Placing a child in residential treatment is not an easy decision, and it tears at your heart to realize you cannot help your child. Sometimes it is a good option; sometimes it's not; sometimes it is the only option. Trust me, I know!
Maryland presently has 12 residential treatment centers (RTCs) licensed by the Department of Health and Mental Hygiene to serve children with intensive mental health needs who require 24/7 care. Two of the RTCs are operated by the state and 10 are operated by private providers. The state is striving to build community-based services to provide alternatives to placing children out of their homes and community. We applaud this effort to keep children in their communities and, if possible, with their families.
This newsletter includes an informative article that highlights the history of residential treatment for children. Next month's newsletter will provide more information on Maryland's RTCs.
- Jane A. Walker
Executive Director
What's in the Stimulus Bill?
Everyone's talking about it, but few of us know what is contained in the new stimulus bill signed by President Obama. Here's an excellent summary courtesy of the Coalition for Human Needs, demonstrating in clear and simple terms the intended impact of the new federal economic stimulus program. Highlights of special interest to the disability community include:
- 13.6 percent increase in food stamp benefits;
- $100 million in emergency food and shelter aid;
- Unemployment insurance benefits extended to year's end and raised by $25;
- One-time $250 payment to recipients of Supplemental Security Income (SSI);
- $50 million for a new program of capacity-building grants to nonprofit organizations, to expand delivery of social services to people and communities affected by the recession;
- $1.5 billion in homeless prevention aid;
- $225 million, available through 9/30/10, of which $175 million is for the STOP Violence Against Women Formula Assistance Program; $50 million is for transitional housing assistance grants for victims of violence;
- $500 million to serve low-income adults, including recipients of public assistance, covering supportive services and needs-related payments as well as employment/training services;
- $120 million to allow nonprofits to add 24,000 older workers;
- $400 million to school districts for preschool special education, and $500 million for state grants for infants and families (with disabilities, birth through age 2);
- $540 million, including $140 million for independent living programs (of which $18.2 million is for state grants, $87.5 million is for independent living centers and $34.3 million is for services for older blind individuals);
- $650 million for evidence-based clinical and community-based prevention and wellness strategies to address chronic illnesses;
- An extension of the moratorium on the following final regulations through July 1, 2009: targeted case management; school-based services; provider taxes; and outpatient hospital services. Also states the sense of the Congress that the HHS secretary should not promulgate as final the proposed regulations related to graduate medical education, cost limit for public providers and rehabilitative services.
Maryland by the Numbers
The Coalition's fact sheet for 2007–2008, Children's Mental Health Matters!, has been distributed to legislators in Annapolis and is available at www.mdcoalition.org. Research indicates that nationally at least one in five children and adolescents have a mental health disorder—with many children, unfortunately, going without necessary treatment.
Here are some key points from the fact sheet:
- In 2007–2008, more than half of individuals served by Maryland 's public mental health system were children and transition-age youth—47,409, with more than half of that number children from birth to 12.
- A total of 5,667 children and youth, ages birth to 24, had an inpatient psychiatric admission in 2008. This number represents a 28 percent increase in admissions over a three-year period.
- Community-based services offer the best outcomes for children with mental health needs and their families. Outpatient and psychiatric rehabilitation services were delivered to similar numbers of children as the previous year; however, 57 percent fewer children received targeted case management services while 20 percent more benefited from crisis, respite and supported employment.
- Some 8,369 students are identified as emotionally disturbed (ED) in special education in 2008—7 percent of all students with a disability in special education. The graduation rate for such students is approximately 50 percent.
- From 1990–2006, there were 1,219 documented suicide deaths completed by Maryland youth ages 10–24. White males ages 15–24 had the highest percentage of suicide. In 2008, Maryland was awarded a $1.5 million SAMHSA grant on youth suicide prevention; the grant will focus on prevention efforts and a curriculum for schools and colleges.
Maryland's Commitment to Veterans
Returning veterans and their families deserve our deepest thanks and also our full support in readjusting to life after deployment in Iraq or Afghanistan. The Mental Hygiene Administration has established an initiative to help returning veterans who may be experiencing difficulty in sleeping, feeling isolated, losing interest in people or things or may be using alcohol or other substances.
Regional resource coordinators are available to help veterans access crisis and emergency services, substance abuse services, individual, family and group therapy and Veterans Affairs services. Offices are located on the Eastern Shore and in central Maryland, Southern Maryland and Western Maryland. The toll-free number for information is 1.877.770.4801.
Deployment Stresses Kids, Too
According to a recent article in The Washington Post , preschool children with a deployed parent are more likely to have psychological or behavioral issues than those whose parents are stateside, leading medical professionals to consider ways to help the youngest members of military families cope.
A study published in November 2008 in the Archives of Pediatric and Adolescent Medicine considered 169 children ages 18 months to 5 years in a day care center on a Marine Corps installation in the United States . The remaining parent and a day care teacher independently completed behavioral checklists for the researchers, who then drew conclusions about the children's stress levels. Some 800,000 children younger than 5 have a parent who has been or is serving in Iraq or Afghanistan , researchers said.
The study excluded the children of National Guard and Reserve members, those not enrolled in day care and those with a pre-existing disability or behavioral problem—and researchers used what one expert called "very conservative" interpretive measures—leading children's mental health experts to conclude the study likely understates the stress felt by preschoolers and perhaps their older siblings. Among the behaviors exhibited by affected preschoolers were disrupted eating and sleeping, increased anxiety or sadness, acting out and an inability to concentrate.
Recommendations included further study of the children of military families and the development of programs and supports specifically geared to this population, like Sesame Workshop's "Deployments, Homecomings, Changes."
Historical Perspective of Residential Treatment for Youth
Inpatient services, specifically intended for adolescents, first began to appear in the United States in the 1920s (Kolko, 1992). The evolution of residential treatment is a direct result of the need to further provide services and a place of purposeful mental healing to a population of adolescents. The original concept of residential treatment was to provide services for children who were abused and neglected by placing them in a safe environment; however, residential treatment for youth has taken many unique transitions since its origin.
In the late 1940s, the term "residential treatment" began to be utilized more frequently as Social Security, Aid to Dependent Children and other New Deal reforms ceased being primary reasons for institutionalizing children for economic reasons. It was during this era that psychiatry and social work developed a greater respect and influence, thus allowing programs to be developed to accommodate the treatment of persons with mental illness.
By 1954, the American Orthopsychiatric Association held a major symposium on residential treatment and at its annual meeting two years later, the American Association of Children's Residential Centers (AACRC) was established by participants in that group including Bruno Bettelheim, Edward Greenwood and Morris Fritz Mayer. Fifteen years later, a National Institute of Mental Health (1971) survey included 261 residential treatment settings. By the 1980s, 125,000 children were being treated in residential treatment facilities and by the year 2000, the number of children being treated had significantly increased to a quarter-million.
In the 1970s and 1980s, the term "residential treatment" was identified with a type of institution and firm distinctions were made between them and hospitals. Whereas hospitals were run by doctors and nurses and designed to treat more disturbed patients, the residential treatment settings typically were operated by psychologists and social workers and provided fewer and less sophisticated therapies. During this period, residential treatment started to receive a lot of criticism by family therapists and other family advocates who were concerned about children being separated from their parents, lack of family involvement during treatment and the institutional behavior of children who had been in residential treatment.
By the 1990s, many felt residential treatment centers were overused. In response, community-based alternatives such as day hospitals, family preservation programs, wraparound services and multisystemic treatment have become options for the treatment of children (Baldessarini, 2000). The 1990s also brought with it the use of medications to make possible the management of disruptive behaviors, affective instability, depression, anxiety and thought disorders in outpatient settings.
Keep Family Together Act
Placing a child in a residential facility to obtain necessary mental health services is a difficult and painful decision. Often there is no alternative and in some cases, parents even have to renounce custody to secure the care their children desperately need.
Maine GOP Sen. Susan Collins is set to reintroduce her Keep Family Together Act during this Congress to promote mental health treatment for children in family and community settings. The measure would provide states with $55 million a year for five years to support and maintain systems of care that focus on community-based services. It also would establish a task force examining access to mental health services and such services within the child welfare and juvenile justice systems.
In Maryland , some 45,800 children received outpatient services in their communities in 2008, according to MAPS-MD, but community-based targeted case management decreased by more than 57 percent from 2007 levels. Nearly 700 children with mental health needs received crisis, respite and supported employment within their communities.
Collins also plans to seek an update to a 2003 U.S. Government Accountability Office report that showed parents in 18 states relinquished their custody of more than 12,700 children, placing them into the child welfare or juvenile justice systems in 2001 to gain mental health services.
The news isn't all bad. The Family Opportunity Act of 2005 allows for the expansion of Medicaid coverage to children with mental health disorders if they meet certain waiver conditions, while the mental health parity law that takes effect in October 2009 requires companies with more than 50 employees to provide equal insurance coverage for physical and mental health services. Maryland already had a parity law, but more employers will be required to provide parity under the terms of the federal law.
Mental Health Off Pediatricians' Radar
More than half of parents responding in a recent survey said their pediatrician or family-practice doctor never asks as part of a routine health visit whether they have any concerns regarding their children's mental health.
ADD? Behavioral issues? Parents say if they don't bring them up, the doctor doesn't, either.
The survey results, announced in December by C.S. Mott Children's Hospital at the University of Michigan , showed that 22 percent of respondents sometimes get asked about mental health and behavioral issues, and another 22 percent said their doctor was on top of the issue.
Of the 2,245 parents answering the survey, 20 percent said one or more of their children had been diagnosed with a mental health issue, most commonly ADHD, a behavioral problem or depression. That's in line with the national average, according to government sources, whose studies show at least one in five children and adolescents have a mental health disorder.
Lack of experience with mental health issues and fears regarding families' ability to access mental health care were given as several possible reasons for not broaching the subject.
Upcoming Events
Financial Planning Seminar—Feb. 25, 7–9:30 p.m. A Merrill Lynch financial adviser, third-party special needs trust attorney and disability organization staff discuss financial, legal and social challenges faced by families raising a child with special needs; participants can view the seminar at www.epliveonline.com in real time or an archived format. Click here to register; there is no registration fee to participate.
School Avoidance and Anxiety Webinar—March 5, 12 noon–1 p.m. Maryland Coalition online workshop presented by Golda S. Ginsberg, Ph.D., of the Division of Child and Adolescent Psychiatry at Johns Hopkins Hospital. Limited to 20 participants; pre-registration is required. E-mail callenza@mdcoalition.org.
Independent Living—March 18, 7–8:30 p.m. Part of the Adolescent Transition Lecture Series sponsored by the Maryland Department of Health and Mental Hygiene, Office for Genetics and Children with Special Health Care Needs and the Maryland Center for Developmental Disabilities at Kennedy Krieger Institute, lecture for youth with disabilities, their parents and providers by Ruth Ann Wynegar, community outreach coordinator at Making Choices for Independent Living; KKI Greenspring Campus, 3825 Greenspring Ave., Baltimore, Bowles Building, 4th Floor Boardroom. Contact Jenny Jones to register at 443-923-2790 or resourcefinder@kennedykrieger.org.
Wrightslaw Seminar—March 19, 8:30 a.m.–4:30 p.m. One-day seminar by lawyer Pete Wright provides accurate, up-to-date information about special education law, education law, educational testing, IEPs and advocacy for children with disabilities for parents, advocates, attorneys, educators, providers and others. Sponsored by Parents' Place of Maryland . Register online at www.ppmd2.org; call 410-768-9100 for more information. Comfort Inn Conference Center, 4500 Crain Highway, Bowie.
Montgomery College Disability Support Services Information Session—March 24, 7–9 p.m. General information session for high school juniors and seniors with documented disabilities and their parents and guardians, covering the application process, course placement, expectations of students and available accommodations. Technical Center Building , Room 136, Rockville Campus. For more information, call 240-567-5058.
Psycho-educational Testing Webinar—April 2, 12 noon–1 p.m. Maryland Coalition online workshop presented by T. Andrew Zabel, Ph.D., ABPP-CN, of the Kennedy Krieger Institute. Limited to 20 participants; pre-registration is required. E-mail callenza@mdcoalition.org.
Maryland School Psychologists' Association Spring Conference—April 24, 8 a.m.–4 p.m. Conference will focus on safe schools and solutions to school violence. Martin's Crosswinds, 7400 Greenway Center Drive, Greenbelt. Click here to see the conference brochure and registration form; registrations must be postmarked by April 15. For more information, contact Dave Holdefer at dholdefer@verizon.net or Laura Shriver at leshriv@k12.carr.org.
Firsthand Information about Transition—April 29, 7–8:30 p.m. Part of the Adolescent Transition Lecture Series sponsored by the Maryland Department of Health and Mental Hygiene, Office for Genetics and Children with Special Health Care Needs and the Maryland Center for Developmental Disabilities at Kennedy Krieger Institute, a panel of four transitioning youth and their parents will share their experiences; KKI Greenspring Campus, 3825 Greenspring Ave., Baltimore, Bowles Building, 4th Floor Boardroom. Contact Jenny Jones to register at 443-923-2790 or resourcefinder@kennedykrieger.org.
Mental Hygiene Administration Annual Conference—May 5–6. "Mind, Body and Spirit: Promoting Health and Wellness over the Lifespan" conference, Martin's West, 6817 Dogwood Road , Baltimore . For more information, contact Carole Frank at 410-402-8469 or Wendy Baysmore at 410-646-7758, or visit http://trainingcenter.umaryland.edu. Registration begins first week in April.
Addressing Behavioral Management in School Webinar—May 7, 12 noon–1 p.m. Maryland Coalition online workshop presented by Peter Leone, Ph.D., of the University of Maryland. Limited to 20 participants; pre-registration is required. E-mail callenza@mdcoalition.org.
