As Connecticut celebrates the opening of four new centers designed to meet children’s urgent behavioral health needs, some fear that a lack of recurring state funding means the program’s future is unsteady.
The four urgent crisis centers established as part of 2022 legislation were launched using one-time dollars from the American Rescue Plan Act. Advocates say in order to operate long-term, the programs will need recurring money from the state.
Lawmakers plan to examine new funding mechanisms in the coming legislative session, and state agencies are working together to discern the best ways to bill Medicaid to cover the cost of running the crisis centers.
“Let’s be real about what this work takes,” said Sarah Eagan, Connecticut’s child advocate. “One is the UCCs cannot have one-time funding. There has to be a sustainable funding plan.”
In addition to long-term funding, officials are also working to get the word out to ensure that schools and emergency services know when to take a child to the crisis center rather than the emergency department.
The launch of the services, Eagan said, is still a cause for celebration. Children nationwide have reported more problems with behavioral health such as eating disorders, substance abuse, depression and anxiety in recent years, and the crisis centers are designed to help them quickly.
The urgent crisis centers are part of a law passed in 2022 as lawmakers pushed to address reports of increasing mental health problems among children during the COVID-19 pandemic. The centers are designed as walk-in outpatient clinics for kids who are having behavioral health crises such as thoughts of suicide or self-harm, depression, anxiety or out-of-control behavior, among other mental health issues.
There are four in Connecticut, at The Village for Children and Families in Hartford, Yale New Haven Hospital in New Haven, The Child and Family Agency of Southeastern Connecticut in New London and Wellmore Behavioral Health in Waterbury.
Startup and implementation of the centers cost $1.7 million in ARPA dollars, said Melanie Sparks, chief fiscal officer at the Department of Children and Families.
The two larger facilities cost about $4.2 million per year to operate, and the smaller two cost about $2.6 million per year to operate, Sparks said
The department anticipates that ARPA funding will last through June 2024. DCF is working with the Department of Social Services to determine what new Medicaid billing codes could apply to the services offered at the centers.
Some services are already billable, Sparks said.
Three of the four centers are licensed as behavioral health outpatient clinics and can use the state’s fee system, according to an emailed statement from DSS spokesperson Giovanni Pinto.
“That being said, we need to add a few more billing codes to align with the model. For example, in outpatient there is no nurse assessment,” Pinto said. “In the UCC, a nurse does an assessment, so we need to add a nursing assessment code.”
The change to the billing codes in Connecticut would require legislative approval.
Sparks added that the state is still conducting an analysis to see whether the billing would cover the entire cost of the crisis center’s operation.
“It’s really hard to analyze that before the programs are operational,” Sparks said. “This is a new service model to the state of Connecticut.”
The Village in Hartford had its official opening ceremony last week. The programs are accepting patients. The Village has treated about nine children, officials said in an interview Wednesday.
Rep. Tammy Exum, D-West Hartford, said in an interview that she’s working with other lawmakers to determine potential sources of funding for the centers. She hopes to have a sustainable system of mental health care that offers community-based support for kids.
She said she doesn’t want it to be “reactive” and hopes lawmakers can create policy to support a system that’s ready for anything — another pandemic, for example. She and Sen. Ceci Maher, D-Wilton, co-chair the newly formed Transforming Children’s Behavioral Health Policy and Planning Committee together.
“They’re rolling out,” Exum said. “We’re excited to be able to roll them out, but we need to be able to fund them.”
Maher said children’s mental health continues to be a priority for the legislature. Maher is co-chair of the Committee on Children.
“Obviously it is really important to make sure that this isn’t just a one-time fund, so we’re certainly going to be working with the chairs of appropriations,” Maher said. “It’s just getting everyone on board.”
Hector Glynn, chief operating officer at The Village, said he thinks lawmakers are supportive and his staff are working to get the word out to show that the program is being utilized.
“I think [House Speaker Matthew] Ritter iterated that there’s still a lot of work to be done to ensure that the funding is stable for these programs beyond this fiscal year,” Glynn said.
Mental health service providers are giving the state certain data on the centers’ operations — who is coming into the clinics, barriers to access to service and what kinds of problems people come in with, among other measures, said Frank Gregory, administrator of children’s behavioral health community service system at DCF.
DCF has also partnered with the Department of Public Health to get the word out to emergency services about the urgent crisis centers.
“Kids come to the emergency department primarily in ambulances,” Eagan said. “Yes, from school or home, but they’re coming to hospitals by ambulance.”
In 2021, physicians reported that children with mental health needs were overwhelming Connecticut’s emergency departments. The kids often had to wait hours for care.
The public health agency is working to revise its protocols so that ambulances can take children to the crisis centers rather than emergency rooms, although some providers are already working with local emergency services to put those protocols in place, Gregory said.
DCF is also working to ensure schools know about the urgent crisis centers by communicating with the state Department of Education and local superintendents, Gregory said.
The Village is working with local mental health providers and schools to ensure community members know about their services, said Amy Samela, vice president of residential programs at The Village.
She added that local partnerships also help ensure that kids are able to get care in the community after their visits to an urgent crisis center.
Community care was another of Eagan’s concerns, as many families have reported difficulty accessing local care or being stuck on waiting lists for mental health treatment in recent years.
“It’s good, but we have a lot of work to do,” Eagan said.
The Village is also opening a subacute crisis stabilization unit with 10 beds in the fall. They’re aiming to open next month. The new unit will be another place that kids who visit the urgent crisis center can go if they need to stay longer to get the treatment they need, Samela said.
The Village also plans to call families every day after a visit to the urgent crisis center to see how they’re doing until they’re settled in with the next level of services, Samela added.
“We really want to keep kids in the community, out of facilities, out of hospitals,” Samela said. “Kids are in crisis. There’s no doubt about it.”