Wyoming follows movement to treat at-risk juveniles close to home
Following a national trend, the number of Wyoming juvenile placements in residential facilities is decreasing as the movement to treat kids in their communities grows.
In 2008, the state had about 1,200 children under 18 in foster care, including family foster care and resident or group home placements.
In 2011, the number in foster care and placement dropped to 918, according to a recent report from the Children’s Bureau of the U.S. Department of Health and Human Services.
The new figure represents 7.4 percent of the 135,000 children under 18 who lived in Wyoming last year.
State data doesn’t differentiate foster care numbers from resident or group home placements.
Changes in policy and state and national laws are driving the downward trend in placements.
The Wyoming Department of Family Services is focusing on better assessments of juveniles. “We have a lot going on,” Family Services Director Steve Corsi said.
Corsi is the former executive director of High Country Behavioral Health, a nonprofit organization that serves Lincoln, Sublette and Uinta counties. He said improvements to and standardization of the guardian ad litem program give troubled children better representation in court.
County attorneys now have the authority and responsibility to say in which court a juvenile case should be heard.
Sheriff’s officers and police also use juvenile risk assessments “to be sure that kids who are not high risk don’t go to jail,” Corsi said.
Another step put juvenile probation officers in the offices of certain county attorneys. A push may be coming to expand that program statewide if the county attorneys agree, Corsi said.
Additionally, the number of kids sent to the Wyoming Boys School at Worland is down.
Gary Gilmore is the director of the Boys School. He said the institution admitted more than 200 children a year in the 1990s. In 2011, the number dipped to 96.
“This year we’re on pace for 100 or 105, it just depends what’s going on,” Gilmore said. “It is trending down, which I think is a great thing.”
Debra Sprague is superintendent of the Wyoming Girls School at Sheridan. She said the average annual count is 40 to 45 girls, which has remained consistent for some time.
“We seldom have a girl who is a stranger to the system,” she said, adding that most of the girls have been through diversion programs and probation.
Kids with mental illness
The more complex at-risk juvenile problem is treatment for children with mental illness.
St. Joseph’s Children’s Home in Torrington is a psychiatric residential treatment facility for children ages 6 to 18.
“The kids we serve are on the severe end,” said Bob Mayor, the home’s executive director.
He said 60 percent of the youngsters who are admitted have been patients in a psychiatric hospital.
The home also receives referrals through the court system. Most court orders are for children in need of supervision or who are abuse and neglect cases.
St. Joseph’s was full last week with 59 residents, including 58 from Wyoming and one from Nebraska.
The movement to keep kids in their homes is a good thing, he said. But it isn’t always possible, especially in abuse cases, Mayor said.
It also is a challenge to find treatment for severe cases in small Wyoming towns.
Mayor noted the signs of the trend away from residential facilities include the closure of the Attention Home residential facility in Cheyenne a couple of years ago and the Sky Ranch for Boys in South Dakota. The boys ranch operated for 50 years before it closed in 2011.
Dr. Stephen Brown is a child psychiatrist and medical director of the Wyoming Behavioral Institute in Casper.
The institution, which offers both residential and outpatient treatment, currently has 25 people in the residential unit but is not at capacity.
The average stay is 40 days, which is shorter than the stay for other residential treatment facilities, such as St. Joseph’s.
“The ones we focus on have a chance to make improvement in a short period of time,” Brown said.
The Casper facility makes referrals to St. Joseph’s for longer-term care.
Brown agreed with Mayor on the limitations of mainstreaming severely troubled kids.
The state, Brown said, is trying to shorten residential stays, but the kids aren’t coming out as healthy as they were before the stay-home movement.
“Then the critical part is making sure there is some fairly structured outpatient care that has a chance of keeping them stable,” Brown said.
The limits on mainstreaming, he said, depend on how safe someone can be without high structure and if he or she can make good decisions without someone watching them all the time.
Medical school help
Dr. James Bush is the Medicaid director for the Wyoming Department of Health. He said government agencies have focused on declining out-of-home placement for two or three years.
In the past, judges would assign children brought into court to a psychiatric residential facility for a few days for evaluations. Often this would be a crisis situation and the children would remain in the facility for a long time, even years.
The Center for Medicare and Medicaid Services, though, says Medicaid can only pay for medically required services.
The Wyoming Department of Health handles psychiatric placements for juveniles eligible for the Medicaid program. The agency wants the children to be examined by a psychiatrist before being sent by the courts to a psychiatric residential treatment facility.
Bush said these children should be examined by psychiatrists before they go to a hearing to determine the recommendation for treatment.
Bush said he was tired of seeing kids who had been in residential psychiatric residential treatment facilities for six or seven years.
“I don’t think it was a good medicine. And it wasn’t good fiscal policy,” Bush said.
With 23 psychiatrists and only five child psychiatrists, Wyoming is a mental health professional shortage area.
The state has good psychiatrists but they are very busy, Bush said.
So Bush and the department turned to the University of Washington, which trains Wyoming students to be physicians.
The department contracts with the University of Washington Medical School for psychiatric assistance for Wyoming physicians through a telehealth program and a partnership access line.
Bush emphasized the new arrangement was conducted in conjunction with Wyoming psychiatrists.
The state Department of Health also told judges the agency can no longer pay for court-ordered placements to a residential psychiatric facility without a medical reason.
As a result of the changes, total admissions to psychiatric residential facilities are down 50 percent and the length of average stay has been shorted.
The department also tightened criteria for case management review teams to be sure each child has a final transition plan from the beginning, along with a clear treatment plan.
“We’re not denying treatment,” Bush said. “The kids are still having good clinical outcomes. We’re having better outcomes because kids are in a less restrictive setting.”
5 August 2012