From 2020 to 2022, state officials repeatedly froze admissions to a children’s psychiatric center in Hamden following repeated reports of abuse and turmoil at the facility, including allegations of staff members kicking and spitting on a child who was under their care.
The state forced The Children’s Center of Hamden to stop admitting patients to its inpatient psychiatric facility four separate times, despite a dire need for inpatient beds.
The intake freezes lasted months, and officials cited the facility on many occasions for abuse and improper monitoring of children that led to dangerous situations, internal documents show.
The thousands of pages of emails and inspection reports reviewed by The Connecticut Mirror noted instances of staff members pushing a child into a bush, punching a child in the face and looking the other way as several children assaulted another patient in their bedroom.
As state officials questioned whether the facility was safe enough to house adolescents, including foster children under the state’s care, another question loomed: If the facility closed, where would the kids go?
The incidents speak to some of the larger issues with a mental health care system for kids in Connecticut that providers and experts say is bursting at the seams. State officials had to grapple with the tension between ensuring patients were safe and knowing that taking action would mean the state would lose desperately needed inpatient beds.
The two-year saga played out largely outside of public view during some of the worst months of the pandemic. But the episodes highlight the fragile nature of Connecticut’s safety net for children and how problems at one key nonprofit provider can have a domino effect on the entire system.
The Children’s Center of Hamden is one of five psychiatric residential treatment facilities — also known as PRTFs — in the state. They’re inpatient treatment centers for people under 21 years old who have serious mental health needs.
Its patients are among the most vulnerable in Connecticut — many are in the state’s foster care system and have experienced severe trauma. The facilities are largely funded through Medicaid reimbursements and state grants.
Since the pandemic, the number of children in need of mental health care and the severity of that need has soared. As admissions at The Children’s Center of Hamden stopped, the number of kids seeking care statewide overflowed. The Connecticut Children’s Medical Center in Hartford reported that children in mental health crises were overwhelming the emergency department.
Meanwhile, incidents at The Children’s Center of Hamden multiplied.
In January 2021, a child swallowed a screw in a suicide attempt, according to an inspection report. A staff member in May 2022 punched a child in the face. A child was given too much lithium, which is used as a mood stabilizer to treat mental illnesses such as bipolar disorder. Children ran away, and one stole a car from a neighbor at knifepoint.
“The state agencies are also prepared to pursue the closure of the facility if progress is not made,” wrote Bill Halsey, deputy Medicaid director at the Department of Social Services, in an email to other state employees on Sept. 2, 2022, nearly two years after the first incidents prompted an admission pause.
Several state agencies have a hand in overseeing the facilities, forming a complex web of regulations and inspection and reporting requirements. They’re licensed by the Department of Children and Families. The Department of Social Services oversees their Medicaid requirements. The Department of Public Health inspects the facilities. Agencies work together to conduct investigations.
The state cited the facility repeatedly for failure to properly monitor children, physical abuse from staff and improper use of restraints. They also weren’t reporting incidents correctly, according to state documents.
State officials’ concerns built up to a fear that there were inherent flaws built into the culture at the Children’s Center, and that the problems couldn’t be fixed.
“We are looking for DSS’s guidance as to next steps, as we do not believe the facility is improving or able even to maintain ongoing compliance,” Adelita Orefice, chief of staff at the Department of Public Health, wrote in an Aug. 19, 2022 email to DSS staff.
The facility faced steep challenges during the pandemic, as it navigated shifting health guidelines around COVID-19. It had leadership changes and, like many residential facilities, struggled with staff retention.
“You had the perfect storm,” said Jim Maffuid, who started as chief executive officer at The Children’s Center of Hamden in 2022. “Pandemic. Everybody scrambling and trying to figure out what to do.
“So the whole system was really challenged with lots of fast changes. At the agency here, there were also a lot of administrative changes.”
But state officials kept the trouble at the Children’s Center shielded from the public eye. Even parents who had children in the facility initially didn’t know about the admission freezes, according to officials at The Children’s Center of Hamden.
And top officials, including the commissioners of the Department of Public Health, Department of Social Services and Department of Children and Families, feared how the information would play out in public. They alerted Gov. Ned Lamont to the issues in 2020 because of “the gravity of the situation and potential media attention.”
When Lamont’s top cabinet officials were alerted to the problems at The Children’s Center of Hamden, former state budget director Melissa McCaw was concerned about whether the governor’s proposal to close an entire wing at one of the two state-run psychiatric facilities made matters worse.
“Did the Solnit proposal in the Governors budget exacerbate this issue?” McCaw asked.
Budget documents from the time show Lamont proposed slashing the funding for the Solnit North, located in East Windsor, by more than $1 million over a two-year period.
The governor’s office told The Connecticut Mirror that the decision to shutter a wing in that facility did not contribute to the overflow of adolescent psychiatric patients in local emergency departments during the pandemic. And the governor’s administration emphasized that the capacity problems at in-patient psychiatric facilities were a problem prior to Lamont’s time in office.
“All health care providers continue to face staffing challenges due to a lack of workers across the entire industry. The state is not immune to these issues,” Julia Bergman, a spokeswoman for Lamont, said. “Recruitment for these workers is a top priority at every level of the executive branch.”
Still, providers who spoke to the CT Mirror said slashing funding for Solnit North added strain to an already-overburdened health care system.
There were fewer residential treatment beds available for kids. That meant the state was under pressure to find open beds even as officials scrutinized The Children’s Center of Hamden for its ability to keep children safe.
The Children’s Center of Hamden also faced millions in financial losses when admissions were frozen.
The state sought a way to reimburse it for at least part of the loss and ultimately landed on a Medicaid reimbursement rate change, which providers say still isn’t sufficient to cover costs.
“The Lamont administration has raised PRTF rates twice in response to the shortage of those beds and has provided an add-on to support additional staffing to address clinical challenges within these facilities,” Bergman said.
Department of Social Services officials said part of the reimbursement changes included an additional nursing position at psychiatric residential facilities as part of an effort to improve government oversight.
Many of these problems have been seen at a national level. A recent Congressional report pointed out persistent problems with abuse, insufficient treatment and lack of oversight, among other problems at psychiatric residential treatment facilities.
Our feeling was it was a mistake to just single out [The Children’s Center] and make it about this provider that couldn’t get its act together, because it’s bigger than that.”
sarah eagan, state’s child advocate
Officials say that they’re confident conditions have improved at The Children’s Center of Hamden. But questions linger more broadly within the state’s mental health care system for children about capacity to help children with more severe needs, particularly as earlier interventions are overrun.
“It’s not just about CCOH,” said Sarah Eagan, the state’s child advocate. “It’s about the level of care, and how do you make it work. Our feeling was it was a mistake to just single out CCOH and make it about this provider that couldn’t get its act together, because it’s bigger than that.”
Frozen admissions
In late 2020, the first of what would be several incidents state officials described as “disturbing” occurred. A staff member bit a child, sending him to the emergency room. They also put the child in a restraint, and while he was restrained and unable to fight back, kicked and spit on him.
This was followed a couple of days later by another incident during which a staff member physically assaulted a youth, pushing them, hitting them and throwing them. The state responded by freezing admissions and issuing its first of several immediate jeopardy orders against the facility, which meant the state determined that the health and safety of the patients was at serious risk.
“The facility failed to ensure the youths were free from physical and/or psychological harm as evidenced by staff biting, spitting and hitting and other injuries during an emergency situation resulting in the finding of Immediate Jeopardy,” the CMS report says.
One staff member was suspended and the other terminated, but the facility didn’t properly conduct a review or take other steps such as re-educating remaining staff to ensure something like that didn’t happen again, according to state documents.
About a year later, a Centers for Medicare and Medicaid Services report described an incident during which four kids attacked another child while they were sleeping.
The “youth presented to the clinic with blood over his face, sweatshirt and pants,” the report says. The child had swelling and scratches on their face, “a headache and a possible concussion.”
The ensuing investigation revealed that a staff member knew about the attack ahead of time. The kids planned it out, and when the direct care worker learned about it, they allegedly told one child “when it happens, I’m not going to be there,” according to state records.
In another incident in March 2022, the facility suspended a direct care worker who punched a child in the face. But they didn’t properly report it to DCF, according to state documents.
The child was dysregulated, meaning they were unable to control their emotions and the staffer began to “encourage” the youth to punch him. When the child followed through, the worker “returned a punch to the youth’s face,” according to a Centers for Medicare and Medicaid Services report.
The subsequent investigation into that 2022 event didn’t occur for months and revealed that since a leadership change at The Children’s Center of Hamden, many incidents hadn’t been reported correctly at the facility.
In an incident in December 2022, The Children’s Center of Hamden was cited in part for its failure to call 911 in a timely fashion when one of the children left the facility. One of the children had been talking about gun violence, guns and gang activity in the days ahead of another incident. The child walked off campus, one of several patients to run away from the facility over those two years.
Staff followed, and the child walked through a nearby residential neighborhood trying to open car doors. One was unlocked and the child found a knife in the vehicle. They used that knife to carjack a woman sitting in her running vehicle parked on the street.
Even as the new director sought to restart admissions, other incidents surfaced.
On Sept. 20, 2022, Maffuid emailed DSS officials to let them know he felt the facility was ready to increase the number of kids in their care. They’d been losing money from a lack of Medicaid reimbursements.
“We are ready to accept new admissions,” Maffuid wrote. “My team has demonstrated competence in their leadership, ability to create and sustain change and a spirit consistent with a continuous quality improvement culture that focuses on safety and individualized care.”
But the day before, investigations revealed, a staffer pushed a child off a bike and into the bushes.
“To be frank, I do have reservations about resuming admissions,” Halsey wrote in an email about the incident to other state officials. “A staff person pushing a youth is very concerning to me.”
That was the balancing act that we were on. So we were trying to ensure the safety of the kids in the facility and making sure that they were getting the treatment that they needed, knowing that there were probably children that needed to access this level of care.”
Bill Halsey, deputy Medicaid director at the Department of Social Services
Most recently, the Department of Children and Families cited The Children’s Center of Hamden in March for insufficient monitoring that led to “inappropriate sexual contact” between a PRTF resident and a member of the day school.
DSS officials said in a June interview that they didn’t remember the details of the incident, but thought it had been dealt with swiftly.
Backdrop of need
Through every incident, through every frozen admission and each denied request to increase the number of kids at the facility, state officials had to balance a critical need for more inpatient bed space with the safety concerns at Children’s Center.
“That was the balancing act that we were on,” Halsey said in an interview with the CT Mirror. “So we were trying to ensure the safety of the kids in the facility and making sure that they were getting the treatment that they needed, knowing that there were probably children that needed to access this level of care.”
Since the pandemic began, kids have reported more instances of mental health problems and more severe occurrences. In 2023, the state opened four urgent crisis centers to try to stymie the flow of kids going to the emergency departments for mental health crises.
“We understand when children are in crisis, sometimes they don’t even know how to express that,” said then-Department of Children and Families Commissioner Vannessa Dorantes, at the time.
“If we can get underneath what’s going on with our children and their families and support them, we can stem the tide of some of the things that we see happening in our community.”
The crisis centers, meant to be 24/7 clinics available to stabilize children in crisis, are part of a larger legislative effort to address kids’ mental health issues.
In 2022, state lawmakers made children’s mental health the defining issue of the session and expanded community-based services for children.
Still, the problem persists.
“It’s a really hard level of care,” Eagan said. “The wait list, particularly for girls, the wait between referral and admission, it’s almost 100 days. So it’s a hard-to-access level of care, particularly for adolescent girls. Is it working? Is it delivering what we want for kids?”
Over the past year, about 12% of the calls or online requests to the state’s 211 system have been about mental health or addiction. That’s more than 204,000 requests for mental health services, addiction help, or assistance in a crisis situation in the last year, or about 560 calls per day.
Service providers and schools have reported more need for mental health resources. Reports last year about physical and sexual abuse, a lack of supervision of kids and insufficient therapeutic care for children with histories of severe trauma at a Harwinton group home sparked broader discussion about the lack of support for kids with mental health needs in Connecticut.
Issues at lower levels of care, foster care and juvenile justice spill over, compounding problems in the rest of the system, advocates and officials have said.
Connecticut’s Intensive Home-Based Services, also known as IICAPS, is overburdened, providers said.
“Now this intermediate level that’s supposed to keep kids in the communities and supportive families is becoming unaffordable for agencies. And so how do you deal when you’re losing some of those community supports?” said Hector Glynn, chief executive officer at The Village for Families and Children, which also runs a psychiatric residential treatment facility.
The industry as a whole has a shortage of workers. Many got burned out during the pandemic, and low Medicaid reimbursement rates have meant that pay is low for many in the mental health field.
It’s very difficult to do this work with the population of youth that are in our PRTFs given the intergenerational trauma that they have experienced, their complex behavioral health and medical needs. So you have a very difficult intensive population to serve with less people willing to do or able to do this type of work.
Ken Mysogland, bureau chief of external affairs at DCF
Connecticut’s reimbursement rates are lower than many other states, and private care reimbursements for inpatient stays at facilities such as a psychiatric residential treatment facility are even lower than the public option, providers say.
The Children’s Center of Hamden also had several changes in upper management, including its chief executive officer, chief financial officer, clinical director and psychiatrist during the pandemic. State officials speculated in internal emails that former chief executive officer Selma Ward “really had no idea of what she was doing.”
Ward didn’t return messages from a CT Mirror reporter, and Maffuid declined to comment on whether her leadership had caused the problems at The Children’s Center of Hamden, saying only that he was sure she was doing what she thought was best at the time.
Maffuid and state officials emphasized the difficult nature of caring for children who are in crisis.
“These are kids that are going to spit on you and kick you and call you derogatory names and maybe try to assault you and everything else,” Maffuid said. “And you get to do that for 18 bucks an hour.”
“It’s very difficult to do this work with the population of youth that are in our PRTFs given the intergenerational trauma that they have experienced, their complex behavioral health and medical needs,” said Ken Mysogland, bureau chief of external affairs at DCF. “So you have a very difficult intensive population to serve with less people willing to do or able to do this type of work.”
Glynn said that The Village also had problems keeping direct care workers. Although it’s improved, the turnover rate is still about 35%, which Glynn said he thinks is likely better than other agencies in the state.
The problem was exacerbated as the minimum wage rose. Previously, workers at The Village earned $17 hourly, and when the minimum wage went up to about $16 an hour, they weren’t earning much more than minimum wage.
Pair the minimal difference with a physically and emotionally taxing job, and many chose to leave, Glynn said. They increased pay to $21 per hour to combat the problem, which has helped.
“We brought up our pay to $21, getting closer to a livable wage and sort of an investment, but it’s something we knew we had to do,” Glynn said.
The Children’s Center of Hamden pays direct care workers $18 an hour, Maffuid said.
State response
State agencies negotiated many corrective action plans with The Children’s Center of Hamden and monitored the facility to ensure they followed the plans. The plans included requirements to secure loose screws in the bathrooms, remediate mold, train employees and develop clearer policies around reporting.
Maffuid said the facility has done a lot of work around training employees, developing clearer policies, encouraging employees to ask questions and now informs parents when the facility has an immediate jeopardy order.
Halsey said DSS allowed increases in the census at The Children’s Center of Hamden in “a trickle,” to help ensure that kids were safe. And officials at DCF said they worked with the other state agencies to ensure that the foster children who were placed in the facility were protected.
“We were in constant communications with our partners meeting routinely on the problems that occurred in that facility during that time. We wanted to make sure they clearly understood how to manage crises, how to report crises to the proper authorities, all of that,” said Michael Williams, DCF’s Deputy Commissioner of Operations. “That’s a part of our process of making a decision to restart admissions.”
The state also required that The Children’s Center of Hamden contract with an outside psychiatrist and hire an outside health consultant to conduct audits of the facility.
The 2021 reports from the consultant, Barrins & Associates, found that while the facility was following safety plans and making progress, it still had “challenging work” ahead.
Documents reviewed by the CT Mirror make it clear that financial woes at The Children’s Center of Hamden also added to the complicated situation.
While beds were left unfilled, the center was losing money. Maffuid repeatedly emailed state officials asking to increase the census, which still has only 25 children instead of its licensed 28.
He asked them to reimburse The Children’s Center of Hamden $2.6 million for the loss in funds. DSS tried to find a way to get Medicaid to cover that cost, but was unable to grant the request, Halsey said.
“We reviewed it internally pretty carefully, but we couldn’t come up with a way to do that under Medicaid and so and get a federal match,” he said in an interview.
Behind the scenes, officials were debating exactly how much help they should offer the center.
“I am not advocating that we need to cover that loss, that is a part of running a PRTF program so I am not looking to rescue them,” Halsey wrote in an April 2023 email. “I don’t want to see this facility close so I could support something, but not that entire amount.”
Maffuid said the center lost millions during that time and had to dip into other funds such as its foundation.
They were looking at enhancing the day rate, Medicaid day rate. That did increase, it increased about $100, per child, per day. And that sounds good. Right? It’s still short of what we really need.
Jim Maffuid, CEO at The Children’s Center of Hamden
“That’s really not our responsibility, solely,” Maffuid said. “We’re in the game. We’re in this business to help children, and we will do our fair share, but it shouldn’t rest solely on our shoulders.”
The state did increase reimbursement rates and added new required positions such as a nursing supervisor to give the psychiatric facilities more cash and to improve oversight, Halsey said.
“They were looking at enhancing the day rate, Medicaid day rate. That did increase, it increased about $100, per child, per day,” Maffuid said. “And that sounds good. Right? It’s still short of what we really need.”
Glynn said the financing structure for psychiatric residential treatment facilities is flawed because it isn’t high enough to cover costs and doesn’t allow wiggle room for infrastructure improvements.
During the COVID-19 pandemic, The Village had lots of kids who ran away, Glynn said. To remedy the problem, they decided to add a fence.
The addition took $1 million, without aid from the state, he said.
A recent Congressional report has also pointed to tension in the funding system. The goal of a psychiatric residential treatment facility is to move children to lower levels of care, ideally back to their communities, the report says.
But the report suggests that funding facilities based on the number of filled beds incentivizes them to keep kids in care longer. It’s led nationwide to low-quality care at the residential treatment facilities, the report says.
Maffuid pushed back against the ideas in the report, saying that their entire goal is to safely move children out of care.
There’s always more need, which keeps the beds full, he said.
But Deborah Dorfman, the executive director of Connecticut Disability Rights, said that is a flawed view of facility-level care.
“If you build institutions, people will go there, like, that’s what will happen,” Dorfman said. “I mean, that happens. There’s a lot of history around that, not just in Connecticut, but just around the United States.”
Moving forward
Officials say things have settled down at The Children’s Center of Hamden; they’re confident the kids are safe.
DCF officials said there are no more holds on admissions at the facility and they continue to refer foster children to the center for care.
“We’re continuing to place kids there now, and there’s no barriers or provisions or concerns about that facility’s ability to appropriately treat our children that we are placing there,” said Williams, the deputy DCF commissioner.
DSS officials agreed with that assessment.
“There are no major concerns,” said Fatmata Williams, DSS’ director of medical administration. “We continue to meet with them. And I also want to highlight, it is not an easy or uncomplicated level of care. It is a lot of ongoing work that Carelon continues to do with all of these PRTFs to ensure safety and high quality of care.”
Carelon is an organization that provides quality assurance assistance to medical facilities in Connecticut.
Maffuid said the facility has made improvements and is continuing to learn.
“We pride ourselves on being focused on wanting to be a learning organization,” Maffuid said. “So we constantly have something to learn.”
The state also implemented some recommendations from the Office of the Child Advocate including giving more money to the facilities and offering ongoing technical support, Eagan said.
But the state hasn’t implemented a system to ensure the public knows about the problems at these facilities when they arise, limiting parents’ ability to do research when they’re considering where to send their children.
The child advocate recommended in 2021 that the state find a system of public reporting. Halsey said if the public wants to get that sort of information from DSS, they’ll have to submit Freedom of Information Act requests.
DCF has an online database of inspection reports, although it contains scant details.
The Office of the Child Advocate has repeatedly criticized state agencies charged with the care of vulnerable children for a lack of transparency and public reporting about care and outcomes for kids.
“If there are changes that need to be made, make them,” Eagan said. “But how do we support and make this level of care work – clinically, fiscally, longitudinally?”