By Zandy Dudiak
For many years, Pittsburgh Mercy operated a Child Diversion & Acute Stabilization (C-DAS) Program, a temporary residential stabilization and treatment program for children and adolescents experiencing an acute mental health crisis. The program aimed to prevent hospital stays or serve as a step between a hospital stay and return to the community.
When the Commonwealth of Pennsylvania announced it would no longer provide licensure for C-DAS programs, Pittsburgh Mercy had to decide on an alternate care model to continue to serve these children ages 7-14 in crisis. The choices were a Residential Treatment Facility (RTF) or a Psychiatric Residential Treatment Facility (P-RTF).
Program Supervisor Staci Bose explains that Pittsburgh Mercy made the choice to adopt the P-RTF model beginning April 12 because of the advantages it offered to the children. Instead of having 21-28 days with a child in C-DAS, the P-RTF offered a better chance of success for children and their families with a 45-60 day window allowed for treatment.
“That allows us to do more therapy,” Bose says. “This gives us more time to work through some of those deeper issues.”
One of the issues with the C-DAS program was that children were sent on their way after three or four weeks of treatment with a referral for family-based or other services. However, because of a shorter period to make a referral to a provider and have services started on the other end, there was often a lag time between leaving the program and beginning family-based therapy. During that time, children began to decompensate.
“We now begin making referrals as they come in the door, so they’re not waiting as long after,” Bose says.
Another advantage to the Child P-RTF program is a longer school day than C-DAS offered—six hours versus three. Two Pittsburgh Public School teachers serve as instructors with one assigned to younger students and the other to the older children. There are also ancillary teachers for language arts and other arts curriculum offerings. Bose says a new nurse is providing medication education to the individuals. Students also attend a social skills group where they learn about hygiene and self-esteem.
Previously, the C-DAS program shared school time and other activities with the Child Partial Hospitalization Program (C-PHP). Now, the programs operate separately from each other, except for sharing the location at Reedsdale Center. Unlike the C-DAS program, the P-RFT staff stays with the children during their classroom time.
Bose says a typical school day at the P-RTF starts after children get their medications and eat breakfast. The day runs from 8:30 a.m. to 2:30 p.m. with a lunch break from 11:30 a.m. to noon. When they return to the unit after school, the children check in with their counselors about how their day is going.
Room time follows, giving children a chance to unwind from their day during the colleague shift change. The schedule proceeds with two hours of group therapy, dinner, gym time, and then free time from 7 to 8:30 for the younger children and until 9 p.m. for the older ones. In between, the schedule includes one hour for weekly family counseling and one hour for a weekly individual session.
Children need a referral to enter the voluntary program. The CARF-accredited program accepts only Medicaid insurance. Children covered by commercial insurance are referred to other providers for services.
The COVID-19 pandemic has created a mental health crisis for some children. The Allegheny County Office of Children, Youth, and Families (OCYF) is seeing increased neglect and is making more referrals for services, Bose notes.
“For a lot of kids, school is a safety net,” she says. “Their safety net was gone. School is an escape for some kids, with breakfast and lunch provided. School keeps people structured and accountable.”
The pandemic has been detrimental for mental health and social skills for school-age children, Bose says, adding, “We’re going to see this for a couple of years, in my opinion.”
The pandemic has also left the Child P-RTF short-staffed with 11 colleagues working as counselors, nurses, and social workers and seven unfilled positions. Bose isn’t sure whether or not as many people are going into those fields, whether the pandemic stopped some students from attending college and delayed their graduation, or whether some folks are hesitant to work in direct services positions because of the virus.
She does know one thing when it comes to her dedicated Child P-RTF colleagues. “We never stopped,” Bose says.