from the NY Times
June 30, 2003
New Jersey Foster Children Lingering in Mental Wards
By RICHARD LEZIN JONES and LESLIE KAUFMAN
At Trinitas Hospital in Elizabeth, N.J., roughly three dozen patients are in the children’s psychiatric ward, and more than half of them are foster children stuck there simply because the state has nowhere else to put them.
Hospital administrators and child welfare officials say the situation is sad, but not unique.
In the children’s psychiatric ward at St. Clare’s Hospital in Boonton, for instance, roughly one out of every six patients is a foster child who was classified upon admission as among the state’s most troubled. Hospital officials admit that these children, after being stabilized, no longer need to live in the unit, which is kept locked.
Across New Jersey, in fact, in nine such specialized wards, scores of the state’s foster children have met the same fate in recent years. While in the custody of the state’s Division of Youth and Family Services, the children are admitted to the wards for emergency eight-day stays, but wind up remaining for weeks or months.
One foster child, records show, was in a locked ward for nine months. Stays of three months or longer, according to records, are hardly uncommon for foster children who have otherwise been cleared for release.
“The situation now is horrific,” said Kathy Wright, executive director of the New Jersey Parents Caucus, a federally financed nonprofit organization that supports parents of children with psychiatric disorders. “DYFS workers bring them there, if they have failed in a foster placement. But once they are in, they stay from 20 days to 180 days. Once a kid has a mental past or violent past, no one wants them.”
Hospital administrators acknowledge that extended stays on the wards are seriously inappropriate. The wards were conceived as a triage stop of sorts, where severe mental and emotional problems could be diagnosed and treated, and then the children moved on to long-term care in a residential program or to their own homes.
The conditions in the wards, by most accounts, are clean and well monitored. Professionals are on duty, and treatment is given. But the wards, known as Children’s Crisis Intervention Services units, were not designed for long stays. Thus, officials concede that children kept there often go without consistent schooling, if they get any at all. And because of security concerns, the children, even once they are stabilized, can go days without even a walk outside.
More than 300 of the 4,000 or so New Jersey children who spent time in the inpatient wards in the last year — children ages 6 to 17 — were foster children. They spent, on average, a month in the wards, four times the average stay for other children.
Hospital administrators, child welfare officials and others say there is just no real alternative — that scarcely any spots are available in residential after-care, and that even fewer foster families are capable of taking in difficult children.
State officials, who last week agreed to turn over control of much of the state’s child welfare system to an independent oversight panel, said they had been working to address the problem of prolonged and unnecessary stays in the psychiatric wards. But the challenge, they admit, is formidable, one made even more difficult in recent years.
According to state figures, 700 more patients spent time in the wards in 2002 than five years ago.
Most of the children who enter the psychiatric wards are admitted by families not involved with New Jersey’s child welfare system. Because those children are able to return to their own homes, their stays on the wards typically last a week.
But many of the children who are sent to the wards are children in the custody and care of the state. Some of them have been turned over to the state because their parents were not able to handle them, or could not pay for their care. Some of the children were already in foster care when they first displayed symptoms of emotional or mental
problems, and some have been surrendered to the state because their parents cannot afford psychiatric care. All of the children have problems that doctors have determined require immediate treatment.
Often these children have severe troubles — sexual aggression or pyromania. Others are admitted to the wards for depression or anxiety. Hospital administrators also say that a sizable percentage of foster children who enter the wards suffer from attention deficit disorder or attention deficit hyperactivity disorder. Administrators say that most children can be stabilized in the wards within a week or two and be ready to be discharged to an after-treatment program. But often — even after doctors, lawyers and a family court judge agree that a child in state custody is ready for discharge — they wait.
A spokesman for the Division of Mental Health Services, Val Casey, said the extended stays of some foster children were the result of bureaucratic challenges like coordinating the efforts of several state agencies.
But others who have worked with the children in the wards over the years question the ability of state child welfare workers to adequately monitor their cases, and still others say the size of those workers’ caseloads further complicates the placement process.
Whatever the full set of reasons, the consequences are obvious on the wards of two hospitals, Trinitas and St. Clare’s. The problem of extended stays became so acute at Trinitas that in 1995 its administrators created an intermediate care unit to accommodate children who were expected to remain in its psychiatric ward for extended stays. The average stay for those in the intermediate unit now exceeds six weeks.
A visit to the ward at Trinitas this month found many of the children gathered expectantly in the hallways. It was court day, as it is known on the ward, and a handful of children who had been in the psychiatric wing for weeks or months were eager to hear if a judge might at last order them released.
A young girl in a pink dress and ponytails shuffled nervously outside a therapy room that has been converted to court chambers. Adolescent boys clustered together, hoping that they might soon be saying their goodbyes.
On this day, however, most of the children who appeared in the improvised courtroom wound up disappointed. There was one bit of good news, though. The ward was abuzz over one child who was finally told by a judge that he was being released, about eight months after doctors first recommended that he be discharged.
“It’s frustrating,” said Michelle Perna, the director of the crisis intervention and intermediate care units at Trinitas. “If you don’t know where a kid is going, you can’t really give them anything to look forward to.”
Ms. Perna said that it pained her to watch children in the unit who, knowing they have been cleared to go, simply remain indefinitely.
“They get excited, and they also get disappointed because they think they’re going to get good news,” she said.
And while hospital workers try to make the children’s stays productive, they are candid that the wards are improper long-term settings.
“We’re not a group home,” said Jean Bronock-Zaccone, a behavioral health official at St. Clare’s Hospital, which has a 28-bed children’s psychiatric ward. “Our job is to stabilize, and then let them move on to a less restrictive facility.”
Ms. Bronock-Zaccone said the presence of children who should have been discharged from the wards sometimes keeps others from getting the kind of emergency help the wards were designed to provide.
The experiences in the wards, then, can be extremely frustrating.
One 7-year-old child, who is not being identified to protect her privacy, had a history of misbehaving during a troubled childhood that included abuse and neglect at the hands of her mother.
In the fall of 2002, her grandmother, with whom she had been living, became homeless, records show, and she signed the child into state custody. But once in foster care, the girl had episodes of screaming and kicking. She wound up in one of the locked wards after she threatened her foster mother with a knife.
Documents from subsequent court hearings to determine her fate record numerous failures that prevented her from getting the kind of care recommended by doctors, and approved by a judge. At one hearing, the state child welfare worker simply did not show up. After the child spent two months in the hospital and was on the verge of being discharged to Davis House, a residential program, her file contains this notation: “By voice mail, Davis House canceled the placement.” After nearly three months, a judge ordered a social worker to take her from the ward.
Child welfare officials said they do not comment on cases involving specific children.
State officials say they are now aggressively attacking the problem of foster children lingering in psychiatric wards. The state’s recent agreement to create an independent panel with broad powers to oversee the Division of Youth and Family Services came with an implicit commitment of more money, some of which will likely be used to provide more beds in New Jersey for children after they are treated in the wards.
For now, officials are optimistic that a program — the Partnership for Children — will allow troubled children to receive sustained and sophisticated mental health care in their homes or foster homes.
“If we can ensure that children, whatever their family circumstances, get services earlier and closer to home, we hope we can prevent the kind of escalation in behavior that leads people to the hospitals,” said Julie Caliwan, director of the partnership.
But hospital administrators, parents and child welfare agency workers say that so far the program has been more theoretical than practical for New Jersey’s poorest children. And they are skeptical that such a system will ever solve the predicament of the children who stay on the wards for the longest.
“It’s all so appealing,” said a state judge who has worked in the system for many years and who spoke only on the condition of anonymity. “It sounds great, but if you have a sexual offender or a kid who has set 15 fires, who’s going to want to take them in?”