Finding long-term residential behavioral health treatment for children is becoming more difficult

Connie MacDonald works for the State Department at the US Consulate in Jeddah, Saudi Arabia. It’s a dream job and she loved living abroad with her two sons.

But earlier this year, MacDonald said, her 8-year-old son began to become aggressive. At first the family thought it was ADHD. Her son was eventually diagnosed with attention-deficit/hyperactivity disorder as well as a mood disorder, making it difficult for her son to manage his emotions, particularly his anger.

“He was insulting me. He threatened to kill his brother. One of the final straws was that four people at school held him for about an hour trying to calm him down,” he said.

The American International School in Jeddah told her that her son could not return. His behavior was so severe that MacDonald began seeking medical treatment back in the US

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He found Intermountain Residential in Montana. Children in the Intermountain program learn to build healthy relationships through intensive behavioral therapy for up to 18 months.

Intermountain Residential in Helena, Montana, is one of the few programs in the US that provides long-term behavioral health treatment for children up to 10 years of age.

Sheila Ragar/MTPR

Intermountain Residential is one of the only facilities in the U.S. that serves emotionally disturbed young children like her son.

MacDonald remembers crying hysterically when she left him in June, but the tears gave hope as her violent outbursts subsided over the weeks and months.

“Now that we have our weekly calls, it’s very normal. It’s like talking to a baby again. It’s wonderful,” he said.

Intermountain is one of about a dozen programs in the nation that provide long-term behavioral health treatment for children as young as 10, according to the National Association of Therapeutic Schools and Programs. It’s one of the only options for 4-year-olds.

Intermountain is located in a quiet neighborhood in Helena and has been treating children for over 100 years. The children Intermountain treats have emotional disturbances, behavioral problems stemming from mental illness or trauma, and other problems. They struggle with self-harm, severe depression, or violent outbursts that can lead to attacks on other people or animals. Most families who come to Intermountain have tried medication, outpatient therapy, or even short-term treatment that has been unsuccessful.

Long-term treatment programs like Intermountain are often a last resort for families.

It can take months before children with serious mental and behavioral health issues feel safe enough to open up to staff at Intermountain, said Megan Bryce, who directs the residential program. Some children were injured or abused when adults were supposed to be caring for them, she said. Living with this can make them deeply fearful or resistant to adult interaction, even when they live in a safe environment. Bryce said Intermountain staff must gain the patient’s trust before working to determine the root cause of a child’s behavior. It takes time before they can develop an effective long-term treatment plan based on intensive behavioral therapy and building healthy relationships.

Intermountain parents and staff were shocked when the facility suddenly announced this summer that it would close its doors this fall, blaming staff shortages.

Some parents threatened to sue. The law firm representing them argued in a September letter to Intermountain’s board that it has a contractual obligation to complete the treatment of the children remaining at its residential facility.

Intermountain then reversed course, saying it would cut back in an effort to keep the program open. But spokeswoman Erin Benedict said that’s no guarantee Intermountain can keep its doors open long-term. Intermountain plans to reduce its capacity from 32 beds to eight.

Megan Stokes, until recently NATSAP’s executive director, believes staff shortages aren’t the full story of Intermountain’s problems.

“We’re seeing a lot of long-term facilities move into what they call short-term, intensive outpatient. You can get the insurance money easier,” he explained. Stokes said he knows of 11 long-term programs for children 14 and younger that have transitioned to offering only shorter stays of 30 to 90 days.

Short-term plans are cheaper and insurance companies will pay for them more quickly, Stokes said. Short-term programs can treat more patients in a year than long-term residential facilities. That could make them more profitable to run for.

But those programs likely won’t help the kids who have to leave Intermountain. In fact, short-term plans can hurt them.

“The problem is if that kid bombs after that short stay, or they’re doing well, and maybe six months later they don’t have the tools in their toolkit to continue that, and now you’re labeled as a cure; resistant when that child was not resistant to treatment,” Stokes said.

Children labeled treatment-resistant may then be rejected from other short-term programs.

For now, parents of children at Intermountain are looking for other treatment options amid uncertainty over whether Intermountain will remain open. Parents told NPR and KFF Health News they had to sign up for waiting lists that can take a year or longer to clear for the few programs that take children 10 or younger. That’s when they can find facilities that will accept their children at all.

Stacey Ballard has been unable to find a facility willing to treat her 10-year-old adopted son with reactive attachment disorder, who is currently at Intermountain. This condition can make it difficult for children to connect with their families. Ballard said her son can be extremely violent.

“He was hanging around our house at night thinking about killing us all, and he said he does it almost every night,” Ballard explained.

Institutions that treat children his age typically do not treat children diagnosed with reactive attachment disorder, which is often associated with severe emotional and behavioral problems.

MacDonald also can’t find another facility that could be a backup option for her son. He had to complete another 14 months of treatment at Intermountain.

She said she can’t gamble on keeping her son at Intermountain because of the uncertainty of whether it will stay open.

So he plans to leave Jeddah and return to the US, taking a leave of absence from work.

“I’m going to take him to my family in South Carolina until I can find another place for him,” she said.

This article is from a partnership that includes MTPR, NPR and KFF Health News.

KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of KFF’s core operating programs, an independent source of health policy research, polling and journalism. Learn more about KFF.

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