Spring 2013

Saturday, April 27, 2013
 

Thursday, May 2, 2013
 

Jingle in July 5K Run & 1-Mile Walk
Gring's Mill, Wyomissing, PA
Saturday, July 13, 2013
 

For information on these events, please visit: KidsPeace.

    

Good morning. I am Dr. Andrew Clark, Medical Director of KidsPeace Children's Hospital and Residential Services. I am a Board Certified Child and Adolescent Psychiatrist and a native of Northeastern Pennsylvania. On behalf of KidsPeace and our clinical staff, please let me express my sincere gratitude to the Pennsylvania House of Representatives Human Services Committee for allowing me to be a part of this important hearing.

KidsPeace is a 130-year-old children's mental health organization that was first established as an orphanage in the Lehigh Valley. Through the years, KidsPeace has grown in size and scope to operate programs in 10 states and Washington, D.C. KidsPeace is one of Pennsylvania's largest providers of child and adolescent behavioral healthcare, including a 96-bed child and adolescent inpatient psychiatric hospital, a residential care program that averaged a daily census of 227 children last year, educational services, therapeutic foster care, community-based outpatient services, prevention and public education programs. In 2012, KidsPeace served more than 10,500 clients in our programs, including more than 2,300 youth admitted to the KidsPeace Children's Hospital in Orefield, Pennsylvania.

We treat kids with a range of needs from Disruptive Behavior Disorders including ADHD, to anxiety disorders such as Post-Traumatic Stress Disorder, to the most severe psychiatric disorders such as Bipolar Disorder and early-onset Schizophrenia. In addition, KidsPeace provides specific programming for developmentally challenged children with Autistic Spectrum Disorders and Intellectual Disabilities. KidsPeace considers advocacy for our kids a priority in meeting our mission. What I hope to convey to you today is the necessity of supporting providers who care for children with severe mental illnesses.

Awareness, funding and access to mental health treatment are critical. Nearly one in four youth have shown signs of a mental health disorder in the past year, according to the most recent community-based prevalence studies. Anxiety disorders are by far the most frequent psychiatric diagnoses in children, followed by disruptive behavior disorders, mood disorders and substance abuse disorders. Sadly, despite having treatments that work, fewer than half of youth with mental health disorders receive specialty treatment and far fewer obtain properly disseminated evidence-based treatments. Nowhere else is lack of access more disheartening than when a teenager commits suicide.

According to the Centers for Disease Control, suicide is the third leading cause of death, behind accidents and homicide, of 15-to 24-year-olds. Even sadder, suicide is the fourth leading cause of death for children between the ages of 10 and 14. Overall, teen suicidal behaviors are increasing. The attempted suicide rate among teens has increased by nearly 20 percent between 2009 and 2011. To better grasp this data, visualize a high school classroom with 24 students in it. According to the most recent Youth Risk Behavior Survey by the CDC, four of these students have seriously considered suicide, and two have attempted it.

In order to address these challenges, providers need your help. A number of factors have reduced the amount of time and resources available for children with mental health needs. Workforce shortages, redundant and outdated regulatory burdens and strict managed care requirements have created barriers for child and adolescent clients. Provider reimbursement rates have not increased for many years but added external expectations have. Given these factors, it is no wonder that caregiver burnout and organizational financial pressures are at an all-time high. While the average approved hospital stay has declined by half, the rate of short-stay inpatient hospitalization rose 81 percent among children and 42 percent among adolescents from 1996 to 2007, according to the National Center for Health Statistics. Shortening the inpatient length of stay and denying residential care has served only to increase readmission rates.

Attempts to minimize the inpatient and residential levels of care can compromise the treatment available to the most severe mental health clients. Due to the recent trend of limiting approval for residential treatment, our hospital has had to expand its number of beds to accommodate the numerous readmissions of children failing community-based services. Many of these children would have had earlier approval for residential treatment in the past. Therefore, the adolescents now referred for residential treatment programs are more severely ill.

Countless studies support that early identification and treatment for youth can reduce mental health costs down the road. Unfortunately, the most recent evidence-based treatments, such as Parent Child Interaction Therapy and Multisystemic Therapy, have significant funding barriers, while the costly, poorly evidenced alphabet soup of outdated Pennsylvania wrap-around services remain in place.

Behavioral healthcare costs continue to climb but dollars are not spent efficiently. The number of individuals seeking access to care in the past four years has risen dramatically according to the HealthCare Cost Institute, but it has become increasingly difficult for providers to be considered compliant and receive reimbursement in an era of managed care. While we realize regulations are created in the best interest of the youth, these external demands are so constant that they compromise our ability to deploy administrative resources to implement evidence-based systems of care.

At KidsPeace, the compliance and utilization management departments now begin to rival the cost of delivering professional services. The demands of the system are steering precious resources away from direct care. The four Medicaid managed care organizations for behavioral health in Pennsylvania have very different business, regulatory and utilization practices, which adds significant complexity for providers.

The Pennsylvania Children and Youth Welfare systems do need further support and modernization to increase access to care and support children who are experiencing abuse, neglect and abandonment. Recent large population-based studies on child welfare systems in both Canada and Sweden have supported that children with mental health disorders who receive care in these systems have dramatically less likelihood of death by suicide, suicide attempts and psychiatric hospitalizations than those not in these systems(1).

Unfortunately, the limited ability for the Department of Children and Youth to fulfill its mandate of placing a child in need has often prevented psychiatrically stabilized youth in the inpatient hospital from moving to a less restrictive level of care. While waiting for appropriate disposition plans, hospital resources are pressured by the system to develop less ideal "interim plans" to return clients into the same environments that may have precipitated their crises.

In addition, laws such as Act 147 provide extensive confidentiality and treatment rights to minors as young as 14 years old in all mental health settings, which sometimes undermine their best interest for family support. Although intended to facilitate treatment with providers, these barriers to communication with parents often do more harm than good. In one recent example, a 16-year-old client, who blames her mom for allowing a step-father to abuse her, refused to sign releases of information to Children and Youth caseworkers, her mother or outside providers, halting her treatment progress and leaving her mother heartbroken as she watches her daughter struggle.

There are a myriad of challenges when providing direct care to children and adolescents at the hospital and residential levels of care. Those of us working in the trenches are acutely aware of the workforce shortages in child and adolescent psychiatry. As an example, Certified Registered Nurse Practitioners work daily in acute care hospitals in a wide variety of disciplines as valued team members under the regulation of the Department of Health. The outdated regulations for behavioral health do not acknowledge the current Pennsylvania vocational standards of a Psychiatric Certified Registered Nurse Practitioner or Physician Assistant working in the acute psychiatric hospital and residential levels of care. Despite limitations on training resources, Mental Health Technicians must maintain near heroic vigilance with tight staffing patterns in the face of sometimes assaultive behavior from clients for low wages, which consequently leads to poor retention.

There are approximately 7,000 board certified child and adolescent psychiatrists in the U.S. The estimated need is 12,600 to meet the demand. An anticipated 30 percent increase to about 8,300 can only be expected if funding for training and recruitment remains stable. Nurse Practitioners and Physician Assistants, responsibly utilized and supervised, can help to fill this gap.

It is time we take a close look at updating the mental health system to better serve children in need in Pennsylvania. Last year's tragedies in Newtown, Conn., and Denver, Colo., have shed light on the needs for early identification, prevention and comprehensive treatment in the mental health system. How many tragedies this year will point to the same? The Pennsylvania public health message should be that psychiatric illnesses are "brain-based" physiological disorders akin to diabetes or hypertension, with the goal of further reducing the stigma attached to mental illness. Notice how communities rally around impairing diseases that you can see, but never the devastating brain-based psychiatric diseases that you cannot. Finally, our leaders must support ending the unfair advantages toward procedural reimbursements over comprehensive care for chronic illnesses including psychiatric illness.

KidsPeace looks forward to partnering with you to ensure mental health treatment services are accessible and providing them is affordable. Every child deserves a chance to have access to treatments that work, and providers need your support to deliver them. 

1. Laurence Y. Katz, Wendy Au, Deepa Singal, Marni Brownell, Noralou Roos, Patricia J. Martens, Dan Chateau, Murray W. Enns, Anita L. Kozyrskyj, Jitender Sareen. Suicide and suicide attempts in children and adolescents in the child welfare system. CMAJ, 2011 DOI: 10.1503/cmaj.110749