The Middletown Press (Middletown, CT)
‘A placement crisis’
Connecticut’s children’s hospitals have increasingly filled with kids who simply have nowhere else to go as DCF looks for new homes
Christina Ghio, Connecticut’s associate child advocate, reels off examples of kids in hospitals who shouldn’t have been there.
In late March, an 8year-old was brought in with a serious medical issue immediately following her removal from her home for child welfare reasons. When she was ready to be discharged from the hospital, however, the Department of Children and Families couldn’t find a foster home that could manage her medical needs, and nearly a month later she still hadn’t left.
Late last year, a 14-yearold on the autism spectrum was hospitalized for several months not for any medical reason but because her behavioral issues made it unsafe for her to be around other children. A 9-year-old, also on the autism spectrum, spent most of last year hospitalized before eventually being sent to a facility in Texas because DCF could find no appropriate home for her in Connecticut.
“There were no placements for her in Connecticut,” Ghio said. “There was just nothing that could meet her needs.”
In recent years, Connecticut’s children’s hospitals have increasingly filled with kids who simply have nowhere else to go. In many cases, this means children spend days or weeks in the emergency room due to a lack of in-patient or out-patient services they need. In other cases, though, it happens because kids require foster care and DCF can’t find a place to send them.
Carl Schiessl, senior director of regulatory advocacy at Connecticut Hospital Association, says this occurs more than you might think. At any given time, he said, it’s likely a child in Connecticut is sitting in a hospital waiting for a DCF placement.
“The hospital emergency department becomes the de facto emergency placement,” he said. “It’s almost its own separate level of care.”
In an recent interview, DCF officials said they don’t have data on how many kids become stuck in emergency rooms or are admitted to hospitals as they await foster care or group home placements but that this happens only in “unique cases” when a child has particular challenges that make placements difficult.
Commissioner Jodi Hill-Lilly said the issue is part of a nationwide “placement crisis” exacerbated by the COVID pandemic, when many children experienced increased behavioral health needs.
“The system is trying its hardest to catch up to the emergent needs,” Hill-Lilly said. “We are we are working as fast as we can, partnering with as many sister agencies and our
providers as as much as we can to address this issue.”
The broader problem of kids lingering in emergency rooms awaiting discharge for one reason or other has been well-documented. In 2023 alone, state data shows, more than 1,500 children on Medicaid were “stuck” in the emergency room, meaning they remained there at least eight hours past when they no longer needed emergency treatment. On average, these kids spent 3.1 days in the ER, the data shows.
Advocates and hospital administrators fear this issue may worsen if the state doesn’t do more to support the behavioral health system. They often cite low Medicaid reimbursement rates, which
have driven some providers to shutter key services, including a popular inhome treatment program known as IICAPS.
While children are hospitalized awaiting a DCF placement, Schiessl said, staff may try to engage them in activities or take them on walks around hospital grounds. Mostly, though, they’re spending day after day in their rooms, waiting for somewhere to go.
“I was waiting for discharge once after a procedure, and I had to wait a day to leave, and I couldn’t stand being in there for a day,” Schiessl said. I couldn’t imagine a 13-yearold having to spend two weeks waiting for discharge.”
In a perfect world, Schiessl said, DCF might offer emergency placements for kids with nowhere to go. Absent that, he said, hospitals become
responsible for children’s non-medical needs.
“It becomes incumbent on the hospital to try to help that family and get the home supports they need or try to find a group home,” he said. “And that can be difficult.”
At Connecticut Children’s, one of the state’s largest youth hospitals, kids wait for placements either in the emergency room or in a hospital bed, depending whether or not they came in with medical needs, said Howard Sovronsky, the facility’s chief behavioral health officer.
Sovronsky said addressing the issue statewide would require “expanding the foster care resources, particularly for kids who are challenged.”
Asked what DCF was doing to reduce the number of kids in hospitals waiting for patients, officials pointed to established kids mental health
initiatives such as urgent crisis centers and subacute crisis beds.
“We’re trying to make strategic investments as much as possible,” said Michael Williams, the agency’s deputy commissioner.
Ghio, from the Office of the Child Advocate said she’d like to see the state do more. As she sees, lawmakers and stakeholders need to “step back and do a better job understanding of exactly what the needs are” — and design a continuum of care accordingly.
“We need an adequate number of foster homes available for children when they need to be placed in foster care, we need adequate in-home services to serve children home so they don’t get to such a crisis level that they need higher levels of care, and we need the higher levels of care,” Ghio said.