(Source: Star Tribune)

The situation of a 10-year-old boy with severe autism and aggression illustrates the dire need for adequate housing and treatment facilities. The boy has been at Ridgeview Medical Center in Waconia for seven months. His case is an example of a growing problem in Minnesota for large and even small hospitals — the boarding of children with uncontrolled behavioral and developmental problems. M Health Fairview Masonic Children’s Hospital was so overrun with such children last spring that it converted an ambulance bay into a shelter for them. 

The boy has injured health cae workers, including striking one worker in the head and causing a concussion, according to a report filed last week with the Carver County Sheriff. 

ERs are the dumping ground by default because of a federal law — the Emergency Medical Treatment & Labor Act, or EMTALA — that requires them to screen and stabilize any patients who show up at their doors. The law also requires “appropriate” transfers of patients, but in the case of troubled children that often means to group homes or residential treatment centers that are full with waiting lists. And so they wait. 

“For children with autism, children with developmental delays, the worst possible scenario would be sitting in an emergency department,” said Lew Zeidner, M Health Fairview’s director of transition and triage services. “What they need is predictability. They need structure. When they don’t have that predictability, that constancy, they get agitated. When they get agitated, people around them get agitated and that can lead to physical confrontation.” 

Part of the problem is that children with developmental or behavior problems don’t necessarily meet criteria for admission into inpatient psychiatric or other units, he said. Masonic eventually closed its shelter, because it deployed social workers to reach out to parents and county child protection agencies and find placements for them. 

But the progress was temporary. The hospital earlier this month reported a new wave of children arriving. What used to be two to four children per month has now increased to about 15 — half of whom are in county protective custody. Their average length of stay in the ER is 12 days, but some have stayed as long as six months. 

The child has had a traumatic upobring, with the death of a sibling and imprisonment ofb his mother. The hospital’s hope is to transfer him to a facility anywhere in the U.S. that is equipped for children with autism and aggressive behaviors. But nobody yet has found space for him. A Sibley child protection supervisor did not reply to requests for comment. 

Privacy protections prevented Ridgeview chief executive Mike Phelps from discussing any specific boarding situations in his ER, but he said it is a growing problem for many hospitals. 

Children’s Minnesota is opening an inpatient psychiatric unit in St. Paul next month. However, Phelps said the expansion and recent state mental health investments don’t really address this population of kids. More specialized residential treatment and group home facilities are needed, and more staffing is needed to maximize the use of facilities that already exist. 

“I can appreciate building inpatient psychiatric beds — that’s great — and investing in outpatient mental health services,” he said. “But this is in between that and it’s a subset of kids who just don’t have a place to go.”