Pima County children needing psychiatric care will soon have more inpatient options, but residential treatment beds and community-based help remain in short supply.
Palo Verde Behavioral Health, at 2695 N. Craycroft Road., will provide 18 beds for teens ages 13-17 once its licensing process is finished, hopefully by the end of this month, said Bob Murray, director of business development.
For years, Sonora Behavioral Health on North Corona Road has been the only local facility providing acute inpatient psychiatric services for children, some as young as 5, as well as adolescents and teens up to age 17. It has 22 youth beds, said Edeli Kinsala, Sonora’s chief executive officer, and they are usually full.
Sonora plans to add up to 74 more beds over the next 18 months, Kinsala said. Some could be for teens and children, but that’s yet to be determined.
People are also reading…
“We have had a great need for additional acute behavioral-health hospital beds in this state for numerous years, and we look forward to having Palo Verde’s opening,” said Dr. Beverly Tobiason, clinical director at the Pima County Juvenile Court Center. “Our community has seen too many children waiting in the Crisis Response Center, hospital emergency rooms and detention for a bed to become available.”
Tobiason said while the new hospital beds will help some children and teens who need stabilization, treatment options remain very limited for those with low cognitive functioning and, in some cases, autism spectrum diagnoses, since hospital criteria often means these children are excluded.
While it’s not possible to gauge exactly how many children and teens might need services here at any given time, Medicaid numbers offer a glimpse: About 95,000 Pima County children are enrolled in Arizona’s Health Care Cost Containment System for the state’s poorest residents, and roughly 11,000 receive behavioral-health services.
Neal Cash, president of the Community Partnership of Southern Arizona, said Tucson has 10 residential treatment beds for children and teens who need intensive services but not hospitalization. There are 13 beds for the next, lower level of residential care — which often spans three to six months — and 208 beds in therapeutic foster homes.
At times, he said, no local spots are available, so children and teens are placed in Maricopa County or, less frequently, out of state.
Other times, children languish in a hospital or emergency bed because residential placements can’t be made. It is, Cash said, “a very sad situation when that occurs.”
LACK OF TREATMENT OPTIONS in county
National data show 66 percent of boys and 74 percent of girls involved in the juvenile-justice system, and 80 percent of youth in dependency cases, meet the criteria for at least one mental-health diagnosis.
Tobiason said the problem is compounded by the lack of service providers to help these children and teens, with national estimates showing less than 10 percent have access to a program that could help them progress or recover.
“This also holds true in Pima County, where approximately 70 percent of juvenile-justice-involved youth are publicly insured through AHCCCS, thus most of the treatment modalities and programs that have been shown to be effective with this population are not currently available,” Tobiason said.
The treatment programs that are available here do not have enough qualified staffing, and often have long wait lists, she said.
“The publicly funded provider agencies have limited numbers of master’s level, licensed staff in which to provide such specialized services,” Tobiason said. “Instead, the Arizona behavioral-health system heavily relies on bachelor’s level and below staff for much of their work.”
Tobiason said the children and teens she sees often have what she calls the triad: trauma, mental-health challenges and substance use.
“For our dependent children, the lack of treatment services and limited permanent placement options can result in multiple group home disruptions,” she said. “For our juvenile-justice involved youth, the lack of treatment services can result in deeper penetration into the juvenile-justice system. Each of these results offer poorer overall youth and family outcomes.”
With better, specialized treatment available earlier on, she said there would be less need for hospital beds and residential placements.
“I have always believed that with a full continuum of treatment services that our need for residential treatment would be reduced significantly,” she said. “However, until we have a full continuum of treatment, we will continue to need more residential treatment bed availability.”
EARLY HELP IS KEY
The National Institute of Mental Health says that half of mental illnesses begin by age 14. Common challenges affecting children include anxiety disorders, post-traumatic stress disorder, autism spectrum disorders, bipolar disorder, depression, eating disorders and schizophrenia.
Parents or caregivers who notice changes in a child’s behavior should realize that not every problem is an indication of something serious, the National Institute of Mental Health reports, as everyday stresses can cause significant changes in behavior. But it is critical to seek help if there’s any question.
“If you, as the parent, feel something is just not right and you’re noticing this or that, it doesn’t hurt to just touch in,” said Jenifer Kent, program director of outpatient behavioral-health services with Arizona’s Children Association. “Meeting a child’s needs in the beginning is far better than trying to play catch-up at the end.”
Changes in communication patterns, performance in school or social situations are areas to watch, said Dr. Sydney Rice, a researcher of developmental pediatrics and associate professor at the University of Arizona.
Rice, who also directs the UA’s LEND, or Leadership Education in Neurodevelopmental Disabilities, said children who experience early trauma are at high risk for later mental-health issues. That risk, she said, is often underestimated and sometime not addressed.
“I see many children who have been physically abused and neglected, and even if the situation is improved, they often have ongoing mental-health issues,” she wrote in an email exchange. “Sometimes these issues present as behavior issues and the children get labeled as a ‘bad kid’ if we don’t recognize that these early problems set them up to have mental-health issues.”
Kent oversees outpatient behavioral-health services for about 1,200 Pima County children and teens. Of these, she said, about 230-250 have open dependency cases. Often, grief and loss compound their challenges.
SUPPORT IS CRITICAL
Local children sometimes miss out on services they need because of high turnover among caseworkers, Kent said.
“Someone may have been working with a child, but then someone new walks in and doesn’t have the history,” she said. “It’s much different to read it on paper than to have someone talking to you about it.”
Rice said supporting the child is critical — more vital than getting the right diagnosis.
“For example, a child may be oppositional and obtain a diagnosis of oppositional defiant disorder, but that does not really tell us why or how to help,” she wrote. “We need to sort out what has led the child to act this way and how can we teach other ways of reacting.”
Experts can assess younger children by observing behavior and looking at how well they are doing in school; the same can apply to teenagers who are more capable of communicating, but might resist.
“Similarly, we look at their function in life,” Rice said. “Are they acting out? Are they hurting themselves? Are they able to participate in sports or other extracurricular activities and do well in school?”
Melinda Vasquez, chief officer of consumer and community affairs for Cenpatico Integrated Care — which will replace CPSA as the public behavioral-health system here as of Oct. 1 — said the organization is aware that children struggling with mental- health issues need more attention.
“We believe it is important to keep children out of in-patient treatment when possible as children recover and stay in recovery longer when treated in their own environment,” she said. “We believe if children can get into recovery in their home, they don’t experience the added stress that can occur when removed from their home.”
