A commissioner outlines DCF reforms after Newtown

By Joette Katz

The unspeakable horror that took 20 young children and six brave adults from their families naturally has spawned a search for answers. While no satisfactory response may emerge, one important part of the discussion has focused on children’s mental health. The Department of Children and Families has children’s mental health as one of our mandates and, as commissioner, I welcome the attention to this complicated subject — particularly in light of this incomprehensible tragedy.

As Governor Malloy pointed out last week, the children’s mental health system needs continued improvements, and I am committed to implementing reforms. While progress has been made under the current administration — notably the share of children receiving treatment in congregate settings has declined 26 percent and the number of children sent out of state to receive treatment has declined 77 percent — much improvement remains necessary. That is why we are initiating a number of further reforms.

In the next month, the Department of Children and Families expects to launch a new RFP, entitled The Community Bridge. It is intended to provide intensive community based treatment for youth who are experiencing mental health or behavioral challenges that are of sufficient severity that a residential placement would have historically been the treatment of choice. The Bridge is envisioned as a flexible array of family-based, community, residential and aftercare programs that are closely linked and integrated.

Most services will be oriented to an in-home venue and will be rooted in evidenced based practice. Youth referred to community based services will be 11-18 years of age and have complex behavioral, emotional, and physical needs that would likely necessitate out-of-home care if a successful intervention were not implemented.

In certain circumstances, however, a youth may require more intensive individual care to address a particularly difficult pattern of behavior. In such a case, in-patient stabilization may be needed to restore the youth to behavior that is acceptable and manageable within the family setting. The therapeutic focus of such treatment will be on decreasing unsafe and high-risk behaviors and increasing pro-social skills, emotional competency, and self-control. This short term stabilization will provide a therapeutic 24-hour living situation with supervision, structure, and multi-disciplinary, multi-modal therapies.  Youth at this level of care will have access to consultation from a psychiatrist to monitor the effectiveness of medication.  Treatment is less intensive than hospitals and residential levels of care and can be a diversion from initial hospitalization for those clients needing less intensive treatment in a structured residential setting.  In the Community Bridge system, intermediate short term stabilization is part of a treatment continuum, not a treatment destination.

For those youth who require a longer term of inpatient treatment, the Albert J. Solnit Children Psychiatric Center remains available. Based on a recent data review, the Solnit Center is in the process of change and reorganization to better meet the needs of Connecticut’s youth and their families.  Upon completion of this conversion, the center will be a 118 bed facility treating youth ages 13 through 17.  On its North Campus, located in East Windsor, current residential beds will be converted to Psychiatric Residential Treatment Facility (PRTF) beds, allocated to adolescent boys, ages 13 through 17, with complex behavioral health care needs that include but are not limited to:  Aggression, self-harm, substance abuse and low-risk problem sexual behavior.

There will be a total of 38 treatment beds on this campus along with 2 emergency beds that social workers can access through the Department’s Careline.  The conversion on the East Windsor campus will be complete by September 1, 2013.  Fifty two inpatient psychiatric beds will remain at the Solnit Center’s South Campus, located in Middletown.  These beds will be for both genders ages 13 through 17.  The 16 PRTF beds for adolescent girls, 13 through 17 will also remain in operation.  Finally, the facility will close two inpatient psychiatric units currently serving very young children and opening them both as PRTFs:  one unit will provide care to adolescent girls, 13 through 17, while the other will serve both genders, ages 13 through 15 with complex behavioral health care needs that include but are not limited to:  aggression, self-harm, substance abuse and low-risk problem sexual behavior.

Notably, the Department also is making strides in expanding the array of in-state resources for youth on the autistic spectrum. The services will include evidence-informed, community based programming as well as closely linked residential services and family supports. Services will be available for both males and females 9-18 years old. Additionally, in February, the Department will open six intensive treatment slots for adolescent girls with trauma histories. These girls have traditionally been served out of state.

The Department has been working diligently with many community providers, physicians and psychiatrists who have identified service gaps and who have helped to design creative solutions. Children’s mental health will need more improvements still, but if there is any good that could possibly come from such extreme horror as befell Newtown and Connecticut, it may very well be a serious and complete discussion of how to improve services for troubled children. I welcome that development.

Joette Katz is the commissioner of the Connecticut Department of Children and Families.