Republican-American | WATERBURY — To combat what state health officials say is a growing children’s behavioral and mental health crisis, Montagno Construction will negotiate a contract with the state Department of Children and Families to become a mobile crisis hub.
The hub would provide in-person mobile crisis intervention services to Western Connecticut children and families during overnight and weekend hours that Wellmore and other providers don’t cover now.
Wellmore, which serves 43 municipalities in Northwest Connecticut and has offices in Waterbury, Torrington, and Danbury, would be one of three mobile crisis hubs serving a third of the state geographically.
Mobile crisis, funded through DCF grants, sends licensed clinicians to calls involving children in crisis. They conduct evaluations and assess needed support for families. Referrals to further support resources often are made.
Clinicians drive unmarked vehicles to reduce the stigma of behavioral and mental health struggles.
Wellmore and other providers run in-person services from 6 a.m. to 10 p.m. on weekdays and 1 to 10 p.m. on weekends and holidays.
During off-hours, public safety officials respond to mental and behavioral health calls. That usually leads to children in crisis being sent to a hospital emergency department when it may not be necessary, a request for proposal from DCF states.
Caregivers of children in crisis can call mobile crisis providers 24 hours per day, but they are connected to United Way’s 2-1-1 call center, which staffs a licensed clinician to speak with families when in-person services aren’t running and then connects them to providers the next day.
THE IDEA FOR MOBILE CRISIS HUBS came after DCF heard from providers and families that they believe the state agency should increase face-to-face assessment hours, DCF Deputy Commissioner Michael Williams told The Sunday Republican.
The severity of mental and behavioral health symptoms has grown during the COVID-19 pandemic, resulting in more children and adolescents going to the emergency department and a higher need for crisis services, DCF’s RFP states.
“There is currently an overdependence on our emergency departments and justice system, and Mobile Crisis is designed to assist in decreasing psychiatric boarding in emergency departments and reduce the demands on the justice system,” the RFP states. “These two benefits translate into better care, better health outcomes, and lower costs to the community.”
Creating the three mobile crisis hubs is a small step forward in meeting the needs of children and families, said Gary Steck, CEO of Wellmore. He’s looking for more funding to make the state’s six main mobile crisis providers run in-person services 24/7.
DCF is allocating $466,666 to each of its three providers who will operate the hubs with American Rescue Plan Act funding and a federal mental health block grant, Williams said. About $6.7 million would be needed for all six providers to be 24/7, Steck noted.
In the hub model, Wellmore would provide in-person services in Region One, or Southwest Connecticut, and then refer families to a nearby provider, he said.
“This is a flawed attempt to go to 24/7 because it is a tiny resource they are talking about with these hubs,” Steck said. “Unfortunately, what will happen, any way you slice it, about half of these families that are now seen in these new hours are going to retell their story the next morning to the next provider.”
The Centers for Medicare and Medicaid Services is reviewing whether the overnight and weekend services will be covered by Medicaid, DCF Commissioner Vannessa Dorantes said.
“This will give us an opportunity to gather data of what our peak times are to be able to provide that mobile response,” Dorantes said of the hubs.
KRISTIN PRACITTO, vice president of children’s services at Wellmore, oversees the organization’s mobile crisis program. She said she’s concerned about DCF’s response-time requirements.
At least 80% of calls received during the new hours need to be responded to within 90 minutes, an RFP states. At least 50% of calls from 10:01 p.m. to 1 a.m. weekdays and 10:01 p.m. to 12:59 p.m. weekends will be required to have in-person services. That number drops to at least 10% to 20% for services between 1:01 and 5:59 a.m., it states.
It takes about 90 minutes to get from Wellmore’s Waterbury office to downtown Greenwich, Pracitto said.
“That is if there’s absolutely no traffic, no construction, no barriers, not getting lost,” she said. “Having worked in the Stamford/Greenwich area for a number of years, once you get off the highways, there are often lots of long, windy roads that make it challenging to get to places.”
Wellmore’s youth mobile crisis division staffs 10 full-time and 20 per-diem licensed clinicians and three managers, said Rosa Baldino, the project coordinator. The division averages 10 to 12 calls per day spanning the region, with a response time of 21 minutes and at least 80% of calls diverted from the emergency department, she said.
Mobile crisis providers statewide responded to 1,320 calls last November with 94.2% receiving an in-person response, according to figures from the Child Health and Development Institute of Connecticut. About 83.2% of calls received an in-person response in 45 minutes or less, figures show.
“Sometimes people think going from Middletown to Meriden is a day’s journey just because they’re two different towns, and it’s not,” Williams said. “That will be something new for us in Connecticut to show that people can cross over territorial boundaries and serve each other without having to invest in a 24/7 mobile response operation in every town.”
DCF officials believe the expanded services will be implemented within the next six weeks depending on how recruitment and contract negotiations go for the three selected providers.
STAFFING WOULD NEED to be reconstructed at Wellmore, with the addition of an overnight supervisor and several staffers to manage cases, Pracitto said. As of now, the organization has just two clinicians to cover the entire western region in the expanded hours, Steck said.
United Way also will be looking to add more licensed clinicians to handle 2-1-1 calls, said Tanya Barrett, senior vice president of 2-1-1, a free confidential service that provides language interpreters.
The workforce shortage has the attention of Gov. Ned Lamont and Kelli-Marie Vallieres from the Office of Workforce Strategy. The state this month launched a CareerConneCT program to expand job-pipeline programs for industries with high labor demand, such as health care, from a regional to state level.
“All of us are experiencing a challenge in making sure we have the people to do the work to meet the clinical needs of kids,” Dorantes said.
STATE REP. LIZ LINEHAN, D-Cheshire, said her priority as chairwoman of the legislature’s Committee on Children is getting funding for mobile crisis providers to operate all day and night in the state’s six regions. The 2022 legislative session starts on Feb. 9.
Many caregivers aren’t aware of how to access mobile crisis providers, Linehan said. She called 2-1-1 the state’s best entry into the children’s behavioral health system. Most referrals, however, come from schools, she said.
“When COVID shut down schools, the referrals dropped so quickly that we’re left with parents not receiving those referrals into the system and left without knowing where to go,” she said. “We need to take more ownership of and provide better access to those families who are not getting referrals from already inside the system.”