State’s One-Size-Fits-All Philosophy a Poor Fit For Serious Mental Health Needs

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The abuse started when he was six. 

She was kicked in the face so hard, by her own son, that she almost passed out. He broke doors in the house, exhibited outbursts in kindergarten. At one point, Anne said, he attacked her with a shovel. 

She adopted her youngest child, Joseph, at the age of two. He has since been diagnosed with Reactive Attachment Disorder, a psychological disorder manifested in violent tantrums, an inability to emotionally connect with family members, and a lack of remorse or regret. 

By his mother’s account, she has tried everything to get Joseph the treatment he needs, but after a number of stays in hospital psychiatric centers, temporary stays at inpatient facilities, outpatient services and at-home services, he still acted out violently. He has also attempted to hurt his siblings. 

Eventually, Anne decided he was too dangerous to bring home.

“I have a child who is ‘cutting.’ I have another child sleeping with a bat in their bed,” she said. 

That was when the Department of Children and Families stepped in. 

Joseph was placed in foster care. And the department submitted a petition to juvenile court alleging that Anne had neglected Joseph. 

Advocates, attorneys and parents who spoke with CT Examiner pointed to the practice of charging parents like Anne with neglect as one of many problems with Connecticut’s approach to children with serious mental health needs — problems aggravated by a woefully underfunded system plagued with staffing shortages, a one-size-fits-all philosophy that doesn’t take into account individual needs and an opaque system that denies – without justification or a process for appeal – requests for higher-level care.

In late 2020, Joseph was admitted individually to several hospitals, generally for physical aggression, and placed in the Joshua Center, an intensive outpatient program providing individual and group therapy for children. 

In early 2021, he returned to the psychiatric center at St. Francis after becoming physically violent and punching holes in the walls, according to notes kept by the family’s attorney. 

Reactive Attachment Disorder is a fairly rare disorder, — although exact data is scarce, a few studies have estimated the prevalence at between 1 and 2 percent of the general population. 

But its implications are tremendous — the children diagnosed with the disorder typically have complex behavioral health needs. Laura Langston, a Licensed Marriage and Family Therapist who specializes in early life trauma, told CT Examiner that these children typically never received the touch or the interaction with a mother or caregiver that most babies receive as infants. And as a result, as these children grow older they are unable to connect with the people around them, and often abuse or manipulate other members of their families.

For these children, Langston said, connection takes the form of outbursts of yelling and breaking things. 

“They really are loving children,” said Langston, “but they don’t know how to do relationships.”

Such children typically also are given a number of additional diagnoses, and are prescribed multiple medications.

Joseph, for example, has been diagnosed with ADHD and Intermittent Explosive Disorder and has a low IQ. He has hit a sibling with a yardstick, and yanked a sibling out of a hammock. According to Anne, he could also be charming, but during the COVID pandemic, when Joseph could not leave the house, his behavior grew significantly worse. 

“We reached a point where it was a good day if only things were broken in the house and no one was hurt,” she said. 

Anne told CT Examiner that after her son was discharged from the Joshua Center, the hospital had recommended intensive in-home services (a program called IICAPS) but her insurance refused to pay for it. The Department of Children and Families, which had investigated her family twice after receiving reports from her son’s school district (the case was closed both times) referred Anne to Voluntary Managed Care, run by the company Carelon, a division of the insurance company Elevance, which contracts with three agencies in the state of Connecticut. For families like Anne’s, Carelon can be a last resort when trying to get payment for mental health treatment.  

Anne said she asked Carelon to approve a short-term stay for her son at a residential psychiatric facility — known as a PRTF. 

But her request was denied. 

By Anne’s account, a doctor present at the meeting told her that Carelon had only once before approved a stay at a PRTF. 

Dr. Ross Porter, the family’s pediatrician, told CT Examiner he remembered the meeting with Carelon. Aware of the family’s situation, he had been sending meals to the family once a week. He told Anne to document everything that happened in the home. 

So, when Carelon told the family that the agency would not approve a PRTF, Porter said he lost his temper. 

“I think [that was] where I finally blew my gasket, [and] said, ‘Fine, get me the form. I’ll fill it out if you want.’” he told CT Examiner. “I couldn’t understand it.” 

In May 2021, with a recommendation from Porter, Anne’s son did finally get approval for Eagle House, a part-time residential facility at the Village of Children and Families. Anne said that an “angel” who worked for the insurance company managed to convince his superiors to approve her child’s care. After the private insurers approved the initial payment, she said, Voluntary Care agreed to continue covering Joseph’s time at the facility when the insurers decided it was no longer necessary. 

Goetz told CT Examiner that the agency does require that families complete lower levels of intervention, like in-home services or services within the community, before Carelon will step in to help pay for treatment. It’s part of being “good stewards” of the public’s dollars allocated to Carelon, she said. 

But advocates and medical providers criticized the requirement to run children through lower-level services when it is clear that they need something more.  

“More aggressive diagnosis earlier, more aggressive treatment earlier, more aggressive listening to the families and therapies would’ve been ideal, with a goal that — let’s see what we can do over x amount of time with a really intense program,” said Porter. 

By September 2021, Anne said, the Village and the insurance were both advocating that her son be discharged. The program is intended only as a short-term placement. 

But Anne believed that the alternative, to bring Joseph back home, was too dangerous. In addition to physical violence directed toward her, she said that Joseph was also making the house unsafe for her other children. She described her home as a “lockdown unit” partially remodeled so that her other children would be able to separate themselves from the violence when her son started to rage. 

This time, Anne called the Department of Children and Families herself. She said she would not pick her son up from Eagle House. In response, the department charged her with neglect. 

“This child is not neglected. This child is severely mentally ill. And we’ve done everything in the power of God that we can for him,” Anne said. 

But according to Ken Mysogland, bureau chief of external affairs for the Department of Children and Families, the department had met with behavioral health providers who had worked with Anne’s family. Mysogland said the behavioral health providers had advised the department that Joseph could receive the services he needed at home. Anne disagreed. 

At that point, Mysogland said, the department had to step in. 

“If the parent is not in agreement to utilize the supports that the clinicians are indicating is best for their child to safely remain in their home, the department has no choice but to obtain a court order, because that child does not have a family where they can reside,” he said. 

Anne told CT Examiner that the providers recommending in-home services worked with Carelon. But she also said that despite her difficulties with DCF, the people in the department who had worked with her, especially her case worker, treated her “with dignity and kindness.” 

“They understood that we were in an impossible situation and the system isn’t designed to deal with it,” Anne told CT Examiner. 

Three months after she called DCF and reported herself for neglect, Joseph was still at Eagle House, and was typically restrained twice daily. In May 2022, her son was placed in a therapeutic foster care home where he has remained since. 

Joseph’s current foster mother told CT Examiner that it’s hard to say if Joseph could have stayed with Anne under any circumstances. She said that when Joseph arrived at her home, he was good for the first few months, but then said he started exhibiting similar behaviors to what Anne has described — aggression, breaking things, running away, even attempting to jump out of a window. 

The current foster mother said that after receiving extensive services through JRI, the Village and the LEO clinic in Hartford, Joseph has improved significantly  and was learning to self-soothe in difficult situations.  

The neglect allegation filed against Anne was ultimately changed to a finding of neglect based on the child having specialized needs that the parent could not meet in the home. 

In late summer, Anne had her parental rights terminated. 

“It’s always going to be the biggest sorrow of my life,” she said. “I have very few friends now because you become isolated … I’m on antidepressants. I’m very close to losing my faith, which was extremely important in my life — in all of our lives.” 


Emilia Otte

Emilia Otte covers health and education for the Connecticut Examiner. In 2022 Otte was awarded "Rookie of the Year," by the New England Newspaper & Press Association.

e.otte@ctexaminer.com