Children and Youth in Crisis Weathering the Storms of Mental Disorders

Conclusions 13

• CL1
  The SAFTY mobile crisis workers do not write 5585 holds in a timely manner because they lack authority to do so without first consulting a supervisor.
• CL2
  The Department of Behavioral Wellness does not keep readily accessible data on the numbers of children on 5585 holds hospitalized out of County, where they are sent, their length of stay in each facility, and the cost of their treatment.
• CL3
  There are no Crisis Stabilization Units for children and youth in Santa Barbara County as an alternative to out-of-county hospitalizations.
• CL4
  There are no licensed Temporary Shelter Care Facilities for children and youth in Santa Barbara County as an alternative to out-of-county hospitalizations.
• CL5
  The crisis call-in phone service and mobile crisis staff of both the contracted provider SAFTY and the Department of Behavioral Wellness’ ACCESS 24/7 Mobile Crisis teams often do not respond to the scene of a crisis or return phone calls in a timely manner.
• CL6
  The Children’s Triage Program staff interacts with children and youth in crisis and their families in the Emergency Rooms and works to ensure community re-integration and linkage to behavioral health services upon discharge from the ER or psychiatric hospitals.
• CL7
  On-line, comprehensive information on mental health services, community supports and resources for children and youth who are experiencing a crisis in Santa Barbara County is not readily available on a central website.
• CL8
  Disagree Wholly, with an explanation
• CL9
  Disagree Partially, with an explanation Responses to Recommendations shall be one of the following:
• CL10
  Has been implemented, with a brief summary of the implemented actions
• CL11
  Will be implemented, with an implementation schedule
• CL12
  Requires further analysis, with an explanation and the scope and parameters of an analysis or study, and a completion date that is not more than 6 months after the issuance of this report 2018-19 Santa Barbara County Grand Jury 9
• CL13
  Will not be implemented because it is not warranted or is not reasonable, with an explanation REQUIRED RESPONSES: Santa Barbara County Board of Supervisors – 90 Days Findings and Recommendations 1, 2, 3a, 3b, 4, 5, 6a, 6b, 6c, 7 2018-19 Santa Barbara County Grand Jury 10

Observations 1

• OB1
  Throughout the County, resources are available that offer information, education, and coping skills, such as the YouthWell Coalition, Family Service Agency, peer and parents’ support groups, and off-campus and school-based programs, such as Signs of Suicide. Despite the available community resources and efforts at crisis prevention, many people throughout the County are unaware of them. Thus, the first step that most families or caregivers usually take when their child is in crisis is either to call 911 or go to the closest Emergency Room (ER). However, many ERs “are not equipped to provide the calming and therapeutic environment needed to manage behavioral health crises.”7 When a child is in crisis, SAFTY offers a crisis hotline (1-888-334-2777) from 8 a.m. to 8 p.m. seven days a week. In response, staff first attempts to resolve the crisis on the phone. If a crisis demands more, a SAFTY counselor may be dispatched to the scene for a face-to-face, in-depth assessment and evaluation. After SAFTY hours, the DBW 24/7 ACCESS (1-888-868-1649) line staff takes over. 7 www.archive.mhsoac.ca.gov. Overview of Crisis Stabilization Services: California, February 26, 2015, last visited A p r i l 1 5 , 2 0 1 9 . 2018-19 Santa Barbara County Grand Jury 4 In late 2018, a Co-Response Team8 consisting of a DBW crisis worker and a county deputy sheriff who has received Crisis Intervention Training became available to respond and resolve crises in the southern part of the County. The Jury learned that mental health workers value the safety of this approach. Although this program may be in jeopardy of being eliminated, program funding discussions are ongoing. During interviews with professionals, they stated that the Co-Response team can often reduce the time required to contain the crisis. Recently, the Jury was told that the Co-Response team approach may be expanded to include the City of Santa Barbara Police Department. Once the DBW response system is activated and the child in crisis is assessed and evaluated, there are several options for action. One is that the crisis is contained in the least restrictive way and the child safely remains at home or may be sheltered in another secure setting. The most restrictive option is for the crisis evaluator to write a California Welfare and Institutions Code §5585.50 hold that allows for an involuntary detainment of a minor in a psychiatric facility for up to 72 hours. The legal criteria for a 5585 hold are danger to self, danger to others, or gravely disabled. Under this code, a gravely disabled minor is “unable to use the elements of life that are essential to health, safety, and development, including food, clothing, and shelter, even though provided to the minor by others.”9 If a 5585 hold is instituted, the child must be transported by ambulance to an ER to be medically cleared before being accepted into an appropriate inpatient facility. At the ER, the attending psychiatrist, if certified to do so, may rescind the hold. However, if the 5585 hold is instituted, a psychiatric bed must be located. All children’s psychiatric hospitals are located out of County. If beds are available, children are transferred to Aurora Vista del Mar Hospital in Ventura. However, if not available, some children are transported as far away as San Francisco and San Diego. There is competition among California counties for these psychiatric beds. The Jury was unable to learn how many children have been sent to inpatient psychiatric facilities in recent years because it was told DBW does not have a computerized data record in place to track all 5585 holds and subsequent hospitalizations out of County, including the length of stay. The Jury interviewed parents of children who had been psychiatrically hospitalized out of County. The stressors for children, parents and caregivers included the long distance from home and the difficulty communicating with both the child in the hospital and medical professionals attending to the child. The uncertainties of discharge planning added to the stress. Some of these stressors might have been alleviated if crisis respite shelters had been available locally. In the past, delays occurred when certified crisis workers were called to the ER to evaluate the child and determine if a 5585 hold was required. Recently, a new program has been implemented to mitigate some of these ER delays. Licensed psychiatrists at local hospitals are now certified to write or rescind 5585 holds. This new protocol is designed to expedite the process of getting the child to an inpatient psychiatric facility through a written 5585 hold, or to resolve the crisis, rescind the hold and permit the child to return home. 8 C a l i f o r n i a W e l f a r e a n d I n s t i t u t i o n s Code §s5t585.25 www.sbsheriff.org. Sheriff’s Roundup, 1 Quarter 2019 9 2018-19 Santa Barbara County Grand Jury 5 In 2018, DBW was awarded a grant by the Mental Health Services Oversight and Accountability Commission of $800,000 to improve mental health services for children in crisis.10 This grant provides funding for the creation of two hospital-based Children’s Triage Program teams located in North and South County, each consists of a licensed clinician and a parent partner. At the time of this report, only the triage team at Marian Regional Medical Center in Santa Maria is in operation. The goal of the Children’s Triage Program is to assess the nature and severity of the mental health crisis, determine what treatment options best meet the needs of the child, and provide support and information to the parents and caregivers who are also present in the emergency room. The licensed practitioner and parent partner will work closely with the hospital staff, the child and the caregivers to de-escalate the crisis, develop safety plans and, if possible, rescind the hold. Additionally, the Children’s Triage Program team members will follow up to ensure effective community re-integration for children upon discharge, including assistance navigating the mental health system and providing linkages to services and supports. SAFTY also provides follow up, aftercare, referrals and linkage to mental health services in the community regardless of the child’s or caregiver’s health insurance. The Jury became aware of perceived difficulties in the delivery of current DBW crisis services. This systemic issue revolves around the need to respond in a timely and efficient way, in keeping with the important MHSA goal of “timely access to needed help, including in times of crisis.” The Jury received several reports that crisis calls made to both SAFTY and the DBW 24/7 ACCESS Team are not always answered or returned promptly and there are often long wait times for the on-scene arrival of SAFTY crisis workers or no on-scene responses at all. Some interviewees also mentioned SAFTY personnel often cannot write a 5585 hold without consulting their supervisor which causes an unacceptable delay in de-escalating the crisis. In fact, the Jury learned that SAFTY workers are no longer allowed to work in the Cottage ERs and UCSB medical services for this reason. DBW has allocated considerable resources to provide crisis facilities for adults in the County, but not for children. The continuum of care for adults in crisis ranges from the most restrictive to the least restrictive setting. The most restrictive setting is the Psychiatric Health Facility, a 16-bed locked unit which accepts individuals 18 and older who have been placed on a 5150 involuntary hold, the adult equivalent of a 5585 hold. DBW also operates a Crisis Stabilization Unit (CSU), which offers adults an alternative to in-patient hospitalization, where they can stay up to 23 hours and receive evaluation, treatment, medications, and aftercare referrals. The DBW also contracts with outside providers to ensure those adults who require longer stabilization times can be placed in two crisis residential facilities in the County. At the present time, there is no CSU, acute psychiatric hospital, licensed crisis residential, Temporary Shelter Care Facility (TSCF)11 or any other crisis respite shelter for children and youth in the County. The Jury was informed that DBW determined a CSU facility for children and youth mhsoac.ca.gov. Triage Grant Awards, April 26, 2018, last visited May 23, 2019 10 www. 11 www.cdss.ca.gov/inforesources/Continuum-of-Care-Reform/Temporary-Shelter-Care-Facilities last visited May 30, 2019 2018-19 Santa Barbara County Grand Jury 6 only would not be economically feasible. However, the Jury learned that DBW is exploring the possibility of establishing a licensed CSU that can accommodate adults, children and youth in the Santa Maria area where there is facility availability. There is another type of shelter that can provide safety and security for children in crisis. A licensed Temporary Shelter Care Facility is owned and operated by a county or on behalf of a county by a private, nonprofit agency and provides 24-hour non-medical care for up to 10 calendar days for children and youth under 18 years of age. TSCFs are safe and supportive places for recovery when more care is required than can be provided at home.

Agency Responses 1

Government agencies' official responses to this report's findings and recommendations. Click on a response to see the structured breakdown.