass and things would pick up. But now, I think it’s permanent. I don’t see it coming back.
“We just can’t afford to sustain a program that isn’t being used,” Duncan said, noting that in October the Newton facility had 25 children; Dodge City had 34.
St. Francis and Youthville are not the only ones cutting back as a result of the new policy.
Prairie View, a mental health center in Newton that serves a three-county area, recently cut its 28-bed PRTF to 14 beds.
New Hope, a 40-bed PRTF in Norwich, closed its doors in August after its census fell below 10 children.
A year ago, there were 841 beds at 17 Kansas PRTFs. Now, there are 627 beds, of which 314 are occupied.
The wave of closures and cutbacks has some worried that Kansas could be losing important infrastructure for treating children with serious mental illnesses and that some children are not getting the treatments they need. The option for those who cannot get into a PRTF is to receive in-home and outpatient treatment through the nearest community mental health center or to move to a group home that’s not as structured as a PRTF.
“We’d like to think they’re receiving services in the community and doing well, but at the same time, it’s not like everybody got well all of a sudden,” said JoLana Pinon, chief executive officer at Florence Crittenton Services in Topeka.
Crittenton’s 26-bed PRTF is now caring for seven girls.
“We’ve never had anyone in our PRTF who didn’t need to be there,” said Duncan of Youthville. “By that I mean they were there because they had some pretty serious problems and there really wasn’t any place else for them.”
SRS officials insist they have been keeping close tabs on the children who have been screened out of the facilities and that so far few have suffered for it.
“We have a licensed social worker reviewing every single screen-in, screen-out, and discharge to make sure that we’re doing the right thing,” said SRS Secretary Rob Siedlecki.
What that means is that SRS officials are reviewing all the referrals or rejections issued by the community mental health centers.
According to SRS, fewer than 15 PRTF-placement denials have been reversed by SRS or by a mental health center.
Siedlecki said he suspected that the PRTFs had “overbuilt” in recent years, generating “more capacity than what’s needed” and causing some children – it’s unclear how many – to be admitted when they could have received comparable services in their communities.
“My job is to focus on the kids, not on the PRTFs,” he said. “I want them to stay in business and be a resource, but we’re going to do the right thing and not just fill them up needlessly, because every time a child is taken out of his family and his community, it’s traumatic for everybody.”
In an email to KHI News Service last week, SRS spokeswoman Angela de Rocha said the department was “not aware” of any child who’d been kept out of a PRTF ending up in a juvenile detention facility. However, three children whose referrals to a PRTF initially were denied later were admitted after they had been hospitalized, she said.
Sen. Dick Kelsey, a Goddard Republican, said he plans to ask SRS officials for a thorough accounting of what’s happened to children who’ve been denied access to a PRTF since March, a timeline coinciding with the sharpest drop in admissions.
“This is a system that’s had around 500 kids in it for the past 15 years, and these are kids with severe psychological and emotional issues,” Kelsey said. “So when you lose 200 of them in a matter of just a few months, I think it’s fair to ask where they went.”
Kelsey once owned and operated a 45-bed group home for children in state custody, many of whom were mentally ill. He now owns three drug and alcohol rehabilitation facilities for teenagers.
At those seven-bed facilities, he said, “we’ve had to turn away kids we thought should have been in a PRTF, but they said they couldn’t get into a PRTF.”
Kelsey said he doubted the closings and cutbacks at the PRTFs would reduce the state’s costs. He said many children who had been in PRTFs are now in less-structured group homes called youth residential facilities or YRCs.
Their stays at the YRCs are paid for by the state. PRTFs are Medicaid-funded, meaning 56 percent of the costs are picked up by the federal government and 44 percent by the state.
On average, PRTFs are paid $296 per child per day; YRCs are paid $126 per child per day.
Most children referred to a PRTF are expected to stay at least 90 days. YRC referrals range from a few days to a few months.
“I don’t think this is going to save us a dime,” Kelsey said. “But the issue isn’t cost or whether a kid is in a PRTF, a YRC or a detention facility; it’s whether they’re getting the services they need.”
Staying too long?
The Joint Legislative Budget Committee is scheduled to take up the issues surrounding the PRTFs on Nov. 14.
“I’ve asked to testify and they’ve agreed to let me,” Kelsey said. “I’ll be there.”
Johnson County Mental Health Center Executive Director David Wiebe said he plans to attend the hearing. He’s among those who think the SRS policy change helped reduce overuse of the PRTFs.
Wiebe said he thought prior to the policy change, many children stayed in PRTFs longer than necessary. PRTFs are not intended to be facilities for long-term stays.
“There are definitely some kids who need PRTF-level services,” Wiebe said. “But what we’ve seen happen over time, I think, is that the PRTF system has moved closer and closer to long-term institutional care rather than short-term residential stays. That’s what happens when the initial authorization (for PRTF admission) is 90 days.”
It’s clear, he said, that children “do not thrive” in institutional settings but fare better in families.
“That’s not always possible, and PRTF-level services need to be available,” Wiebe said. “But when we see children spending months and months in institutional care, we have to conclude that that’s not good.”