NEW LONDON — Funding and staffing shortages have left the entire eastern half of Connecticut without any intensive in-home mental health services for children, a void that industry professionals say is particularly damaging for elementary schoolers in need of help.
IICAPS, a program designed by the Yale Child Study Center that provides at-home therapy for children with psychiatric disorders, originally had two sites in eastern Connecticut — one at Natchaug Hospital in Willimantic and one at the Child and Family Agency in New London. Both are now shuttered.
Lisa Otto, director of the Child and Family Agency, told CT Examiner that the program had been running at a deficit for several years and was facing a workforce shortage.
“Combined with insufficient funding, our ability to increase salaries to the point that it would be a desirable job was becoming harder and harder,” Otto said.
The loss was particularly devastating for Sarah Arpin, a Norwich resident, whose now 6-year-old son began having behavioral problems at school when he was 4.
“When he started the school system, he had a really hard time regulating his emotions, sitting down and doing tasks. Their whole day revolved around fixing behaviors or doing coping skills, and he had no time to learn,” she said.
Her son ended up in the emergency room, and then in an in-patient program through the Joshua Center at Natchaug Hospital. But according to Arpin, her son was too young to sit in group settings, and he was eventually expelled from the program.
It was then that she found IICAPS. Clinicians in the IICAPS program visit a child’s home and work with children and their families up to six hours each week for about six months. Arpin accessed the program through the Child and Family Agency and she said it became a huge support.
IICAPS, she said, was present with her son at school, helped Arpin advocate for him during his special education team meetings. The program also held family sessions at Arpin’s home and offered parent sessions over Zoom.
“There was a time where I had to call an ambulance, and we had IICAPs here, and they were fully supportive the entire time,” she said. “They helped me through the mental health crisis my son was going through. They sat with me through the ambulance. They even went to visit him when he was waiting to be put [in] in-patient.”
IICAPS worked with Arpin’s family for about six months and, according to Arpin, they were considering an extension. But in December 2022, the program at the Child and Family Agency closed.
“It was very unfortunate, because I really loved them,” she said.
The loss of IICAPS means the region must find another way to serve the large number of families whose children need in-home services. But for many, the alternatives aren’t satisfactory.
Most of the children IICAPS serves have highly acute needs, with many ending up in the emergency room and nearly a quarter admitted to the hospital for psychiatric reasons. Sixty percent of the children are people of color, and about half said they had “adverse childhood experiences,” according to data from the program.
“Oftentimes, kids coming into the program have been in and out of the emergency room several times just before they came, are coming straight from the inpatient unit, are coming from residential. So there’s a lot of crisis in the beginning,” Victoria Stob, assistant clinical professor of social work at Yale and co-director of IICAPS, told the legislature’s Child/Adolescent Quality, Access and Policy subcommittee at a meeting in January.
Lack of alternatives
Stob told CT Examiner that IICAPS had closed three sites in the last two years, including a recent site in Hartford, and that other sites were in danger of closing.
During the subcommittee meeting, she noted that IICAPS had struggled to provide competitive salaries for retaining clinicians with a master’s degree, even with a 15 percent Medicaid rate increase that went into effect in January.
At the same time, the pandemic has increased the demand for the services. Before 2019, Stob said, the program averaged a waitlist of 100 to 200 families. But since 2020, that waitlist has steadily hovered around 500 families.
The children’s needs are also presenting challenges. Brittany Sanchez, director of outpatient services at the Child and Family Agency, told CT Examiner that she’s seen children coming in with more severe needs since the pandemic. Many were on the autism spectrum, and others came in with sensory challenges, anxiety trauma and behavioral issues.
Aimee Bliven, Child and Family’s program manager of outpatient services, said the children struggled to function in traditional classroom settings, and the teachers, preoccupied with a room full of elementary schoolers, didn’t know how to manage them.
“The teacher’s trying to get them to do something specific, and then they have a really tough time being able to follow through, and then they can’t follow through, and they start to lose it a little bit,” Bliven explained.
According to Otto, the IICAPS program in New London typically served 28 families at a time. In 2022, it was averaging a waitlist of 43 families, and 36 families were still on the waitlist when the program closed.
After the program shut down, some of the children on the waitlist were shifted to other programs like functional family therapy and multidimensional family therapy. But the additional need created backups in those programs as well.
Losing an in-home program with flexible scheduling also caused problems for families who struggled to transport their children to certain locations, or couldn’t commit to a set treatment schedule.
This was the case for Arpin, who has five children all under the age of 7.
“Me being able to get out to a place is kind of difficult with a family my size,” she said. “So to have a service that can come out and that can cater to somebody who doesn’t have the transportation means, or that can be in multiple places … was phenomenal.”
She also underscored the difficulty of finding adequate services for someone in her son’s age group.
Otto noted that other family therapy programs weren’t designed for children who had more severe mental health needs, and there was a particular void for children between the ages of 6 and 10 years old.
“If you have a kiddo that has acute psychiatric needs in that age range, there just aren’t great options,” Otto said.
‘We really do miss it’
After IICAPs shut down, Sanchez said some children were placed in group therapy settings at the agency, but were eventually kicked out because of aggressive behavior.
“They’re not great candidates for it,” Otto said. “They’re not kids who really can navigate a group successfully, or they have pretty intensive behaviors, or the intervention really needs to happen in the home.”
This left clinicians scrambling to offer a combination of services that would get children the help they needed. Otto said they tried increasing the children’s frequency in the outpatient program and getting psychiatrists involved in supporting them. But if their needs are more acute, she said, those children have to go elsewhere.
“They wind up making multiple [emergency department] visits, they wind up coming back to our Urgent Crisis Center more often, or they ultimately wind up being placed out of home,” Otto said.
Sanchez said the agency had to slow adult outpatient services to keep up with the children’s needs. And the extra pressure on mental health professionals increased the risk of people suffering from burnout and leaving the agency, she said.
“There’s just not an adequate number of staff providing that level of care for the degree of need in the community,” Otto said. “With a workforce that’s already really strained, serving the most acute families under the most difficult circumstances is just harder to hire for.”
Stob said if IICAPS wants to be sustainable, the program would need at least another 15 percent increase to the Medicaid rates, plus an annual cost-of-living adjustment. She said the Medicaid rate increases would allow a $10,000 to $15,000 salary hike to a master’s level clinician or counselor.
Stob said all families in crisis needed access to IICAPS, adding that they have looked into opening sites in New London and Windham County. But most agencies want to take a “wait and see” approach, she said.
“You wouldn’t want to onboard at a rate that is not going to be sustainable, especially with all the startup costs of introducing the model,” Stob explained.
Arpin’s son was recently released from Natchaug Hospital and accepted back into the Joshua Center. He’s also attending Green Valley School in North Franklin, a day school run by Natchaug Hospital for children with mental and behavioral health needs, something Arpin said her IICAPs clinicians helped her advocate for.
“We’ve seen so much improvement since he’s entered his behavioral school versus from where he was at before,” she said.
But if IICAPs returned to eastern Connecticut, Arpin said she’d be first on the list to sign up.
“I’m really hoping that they can just bring it back. It was a really big loss to us. We really do miss it,” she said.
This story has been updated with revised salary estimates provided by Victoria Stob