4 facilities, 12 months: For one child needing complex mental health care, there’s no end in sight

Published: Aug. 13, 2020 at 10:25 PM CDT
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WAUSAU, Wis. (WSAW) - Since eight years old, Francisco (“Frankie”) Martinez has spent much of his time in and out of treatment facilities for an array of severe mental health disorders.

If he could snap his fingers and change his life, Frankie says he’d want to stay with his family in Mosinee, Wisconsin. Instead, he’ll be on a flight to Utah next month, on his way to the fourth facility (and third long-term treatment center) to admit him in a year. Diagnosed with an array of severe mental health issues including intermittent explosive disorder and PTSD, he’s been through eight long term facilities in as many years; his crisis stays are innumerable.

Since before his birth, his adopted mother Sherry says the cards were stacked against him and his brother. (The family adopted five children in total; all have special needs.) He was born addicted to methamphetamine and cocaine, she says; his entry into Hawaii’s foster care system was nearly parallel to his entry into the world.

He came to the Martinez family when he was almost two years old. He’d been sexually abused before he could speak. By seven years old, his adopted family couldn’t handle the aggression and sexual behaviors, and he had his first residential treatment stay. Some have lasted longer than others in the years since, but the average is nine months before he’s on to the next.

“He would break doors, he would break windows, he would throw rocks on us at our cars,” Sherry said. “As he got older, the aggression built more and more and more, and we could never really get a handle on his behaviors.”

Now sixteen, he was discharged in the past year from Minnesota’s Mille Lacs Academy after an incident where three staffers ended in the hospital. Brought home to Marathon County, he was housed temporarily in their juvenile shelter facility before the county found him placement at Iowa’s Woodward Academy, before Sherry removed him after what she believed were unsuitable conditions and incomplete COVID-19 protocols. He’ll head to Utah next.

“Wisconsin just doesn’t have any placements for him,” she said, adding that he’s been rejected from all of the eligible facilities out of Wisconsin’s 19 residential care centers for youth.

Frankie’s plight in need of out of state care is similar to scores of children over the years in Wisconsin, sent to states hundreds of miles away in search of a long term residential care center (RCC) that can provide the level of treatment needed to cope with complex mental health needs. In 2015, the Wisconsin Department of Children and Families (DCF) recorded a point-in-time count of 16 children sent out of state to residential care centers. Every year since that number has increased; in 2019, a point-in-time count showed 60 children out of state in treatment centers.

“I’ve had three of my kids go out of state for placement because Wisconsin cannot provide placement for my kids,” Sherry said.

The trend runs counter to what the DCF and county social services departments in Wisconsin consider best practices for mental health needs, which is to keep children near or within their homes and communities for treatment. The federal Family First Prevention Services Act of 2017 will reinforce that nationwide once fully implemented, a law that prioritizes funding away from group homes and toward home- and community-based care for children in the system.

“The small number of children out of state...represents a group of children that need something that we don’t have to offer here,” noted Wendy Henderson, administrator for the DCF’s Division of Safety and Permanence and responsible for overseeing the state’s RCCs. “That’s important for us to acknowledge.”

A push away from residential treatment centers and toward family and community-based treatment nationwide came in the wake of them being overused, Kari Sisson explained. The executive director of the Association of Children’s Residential Centers, she says that a focus on specialized care might mean placements farther away, and if the placement meets their needs, it’s not necessarily bad. But in the transition away from an emphasis on residential treatment, some states may have gone too far, too quickly.

“Some states are experiencing that they don’t have the facilities to meet the needs of the kids,” Sisson noted.

In Marathon County, it wasn’t until four years ago that any juvenile had to be sent out of the state for treatment needs--a county that has more local treatment options than most in rural Wisconsin.

“We are seeing more and more youth with mental health needs that cannot be met locally,” Marathon County Social Services’ Becky Bogan noted. From the county, a few children now over the past few years have been sent to Tennessee, New Hampshire and Iowa for long term treatment care once less-restrictive and local options have been exhausted. The goal is typically at least a year in a facility like that, Bogan said, but the objective is always to bring them back, in keeping with nationwide standards of mental health treatment for youth.

“Reunification is always the goal of any out-of-home placement. We want to get those youth back home.”

The Martinez family moved to Mosinee four years ago. In the fall of 2019, Frankie was in Minnesota’s Mille Lac academy when he broke a staff member’s wrist and landed three employees in the hospital. He was found incompetent to stand trial due to the mental health diagnoses, something his mother takes issue with: she believes he needs to be under correctional orders that would pave the way to a stay in the state’s psychiatric hospital, Mendota Mental Health Institute. Operated by the Wisconsin Department of Health Services, the hospital has been used only for criminal patients since 2014. For male juveniles, MMHI is the state’s psychiatric hospital for youth already under correctional orders placed in Lincoln Hills, the state’s only youth prison

“Every facility that he’s been in for the last five years has told me he needs…a secure mental health facility like MMHI,” Sherry said.

MMHI is legally not an option, and a change that would admit non-criminal youth into the facility would require legislative change and a fundamental shift away from widely accepted research for the treatment of youth with mental health issues.

Sisson noted that the goal of psychiatric hospitals is always stabilization, not long term stays for children in need of mental health treatment.

“At some point when you have a really complex kid like that, the onus is on the state to find a program that can serve him and find a contract that can help them,” Sisson said. “The goal is to provide intensive treatments and family involvement to return them to their home and their community...the goal should always be permanency.”

Wisconsin doesn’t have designated psychiatric residential treatment facilities, Wendy Henderson explained, a designation that comes with locked units and would require consideration from the state legislature to change. At Youth Villages in Tennessee, a frequent destination for Wisconsin children, the state allows the use of cameras and locked rooms.

“That’s something that we don’t do here for kids that are not incarcerated,” Henderson said, adding that any changes to that policy would need serious discussion about whether it was indeed wanted--and a legislative act to change.

Experts with a background in counseling juveniles diagnosed with aggressive or explosive disorders point to lack of funding for the treatment centers and advanced training needed to effectively provide children with treatment that produces long term results, a need that has only increased in recent years. At The Centre for Well-Being in Wausau where Frankie has received counseling in the past, director and therapist Noreen Salzman (who was not directly involved in his case) says that between 15 and 20% of their clients have needed inpatient treatment.

“Some of the newer types of therapies that we have to work with these types of children, there just hasn’t been either time or training money available to get staff the kind of training that they need to work with these individuals,” Noreen said. “So sometimes...the best they can do for this child is to say, ‘We’re not equipped to handle this kind of behavior,’ and so they do transfer them to another facility.”

A rate regulation law passed in 2011 may have had unintended consequences for increasing the number of children sent out of state in recent years, Wendy Henderson said. The Department of Children and Families determines how much money a county pays the RCC for treatment, a rate that currently averages $431 per child, per day. That amount has increased from an average of a daily rate of $395 in 2018 and $344 in 2016. But in states where facilities can set their own rates, funding for needs like more staffing or training is more flexible.

“[Rates] used to be unregulated, which has its own unintended consequences,” Henderson explained. “We’re making sure that the way we implemented that is hitting the right tone in terms of having the high quality treatment that we want.”

For Frankie, approaching adulthood after a childhood spent facility-hopping, Salzman says lack of permanence can form a trauma all its own.

“Where there’s been severe trauma in that child’s life, that can cause some pretty significant... trauma-related symptoms,” Salzman explained. Cycles of aggression, emotional dysregulation, and problematic behaviors can stem from a history of trauma that a child is ill-equipped to manage, and are not uncommon among youth within the system. (By definition, anyone in foster care as Frankie was when very young has at least one adverse childhood experience (ACE), or a traumatic event occurring before the age of 18. Most have several.)

For Frankie, he says his life has been a cycle of one facility after another. All feel the same; none feel like they help. He loves his family; he wants to be home. But next month, he’ll board a plane to another facility in Utah. His mother doesn’t think he’ll last long there, and the cycle will continue.

It’ll be his fourth home in twelve months.

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