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New Rutland Mobile Response Teams Aim To Reduce ER Wait Times For Kids Seeking Mental Health Care

A man wearing a green shirt stands near a sign.
Nina Keck
/
VPR
Doug Norford, Director of Child and Family Services at Rutland Mental Health, hopes a new mobile response pilot program will help kids in crisis access mental health services and avoid trips to the Emergency Department.

During the height of the pandemic, hospital emergency departments in Vermont saw an alarming rise in young Vermonters seeking care for suicidal thoughts and self harming behaviors. According to the Department of Health, ED visits among females tripled, while they doubled for males.If you or someone you know is considering suicide, help is available.

Even before the pandemic, Vermont's Department of Mental Health was reporting a significant increase in children under 9 who were accessing crisis services through the state’s community mental health agencies. 

More from VPR: A New 988 National Suicide Prevention Lifeline (And Why It Changes How You'll Make Local Calls)

In response, the state approved initial funding for a two-year pilot program in Rutland, that advocates believe will provide a faster, more user-friendly way to help kids and families connect with area services and reduce costly stays in the emergency department. 

"We see numerous patients under the age of 18 come in seeking mental health treatment several times a day." - Sheena Daniell, Rutland Regional Medical Center

One a recent day, Sheena Daniell made her way through an emergency department hallway at Rutland Regional Medical Center. The place hummed with the sounds of electronic doors, heart monitors and constant conversation.

Daniell is nurse director of emergency services at RRMC.

“Unfortunately, it is common," she said. "We see numerous patients under the age of 18 come in seeking mental health treatment several times a day."

Daniell said some of those young people will need inpatient mental health treatment, and the Brattleboro Retreat is one of the few places that offers that kind of care.

“But a lot of times, beds aren’t available,” Daniell admits. When that happens, kids have to wait.

A woman wearing a green shirt and blue medical mask with glasses stands in a hospital desk area.
Credit Nina Keck / VPR
Sheena Daniell, Nurse Director of Emergency Services at Rutland Regional Medical Center says too often young people who enter the ED needing psychiatric services have to wait days for inpatient care.

Typically, they wait in one of six specially designed psychiatric rooms. “These are ligature free spaces, where there’s nothing a person can use to harm themselves with,” she explained.

They’re modern and clean, but the rooms are tiny and spartan, and she says the nearby hallways are almost always noisy. “It's not an ideal enviroment. And the things that these patients see while they’re in our ED sometimes can be pretty traumatizing to them,” Daniel continued.

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Sometimes a young patient may only have to wait 24 hours for a bed to open up in Brattleboro or in another facility out of state. But Daniell says that’s a best-case scenario.

“Our average is about three to four days. But we've had young patients here for over two weeks, waiting for inpatient treatment," she said. "And that is heartbreaking for our providers, for our staff and for the patient.”

"... We've had young patients here for over two weeks, waiting for inpatient treatment. And that is heartbreaking for our providers, for our staff and for the patient." - Sheena Daniell, Rutland Regional Medical Center

Doug Norford is director of child and family services at Rutland Mental Health, one of a network of  designated agencies in Vermont that provides community-based mental health services. He says not every child who’s brought to the emergency department needs inpatient psychiatric services; some parents just don’t know where else to go.

Norford thinks that’s when this new pilot program may be a game changer.

State lawmakers approved $600,000 to fund the first year. Rutland was chosen because according to state data, more kids with mental health needs visit Rutland’s emergency department, on average, than other hospitals in the state. 

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As part of the new program, Norford says they'll create three separate mobile response teams, each made up of a clinician and a case manager. 

"They'll be able meet with kids at home or at school or wherever works best."  he explains. Their goal, Norford said, is to help kids and their families, "Be they birth families, foster families or guardians. To be able to talk with a person who can provide some eyes on that child, can talk directly with the family, can explore some different strategies, can, you know, give the family hope. That's really, really huge."

"These new teams will interface with every branch of community and family services in the region, so this is a very significant new model of care." - Dick Courcelle, Rutland Mental Health

The teams will help families access psychiatric care, behavioral therapy and other services and they can provide follow up care.

Rutland Mental Health already has an emergency response team that can swoop in when needed. But Dick Courcelle, Rutland Mental Health’s executive director, says this will be different.

He says the goal of this new mobile response effort is to help children and adolescents before their emotional and behavioral difficulties escalate to a crisis.

More from Vermont Edition: Parenting During The Pandemic: Child Care, School And Isolation

“These new teams will interface with every branch of community and family services in the region, so this is a very significant new model of care," he said.

It’s a model that’s shown success in other states, like Texas, Arizona and Connecticut.

In King County, Wa., where Seattle is located, this type of effort diverted between 91% and 94% of hospital admissions between 2013 and 2015. Data compiled by the National Association of State Mental Health Program Directors shows that saved the state of Washington between $3.8 million and $7.5 million in hospital costs.

RRMC-Emergency-Door-vpr-keck-20210604_0.jpg
Credit Nina Keck / VPR
During the height of the pandemic, hospital emergency departments in Vermont saw an alarming rise in young Vermonters seeking care for suicidal thoughts and self harming behaviors. Rutland had the highest number on average of any hospital in the state.

Sheena Daniell says that at Rutland Regional Medical Center, any time a pediatric psych patient comes into the emergency department, a specially trained staff is assigned to stay with that patient, "to make sure they don’t have inappropriate interactions with other patients and to make sure they are safe at all times,” Daniell said. “So it requires 24/7, one-to-one staffing. And when we have several patients in the emergency department at one time, that puts a significant burden on staffing and obviously impacts costs.”

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In Rutland, a number of challenges still need to be worked out before this pilot program is launched, like how best to get the word out in the community that these teams will be available. Doug Norford says hiring seven or eight qualified staff members during the current worker shortage will also be daunting.

"It's such a necessary piece that we've really struggled with." - Doug Norford, Rutland Mental Health

Nonetheless, he, Dick Courcelle and Sheena Daniell believe the program will make a big difference and potentially serve as a model for the rest of the state.

“It's such a necessary piece that we've really struggled with,” Norford said. “To be able to help families when they need help, where they need help: I’m tremendously excited about it.”

If all goes as planned, he says they hope to launch the program this fall. 

Have questions, comments or tips? Send us a message or get in touch with reporter Nina Keck @NinaPKeck.

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