A panel of lawmakers on Tuesday asked advocates, medical professionals and state officials to explain the reasons for often hospitalizing children in the care of the Illinois Department of Children and Family Services “beyond medical necessity” — a term used to describe a longer hospital stay after a child is cleared for release after a psychiatric stay.
State Sen. Julie Morrison (D-Deerfield) called the hearing in response to a ProPublica Illinois investigation from June, which found that hundreds of children in the care of DCFS are forced to stay in psychiatric hospitals long after their treatment is over, as the state cannot find appropriate placements for them.
Dr. Tom Cummins, the medical director of inpatient psychiatric services at Chicago’s Lurie Children’s Hospital, laid out the issue for lawmakers on Tuesday, saying the issue of prolonged stays by children in the care of DCFS means that hospitals are less able to accept other patients.
In Fiscal Year 2017, for example, Cummins said Lurie was unable to accept 664 patients in part because of the children under DCFS care who occupied beds. But more importantly, Cummins said, prolonged stays leave scars on the children.
“Prolonged hospital stays reopen old psychiatric wounds, including feelings of being unwanted,” Cummins said.
Children being hospitalized beyond medical necessity is primarily a result of the issue of placement capacity, according to Danielle Gomez, an attorney with the Office of the Cook County Public Guardian.
Children also wait unnecessarily at detention centers like the 13 youths who were technically released from Cook County Detention Center in July, but had not been found placements through DCFS, Gomez told lawmakers.
“[Beyond medical necessity] is a really significant symptom because it’s such a severe restriction on a child’s civil rights to be kept at a hospital, but it’s a much bigger problem that we have in terms of meeting the needs of children with high-end needs in safe, appropriate placements in our state,” Gomez said.
Gomez told the story of “Alissa,” an 11-year old girl who had been hospitalized for psychiatric trauma, and who had faced a childhood of sexual abuse at the hands of caretakers and even a cab driver who had been contracted with DCFS to take her to school. Gomez said the girl “needed a placement 255 days ago,” but has remained hospitalized due to DCFS’ inability to find an appropriate placement.
“As children get older, every year counts so much when it comes to finding a placement for them,” Gomez said. “If you waste a year of a child’s life, it’s not only horrible for them but it makes it that much harder to heal them and get them placed in the future.”
The state has made the problem worse by reducing the amount of beds in residential treatment facilities under the banner of reducing costs and finding alternative care, Gomez told lawmakers.
“They’ve commended themselves for reducing reliance on residential care,” Gomez said. “There are 500 fewer beds…so now we have 300 kids [hospitalized beyond medical necessity] instead of 75.”
DCFS Director Beverly Walker, however, refuted part of the witnesses’ critiques of the agency’s direction on kids in psychiatric care, telling lawmakers on Tuesday that “placement is not treatment.”
“One of the reasons we’ve come to this fork in the road is that we had a big problem in Illinois with placements that weren’t appropriate for young people,” Walker said. “Out of that work, I believe we probably closed some placements but we did not do the adequate amount of work to replace what was closed. But some things needed to be closed.”
The issues is about more than just finding a placement for children in DCFS’ care, and said it is never the agency’s intention to just “leave young people in hospitals,” Walker said.
“This is about placement and treatment married to one another,” Walker said.
Walker said DCFS is working to ensure that every child within its care has a discharge plan within 10 days of admission to a hospital. The agency has also upped the number of beds in both residential treatment centers and at specialized foster care homes around the state, that children can be sent to post-treatment, Walker said.
Lawmakers also heard testimony about the extremely difficult choice some parents must make in order for their children to receive psychiatric health care, known as mental health lockouts. In a lockout situation, a parent gives up custody in order for their child to become a ward of the state, so the state is forced to provide the psychiatric care the parent could not access alone.
Carrie Overbey, chief clinical officer of Riveredge Hospital in the near west suburb of Forest Park, told lawmakers Tuesday that she is experienced in lockout situations, but State Rep. Sara Feigenholtz (D-Chicago) told Overbey she was concerned about losing kids “to the system.”
“Do you know how offensive it is to hear you say, ‘I know how to work a lockout?’” Feigenholtz asked Overbey.
Overbey replied that she meant no offense by describing her experience in helping parents navigate lockout situations.
“I mean the process of a lockout and the people and the involvement and the time is not something you learn when you’re hired to do a job,” Overbey said.
It’s estimated that a parent gives up custody of a child about once every four days in Illinois.