The recent closure of three Maine residential programs for children has rapidly reduced the services available to youth with developmental disabilities, sparking alarm among health professionals.
As of July, there are only two residential treatment programs covered by MaineCare left in Maine that specialize in youth with serious developmental disabilities. Two programs operated by Spurwink Services in Chelsea and another in Scarborough closed within about the past month.
The closures continue a long-term trend, but the quick succession of them has concerned behavioral health professionals who were already navigating a crisis-level shortage of services for kids.
The contraction will likely increase the number of youth waiting in hospital emergency rooms because there is nowhere else to safely manage their behavior. And it could force more youth to seek treatment program programs out of state, behavioral health professionals said.
“It is a catastrophic crisis. It is the worst I’ve seen,” said Rachel Bousquet, the executive director of KidsPeace in Ellsworth. The organization runs one of the two remaining residential programs for kids with developmental disabilities such as autism.
Residential programs help youth with acute mental health disorders and disabilities who, usually for several weeks or months, need a more structured environment than outpatient services can provide.
When Spurwink closed its Chelsea programs, some of those displaced patients found beds at KidsPeace, Bousquet said. While they had a safe place to go, it further tightened the availability of care for youth trying to enter the system.
Bousquet said she has noticed an uptick in referrals for youth with developmental disabilities since the Spurwink programs closed.
The closures will worsen the statewide problem of youth enduring extended stays in emergency departments and inpatient hospitals, which can harm their wellbeing and places enormous strain on hospital staff, said Kelly Barton, president of Maine Behavioral Healthcare. Maine Behavioral Healthcare is part of the MaineHealth system and provides inpatient and outpatient psychiatric care, and community-based treatment programs.
Barton cited the recent example of a severely autistic kid who was admitted to Spring Harbor Hospital in Westbrook, the only inpatient psychiatric hospital with a specialized unit for children and adolescents with developmental disabilities. The patient stayed for two years.
Inpatient hospitals are intended to stabilize acute psychiatric symptoms and then discharge patients to long-term services, but, in this child’s case, no residential bed was available.
The hospital was only able to discharge the patient when a bed became available at the Spurwink program in Chelsea. When it closed, the young patient was thrust back into limbo, Barton said.
KidsPeace treats children with and without developmental disabilities, so the breakdown of beds dedicated to developmental disabilities fluctuates with the availability of bed space, children’s needs and staff, she said. The program is licensed for 44 beds, but only 21 were full as of last week due to staffing levels.
A decade ago, Spurwink offered about 200 residential beds for children, said Eric Meyer, the nonprofit’s executive director. Before its Chelsea programs closed, the nonprofit was down to 40 licensed beds specialized for youth with developmental disabilities — though the Chelsea programs were not running at full capacity when they shuttered. Spurwink now operates only the Brook House in Westbrook, which has 16 beds.
One of the primary reasons Spurwink shuttered the programs was because of the difficulty finding staff with the advanced degrees required to supervise direct care staff, as well as hiring direct care staff capable of meeting the state certification requirements for working with youth with developmental disabilities, Meyer said.
For direct care staff, the certification process “is probably a college-level curriculum and test,” he said. People can perform the work with only a high school diploma, but the nonprofit struggled to recruit staff who could earn the required credentials.
He has proposed to state officials the possibility of relaxing the rules to allow supervisors to train staff instead of requiring them to pass a certification exam in order to retain employees and keep programs like the Brook House open.
Lindsay Hammes, a spokesperson for the Maine Department of Health and Human Services, which oversees the children’s behavioral health system, did not respond to repeated attempts to understand the demand for residential treatment among youth with developmental disabilities and how the department was responding to the program closures.
Measuring the number of children’s residential beds in Maine is a moving target as programs do not always run at full capacity due to staffing limits.
For instance, the state has 220 licensed beds for children, whether they have developmental disabilities or not, but only 121 were full in mid-July, according to numbers that providers shared with the Bangor Daily News after receiving them from the state. Comparatively, 147 beds were full in May, according to a state dashboard.
In addition to the 121 youth receiving treatment in Maine in July, another 64 received care at facilities out of state, and 68 were waiting for a placement somewhere.
“Obviously some kids we are serving need so much hand-over-hand support that they will eventually go into adult services and a group home,” Meyer said. “But for many kids in residential care, the correct way to look at it is to help them heal, make progress and return home. I think it is very rare and incredibly difficult for kids out of state to have that as an outcome, so I’ve always regarded out-of-state residential care as tragic.”
Barton echoed Bousquet and Meyer, saying that program closures will force more kids out of state — a practice that providers, families, disability rights advocates and lawmakers have been pushing to end for years.
State health officials have been willing to collaborate with providers and are aware of the dire nature of the situation, Barton said. She would like to see a collaboration result in a “big picture” plan to fill in gaps across the spectrum, she said, so providers no longer have to “play whack-a-mole” in reacting to crisis-level situations.
Barton, Meyer and Bousquet all emphasized that the erosion of community-based programs for children with disabilities has resulted in more children relying on intensive services because their behavioral issues worsen in the absence of earlier interventions. The solution has to involve making sure there are community-based services to help kids avoid residential care in the first place, Meyer said.
Callie Ferguson is a reporter at the Bangor Daily News and may be reached at [email protected].
