It is increasingly difficult to find long-term behavioral treatment for children in residential settings

Connie MacDonald works for the State Department at the US Consulate in Jeddah, Saudi Arabia. It’s a dream job, and she loved living abroad with her two sons.

But earlier this year, Macdonald said, her eight-year-old son began to become aggressive. At first, the family thought it was ADHD. Her son was indeed eventually diagnosed with attention deficit/hyperactivity disorder as well as mood dysregulation disorder, which makes it difficult for her son to control his emotions, especially his anger.

He hurt me. He threatened to kill his brother. One of the last straws was that four people at the school held him for almost an hour trying to calm him down, she said.

The American International School in Jeddah told her that her son could not return. His behavior was so serious that MacDonald started looking for accommodation in the US

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She found Intermountain Residential in Montana. Children in the Intermountain program learn to build healthy relationships through intensive behavioral therapy for up to 18 months.

Intermountain Residential in Helena, Montana, is one of the few programs in the US that provides long-term behavioral health treatment for children under 10 years of age. He cited staff shortages in reducing the number of beds from 32 to eight, with no guarantee it could stay open long-term.

Shailee Ragar/MTPR

Intermountain Residential is one of the few facilities in the US that serves young children with emotional dysregulation, like her son.

McDonald remembers crying hysterically when she left him in June, but the tears gave way to hope as his violent outbursts lessened in the weeks and months afterward.

Now that we have our weekly calls, it’s quite normal. It’s like talking to your child again. It’s wonderful, she said.

Intermountain is one of a dozen programs in the country that provide long-term health treatment for children younger than 10, according to the National Association of Therapeutic Schools and Programs. It is the only option for children from 4 years old.

Intermountain is tucked away in a quiet neighborhood in Helena and has been treating children for over 100 years. Children treated by Intermountain have emotional disturbances, behavioral problems stemming from mental illness or trauma, and other problems. They struggle with self-harm, severe depression or violent outbursts that can lead to attacks on other people or animals. Most families who come to Intermountain have tried medication, outpatient therapy, or even short-term treatment, all without success.

Long-term treatment programs like the one Intermountain offers are often a last resort for families.

It can take months before children with serious mental and behavioral health problems feel safe enough to open up to Intermountain staff, said Meegan Brice, who manages the residential program. Some children were traumatized or abused when adults were supposed to be taking care of them, she said. Experiencing this can leave them deeply fearful or resistant to adult interaction, even when they live in a safe environment. Bryce said Intermountain staff must gain the trust of patients before they can begin to uncover the root cause of children’s behavior. It takes time before they can create an effective long-term treatment plan based on intensive behavioral therapy and building healthy relationships.

Intermountain parents and staff were shocked when the facility suddenly announced this summer that it would close its doors this fall, blaming staff shortages.

Some parents threatened to sue. The law firm representing them argued in a September letter to Intermountain’s board that it has a contractual responsibility to complete treatment for the children who remain in its home.

Intermountain then reversed course, saying it would cut back in an effort to keep the program open. But spokeswoman Erin Benedict said it’s no guarantee Intermountain can keep its doors open long-term. Intermountain plans to reduce capacity from 32 beds to eight.

Megan Stokes, until recently the executive director of NATSAP, believes that staff shortages are not the whole story of Intermountains’ problems.

We are seeing a large number of long-term facilities moving into what they call short-term, intensive care facilities. You can get insurance money more easily, she explained. Stokes said she knows of 11 long-term programs for children 14 and younger that have transitioned to only shorter stays, from 30 to 90 days.

Short-term programs are cheaper and insurance companies will pay for them more quickly, Stokes said. Over the course of a year, short-term programs can treat more patients than long-term residential facilities. This can make them more profitable to run.

But those programs likely won’t help the kids who may have to leave Intermountain. In fact, short-term programs could harm them.

The problem is if that kid bombs that short-term stay, or they’re doing well and maybe six months later they don’t have the tools in their toolkit to continue that, and now you’re labeled as treatment-resistant, when that kid wasn’t treatment-resistant, Stokes said. .

Children who are labeled as treatment resistant may then be rejected from other short-term programs.

For now, parents of children at Intermountain are seeking other treatment options because of the uncertainty of whether Intermountain will remain open. Parents told NPR and KFF Health News they’ve had to sign up for waiting lists that can take a year or longer for several programs that take children 10 and younger. That is if they can find facilities that would accept their children at all.

Stacey Ballard has been unable to find a facility willing to treat her 10-year-old foster child with reactive attachment disorder currently at Intermountain. This condition can make it difficult for children to form a bond with their family. Ballard said her son can be extremely violent.

He walked around our house at night thinking about killing us all and said he did it almost every night, Ballard explained.

Institutions that treat children his age generally do not treat children diagnosed with reactive attachment disorder, which is often associated with severe emotional and behavioral problems.

MacDonald also can’t find another facility that could be a backup option for her son. He was scheduled to complete another 14 months of treatment at Intermountain.

She said she couldn’t gamble on keeping her son at Intermountain because of the uncertainty of whether it would stay open.

So, she is preparing to leave Jeddah and fly back to the US, taking a leave of absence from work.

I will take him to my family in South Carolina until I can find another place for him, she said.

This article is from a partnership that includes MTPR, NPR and KFF Health News.

KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the key operating programs of KFFan, an independent source of health policy research, polling and journalism. Learn more about KFF.

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