Hundreds of children in county custody — many with severe mental illness and other disabilities — are unable to access the care they need.
That’s according to a report by a workgroup of 17 county leaders across Pennsylvania.
Members of the County Commissioners Association of Pennsylvania analyzed data from 45 counties. They found 255 minors under county custody slept somewhere other than a licensed placement facility in the first half of 2023. For a total of 772 nights, minors slept in offices, hotels, cottages or hospitals.
The report also found 99 young people did not receive the mental health care they needed because hospitals they were taken to could not provide the level of care they needed, so they were discharged.
Complex cases involve minors in custody who are not able to access adequate treatment for their mental and physical needs. There are not enough places or specialized staff to handle the amount of complex cases, said Brian Bornman, executive director at Pennsylvania Children and Youth Administrators Association.
In some cases, treatment centers will decline to admit minors who have multiple conditions. For example, some might have a severe mental illness such as schizophrenia, or a serious medical condition such diabetes and require insulin injections.
“You have treatment facilities that could provide care for the mental health, but they’re reluctant to take on the liability of managing diabetes on top of that,” Bornman said.
The minors end up under county custody for a variety of reasons. Some are in the juvenile justice system. Others might have parents who were arrested or passed away.
In many cases, Bornman said, parents might have been too poor to access the care the child needs. When the condition reaches a crisis point and the child has to be taken to an emergency room, a doctor might recommend a treatment facility. Often, there aren’t available treatment facilities, so the child has to be discharged back to the parents.
“At that point, nothing has changed since the acute mental health conditions breakdown. The parents are unwilling to take the kids back because they haven’t gotten any kind of treatment, “ Bornman said. “And so they (the hospital) basically call Children and Youth and say ‘they abandoned their kid. We released them, they wouldn’t come pick them up.’ It’s an unfortunate situation, because it puts the parents in a very bad role.”
The report recommends the state create a “no eject/no reject program,” which would direct youth to safe transitional facilities if they were rejected by private providers. When children are unable to get a placement at a treatment facility, the responsibility of finding a placement falls on the county child welfare. This has resulted in children having to sleep in welfare offices or hotels.
Bornman said a “no eject/no reject program” could take the form of a regional facility that could house children from various counties. Some western Pennsylvania counties, such as Allegheny and Butler, pooled resources to provide a specialized program for youth unable to find placements. But for smaller, poorer counties struggling to find placement for youth with complex cases, there are too few of these cases to warrant the construction of an entire facility.
“They don’t have the volume to be able to contract for services,” Bornman said.
The report also recommends more county staff work with families and the creation of a statewide mental health resource navigation system for parents navigating the mental health system.
The Department of Human Services said in a statement that it is “aware that counties have immediate temporary shelter needs” and that sometimes in emergency situations, counties might have to find “very short-term housing.” while a county seeks adequate placements for minors with complex cases.
“This type of temporary housing is not licensed by the department, and in those cases, counties would be responsible for the child’s safety and this option should be used only as a short-term, last resort. We are in regular communication with counties to monitor needs and opportunities for collaboration to facilitate placements,” DHS said.
As part of the 2024-25 proposed budget, DHS said it hopes to invest $18 million to expand capacity in state-operated secure treatment units to help county-run detention facilities.
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