Mental health team hits the road to help youth in crisis
Ten-year-old Joey Smith shared a celebratory high-five with Heather Kunkel, a mental health professional visiting the boy's Thomaston home. "Things are great, spectacular even," he said, as the two chatted at the kitchen table.
It's a dramatic turnaround for Joey, who met Kunkel when she was summoned to Thomaston Center School because he had threatened to harm himself. Now Joey, who has autism, is back at school with a modified curriculum to suit his needs and his parents have access to an educational advocate and community resources.
The Smiths are among the thousands of Connecticut families turning to the Emergency Mobile Psychiatric Services -- a crisis intervention program that includes a network of 150 mental health professionals who assist children at home, school or in the community. Like a special weapons team called into action, EMPS clinicians can respond immediately by telephone or mobilize to provide face-to-face intervention within 45 minutes of a call to 2-1-1 placed from any Connecticut town.
"We see the entire gamut, from little ones with temper tantrums to children with attention deficit hyperactivity disorder who can't be controlled, to older kids who may be suicidal, homicidal, or injuring themselves. Whatever the crisis, we work with families and schools to support the child," said Michelle Andrews, EMPS team leader at Wellmore Behavioral Health in Waterbury. Wellmore is one of six agencies that provide crisis intervention services from 15 EMPS satellite sites statewide.
The growth of the EMPS program comes at a time of heightened awareness of the need for mental health services following the massacre that left 26 people, including 20 children, dead at Sandy Hook Elementary School in Newtown last December. EMPS clinicians were among the first responders to arrive at the firehouse to assist and comfort families waiting for news about their children.
"We thought we were responding to a school shooting involving one death. It wasn't until we got to the firehouse that we realized the magnitude of what was happening," said Andrews. "We did whatever we could to help in the moment, whether it was holding hands, looking at pictures of the children, or contacting family members. The inner strength of those families facing such unimaginable loss left me in awe."
`Support the child'
An estimated 39,000 children live with a serious mental health condition in Connecticut, according to the National Alliance on Mental Illness. Sixty-three percent of the children served by EMPS last year reported one or more trauma exposures.
Locally, services like EMPS are badly needed, said Brenda Concepcion, a social worker at Central High School in Bridgeport, which has 2,300 students. She contacted EMPS about 17 times last year for help with students who were suicidal, harming themselves, or severely depressed.
"We're seeing a growing number of kids with more severe mental health problems," Concepcion said. "The fact that (EMPS staff) are mobile is the biggest and greatest thing.
"They are my second set of eyes and ears."
Last year, EMPS served 10,560 children and families ---- that's a 61 percent increase from 2010 -- and experts expect the demand for services will increase. Funded by the state Department of Children and Families in partnership with United Way of Connecticut, EMPS was designed to serve children up to age 18 in their homes and communities, reduce the number of emergency department visits and keep youth from more restrictive and costly interventions -- such as hospitalizations or arrest -- whenever possible.
The EMPS program is open to all children, whether or not they are associated with DCF or have health insurance. EMPS staff can provide follow-up services at home or school for up to 45 days following an intervention. Most calls to 2-1-1 for crisis intervention come from parents and family members (43 percent), followed by educators (33 percent) and emergency department personnel (11 percent).
Not only does EMPS provide children with some much-needed help, there's evidence that programs like this save the state money. Connecticut has saved about $3.5 million in Medicaid funds by diverting children from inpatient settings, while the percentage of youth in the Department of Children and Families' care who are served in congregate settings has decreased to 23 percent from 29 percent.
"Kids do much better when they get help in their natural environment," said Tim Marshall, EMPS contract manager for the state. "The more restricted the level of care, the more artificial the environment, which makes it difficult for kids to develop the habits and coping mechanisms they need to live in a normal environment."
One environment EMPS strives to keep kids out of is the juvenile justice system, Marshall said.
"One of the unintended consequences of having officers at schools is that police become involved in behavior and discipline issues in school districts that aren't clear about their role," he said. "Incidents that may have led to a suspension in the past can now lead to arrest."
Programs like EMPS can also help keep children with mental health issues out of emergency rooms, said Dr. Peter Jacoby, chairman of the emergency services department at St. Mary's Hospital in Waterbury. St. Mary's has a contract with EMPS to assist children and teens with mental health problems when they arrive at the emergency department.
"Emergency departments across the state are overcrowded and they're often not the best place for a child with a behavioral health issue," said Jacoby. "We work with EMPS to get kids out of the emergency department who don't need to be there and make sure they receive follow-up care in the community." EMPS assists hospital staff to find the appropriate setting for children who require a higher level of care, he said.
The need for mobile intervention services surfaced a decade ago because the state was "spending a disproportionate amount of funds to treat children with mental health needs in institutional settings," said Robert Plant, chief clinical officer at Wellmore, who helped design EMPS when he worked at DCF. But the program "wasn't producing the results we needed," prompting DCF to contract with the Child Health and Development Institute to improve quality and performance, he said.
EMPS counselors are available immediately to talk by phone or evaluate the situation, 24 hours a day, 365 days per year. EMPS hours of mobility are: 9 a.m. to 10 p.m., Monday through Friday; and 1 p.m. to 10 p.m. on weekends and holidays.
This story was reported under a partnership with the Connecticut Health I-Team.