In Minnesota, thousands of children participate in day treatment programs: site-based, structured support programs that are designed to help young people with serious mental health needs build emotional coping strategies in a supportive environment without having to leave their home, school or community.
These programs, run by community-based mental health providers and funded by payments from Medical Assistance (MA) and commercial insurance plans, help kids learn how to recognize and understand their emotions, building personal strength and reducing behavioral challenges.
Because they aim to cause as little disruption to a child’s life as possible, day-treatment programs are closely linked to schools. To make transitions even easier, some programs are even co-located in schools, while others bus young participants from their school directly to day treatment.
COVID has taken a toll on these programs. Because they are reimbursed only when a child participates, school closures, quarantines, and bus driver and teacher shortages have all meant that many children’s attendance has been spotty at best over the past two years. That has hobbled the finances of many programs and even caused some to close.
Tom Steinmetz, CEO Washburn Center for Children, a Minneapolis-based mental health center for young people, explained that before the pandemic hit Minnesota, day treatment was his nonprofit’s most heavily subsidized service. Those programs have also been “the most disrupted and have experienced the most financial losses.”
Because these services are fee-based, he explained, “Any time a child doesn’t make it to treatment for any reason — illness, their school transitions to virtual learning, anything — there is no reimbursement for that.”
In a report from earlier this month, “The Impact of the Crisis on Children’s Mental Health Providers,” AspireMN, a state association of children’s mental health service providers, surveyed 17 of its member organizations representing day treatment and residential service providers. One hundred percent of respondents said that they have had to close programs or significantly decrease their capacity to serve children over the past two years.
“Some (day treatment) programs have had to shut down significant numbers of classrooms, shrinking their ability to deliver care,” said Kirsten Anderson, AspireMN executive director. “It’s incredibly painful to make these decisions.”
Steinmetz said that illnesses and absences caused by this winter’s Omicron surge has been particularly tough on day treatment providers. “The bottom line is that children’s day treatment in Minnesota is on the verge of collapse right now.”
Washburn Center’s revenue was down 30 percent in 2021 alone. While this has been hard for his organization, Steinmetz said that other, smaller day treatment providers have had an even tougher time of it.
“Some providers have already reduced their capacity for their day treatment programs by 50 percent,” he said. “One program shut down in July 2021. When you have a program that was already underfunded that is now reeling from the continued impact of COVID, they just can’t continue to absorb financial losses and programmatic disturbances for so long without seeking some kind of extra funding.”
Any whatever emergency state or federal funding that helped to shore up mental health services at the beginning of the pandemic has since ended, Steinmetz said, leaving providers on their own.
In order to face what Steinmetz describes as “tsunami” of children’s mental health concerns, day treatment programs should be financially stabilized by state or federal relief dollars, rather than forced to shut down, said Diane Cross, president and CEO of Fraser, Minnesota’s largest provider or autism and early childhood mental health services. The pandemic has wrought trauma for many families, Cross said, and children suffer the psychological consequences.
“It stays with these kids for a lifetime. Finding ways to invest in these young children so they can get ahead of the curve is what these day treatment programs do. That’s what makes them so important.”
COVID-forced closures not only impact a day treatment program’s bottom line, they also destabilize their young participants’ mental health, Cross added, reversing any progress that their prior participation in these programs has made.
“We’ve had to quarantine when there is exposure,” she said. “We have to shut down the program for 10 days at a time. These days, it feels like we are existing in a circle that’s never-ending: We get our kids in for a while and then we have to send them back home. This is really hard on our kids and we need to do whatever we can to make sure they’re okay.”
While providers of physical health care have played a central role in this pandemic, providers of mental health care should also be considered essential, Cross said. The key nature of the services that programs like Frasier and Washburn provide for children should qualify them for emergency relief funds, she added.
Mental health supports provided by day treatment programs, Cross said, are, “medically necessary services for these kids, just like hospital services are. What I’m hoping is we could get the same financial relief from the state that our hospitals and schools are getting — because we meet just as an important a need for our children.”
In parts of Greater Minnesota, day treatment programs are the only community based children’s mental health options available, said Jinny Palen, executive director of the Minnesota Association of Community Mental Health Programs (MACMHP). In some rural areas, these programs are the region’s “safety net” mental health providers.
“If we have kids who are unable to participate, it is a struggle,” Palen said. “We have to keep staff in the clinics and keep the clinics open and appointments available. If we have an increased number of no-shows or less and less kids, we’re not able to keep up the costs of keeping the doors open.”
This requirement adds increased financial burden to existing programs and means that many teeter on the brink of closure. “There is no back up for residents of their counties if these agencies close,” Palen said. If that happens, she explained, “Hospitals and emergency departments will be the only source for care and must absorb the demand.”
At the beginning of the pandemic, some Minnesota treatment providers offered virtual options for young participants and their families. While that was a needed response to an emergency, participants soon found out that for the youngest participants at least, online group therapy is a sorry substitute for in-person treatment and interaction with peers. As soon as restrictions surrounding in-person learning were eased, these programs moved back to their original format. Participant response was positive, but a string of COVID-forced interruptions have limited many children’s progress.
“The majority of our kids are in person now,” Anderson said. “Our day treatment providers are anxious to get back in person because they can have a level of connection that way.” While peak pandemic strategies were remarkable in their innovation and creativity, all involved feel that the original model works best. “We all know we do better when we are face to face,” Anderson said.
Nonprofit providers can seek foundation grants to support their work, and many do, but there is only so much of that sort of funding to go around.
“We can do some fundraising but it is not a guarantee that it will solve this crisis,” Cross said. “We are operating these programs as best we can with dollars that are coming from donors (but) our problems are much bigger than foundations can fix.”
Cross said leaders of day treatment programs have teamed with the advocacy arms of organizations like Aspire-MN and MACMHP to develop an official list of funding requests to present to lawmakers at the state capitol.
The requests include:
- Immediate relief funding to sustain access to current community mental and chemical health services (House File 3215),
- Streamlined, and reduced, reporting and regulatory burdens, allowing providers to focus on care delivery, not reporting requirements and
- Rate reform on MA rates for mental and chemical health programs.
Getting lawmakers to approve these changes could require a shift in the way people think about providers of children’s mental health services, Cross said. “We need some of the same funding that the health care system has been getting. We are health care. We are one of the most critical pieces of the puzzle.”
This year, the state of Minnesota is in strong financial shape, Anderson said, which should mean her organizations’ requests could be met. “We have a state with unprecedented resources at its fingertips. It makes sense to take immediate and urgent action to provide financial support for these essential services.”
Not helping out day treatment programs when the resources are at hand would be a tragic mistake, she added.
“These are our babies. They are our children and families. To not provide this basic mental health care at this time in history puts our kids and communities in a really challenging place,” Anderson said.