When Tricia Ellinger adopted Matthew, her oldest son, at age 2, she never thought that at age 8 he would be living half a continent away from their home in Emmett.
Ellinger is a single mother who adopted Matthew and his two siblings. Matthew’s biological mother had used drugs up until she was several months pregnant with him. The children’s parents were later jailed because of drug use, Ellinger said.
When Matthew came into Ellinger’s care, she immediately sought mental health services for him. They saw a child-parent interaction therapist, a child psychiatrist and an attachment therapist.
But Matthew started to become violent with his siblings and family pets by age 5. He killed a kitten and tried to harm his younger brother and sister.
Matthew has a wide array of diagnoses now: reactive attachment disorder, attention deficit hyperactivity disorder (known as ADHD), explosive behavior disorder, disruptive behavior disorder, serious emotional disturbance and mild intellectual disability.
After years of trying to find help in Idaho’s mental and behavioral health systems, Ellinger made the decision this summer for Matthew to receive residential psychiatric treatment in Little Rock, Arkansas — 1,803 miles from home. After applying for residential treatment through Medicaid, she said the treatment center in Little Rock was one of few in the nation that could help her son’s specific needs.
Hundreds of beleaguered parents of children with serious emotional and mental health needs have found that Idaho has no place for their children to go for residential psychiatric care, so the only options are out of state.
Between 25 and 30 new applications for such care are filed each month in Idaho, said Ross Edmunds, administrator at the Idaho Department of Health and Welfare’s Division of Behavioral Health. And about 100 children are in residential facilities now, he said.
Demand for those services has surged in recent years, Edmunds said. That is likely due to Idaho’s population growth, as well as better recognition of mental illness and the treatment options available, he said.
Edmunds said it should be “a last resort” to place a child in a facility far away from home. But it is necessary in some cases.
Residential treatment ‘a long-term goal’
Idaho has only one psychiatric residential treatment facility for children. It’s in Idaho Falls. The other 35 facilities that can take Idaho patients are in other states.
A psychiatric residential facility isn’t just a place where patients spend time getting therapy and medications. It is a special type of non-hospital facility that contracts with Medicaid to provide inpatient care to patients younger than 21.
With only one such facility in Idaho, families are forced to send their children elsewhere. While no parent wants a child to be far from home, many say it is often the best thing for their sons or daughters, and their families.
The treatment isn’t permanent, though, spanning from a few months to years, depending on the needs of the child.
But when a child is ready to return to Idaho, some parents say gaps in step-down services, which transition the child from psychiatric residential treatment to in-home or community-based treatments, can lead to children returning to the out-of-state facility or to a crisis for the family.
“It takes a wide expertise of mental health services and a wide range of provider expertise to really have what you need within your state,” Ruth York, executive director of the Idaho Federation of Families for Children’s Mental Health, said in a phone interview. “This is definitely a long-term goal that is being worked on.”
Journey to mental health
Like Ellinger, many parents want to be proactive about getting their children access to mental health care. Beginning to find help, however, can be a challenge.
Laura Wallis has a story about that. Wallis is director of operations for the Idaho Parent Network for Children’s Mental Health, which acts as a liaison among families, providers and the state. She says that when she first tried to communicate her son’s symptoms to his pediatrician, he ignored her and suggested that she was the problem.
Her son later received psychiatric residential treatment out of state.
Many parents seeking mental health resources for their children feel completely alone. Some people tell them their children just need to be more active. Others blame the parents. Some people don’t believe the child’s symptoms are a real health concern.
“Everyone tries to find a reason that it’s not the kid who has a medical condition, but it’s some outside thing,” Wallis said in a phone interview. “So the very first thing that many, many families find is that either no one believes them, or no one wants to get involved.”
Even if they push through the stigma and misconceptions surrounding mental health, many parents say Idaho’s system is reactive, not proactive.
The state still struggles to find mental health professionals to fill jobs, and it is difficult for existing facilities to meet the standards required for Medicaid to fund treatment.
The state of mental health in Idaho
Families that receive Medicaid are generally the least able to afford intensive mental health care for their children. And unlike much private health insurance, Medicaid covers that care. For Medicaid to pay for residential treatment, however, the child must be placed in a certified psychiatric residential treatment facility.
Teton Peaks Residential Treatment Center in Idaho Falls is the sole such facility in the Gem State; it is run by the Eastern Idaho Regional Medical Center. Only girls ages 12-18 can receive treatment at Teton Peaks, which means that boys and younger children have no options other than going out of state.
Wallis said it can take more than three years to license a facility, and because most private insurance won’t cover residential care to the needed extent, it becomes nearly impossible to open new centers in Idaho.
That doesn’t mean the state isn’t trying. Edmunds said the department is working with existing facilities in hopes of turning some into nationally accredited operations that meet Medicaid’s requirements.
“We’re constantly trying to do that because we recognize … what’s better for the kids and the family,” Edmunds said. “It is better for kids and families if we can keep them in-state and closer to home, or as close to home as possible.”
Four Idaho hospitals provide inpatient psychiatric hospitalization for children. That treatment, however, is usually limited to five to 10 days — not nearly long enough for some children to return home safely. Saint Alphonsus Regional Medical Center in Boise provides services for children 12 and younger. Intermountain Hospital, also in Boise, cares for adolescents. The other hospitals are in Idaho Falls and Coeur d’Alene.
Jen Griffis’ family has accessed different residential treatments out of state for her daughter over the past seven years.
Once, when her daughter was discharged from treatment and able to come home, she needed to go back into residential treatment after six months because she did not have step-down care where they live, in Grangeville.
After a child has received care in a psychiatric residential treatment facility, the next step to transition home is often to go to a less-intensive treatment center or a group home.
Idaho offers some of these step-down resources but not all of them.
“You really have to look at us needing more resources on a spectrum of intensity,” Griffis said in a phone interview. “I don’t believe the system benefits families when they put children in residential treatment without solid community resources and a transition plan home.”
Edmunds said he knows children sometimes need transitional care to readjust. Sometimes the child’s illness put tremendous stress on the family, and the family needs help to adjust, too.
“You just can’t find a one-size-fits-all,” he said.
Ellinger worries that the detachment from family while her son is out of state will forever alter their relationship and family dynamic. Matthew already had challenges with bonding and attachment, and she worries they will get worse. And what will happen if he returns to Emmett, where there is little help, or if he ages out of the treatment center or the system as a whole?
“For six years of our life, I’ve sacrificed everything to help him,” she said. “I was forced to place him in residential knowing that at 8 years old, it may be something we can never recover from.”
Lawsuit forced an overhaul
Idaho’s mental health system for children is undergoing major changes because of the introduction of Youth Empowerment Services, or YES. Some parents think the project is a fantastic start because its focus is on community-based services.
The services are a result of a yearslong lawsuit: the Jeff D. class action lawsuit. The lawsuit began in 1980. At the time, children were integrated with adults at State Hospital South. There weren’t appropriate treatment and education services for children.
Griffis said there has been a shift from a mindset that forced the child to fit the system, to a mindset that makes the system work for the child and family based on their specific needs.
Now, the Idaho Department of Health and Welfare, State Department of Education and Idaho Department of Juvenile Corrections have worked together to build a new system that “communicates a child’s treatment goals between providers and agencies to reduce duplicated effort and conflicting treatment plans,” according to the YES website.
“If those are put into place effectively, those are huge steps to getting to that point where it can fill that gap,” Griffis said.
The goal of YES is to strengthen the mental health care system in Idaho, but that takes time, funding and professionals.
York, the Idaho Federation of Families for Children’s Mental Health leader, said one component that’s weak right now, but is set to be improved, is intensive home-based community services. A child would be able to receive intensive services closer to home.
“If we’d gotten (those services) in the home or community early enough, we probably would have prevented the various crises that resulted in needing a residential place out of state,” York said. “But not always. There are always going to be times where it’s just not safe for the child and family to share the same place.”
While YES is a start, many parents think there needs to be a dynamic cultural shift to change the children’s mental health system in Idaho.
Parents have said they want to see incentives for professionals to help build the system; they want to see a more proactive approach when it comes to treating children’s mental health needs; and they want to be heard and recognized, not ignored.
“Rome wasn’t built in a day. We’re building something much bigger than Rome,” Wallis said. “Rome was buildings. These are lives. It’s a cultural change we are making, and Idaho is in a position to be amazing.”
Statesman reporter Audrey Dutton contributed.