DCF looks at mental health post-Newtown

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 Albert

J. Solnit Children’s 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 Solnit 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

Connecticut.  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 12 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.