*This article has been corrected to include additional details about wait times at Burrell Behavioral Health.
This article is Part 1 of coverage on the proposed quarter-cent sales tax for children's mental health that Boone County voters will see on the Nov. 6 ballot. Read Part 2 here. A summary of the proposal can be found in the Missourian's Voters Guide.
COLUMBIA — A growing number of children in Boone County are homeless, abused or neglected, and there aren't enough shelters for them.
The number of homeless students enrolled in Columbia Public Schools increased from 120 students in the 2007-2008 school year to 182 students in the 2011-2012 school year, according to the Missouri Department of Elementary and Secondary Education. The peak was 240 students in the 2009-2010 school year.
The Missouri Child Abuse and Neglect Hotline fielded 1,281 reports of child abuse or neglect, involving 1,815 total children, in Boone County during 2010, up from 1,008 reports, involving 1,458 children, in 2005.
Boone County shelters have not been able to meet the demands of either population, says the coalition backing the quarter-cent sales tax for children's mental health on the Nov. 6 ballot. The group says tax revenue could expand housing for kids in crisis and increase early intervention efforts so that fewer kids need shelter.
In 2010, 149 children were turned away from shelters in Boone County, according to the children's mental health assessment by the MU Institute of Public Policy and commissioned by the Putting Kids First coalition. The coalition is responsible for getting Proposition 1 on the ballot.
Proposition 1 would generate an estimated $5.4 million a year, based on sales tax collections in 2009, for services that include shelters for crisis intervention, transitional living, outpatient psychiatry and counseling, both in schools and in the community. The revenue would be divided according to the decisions of a nine-person board of volunteers appointed by the Boone County Commission.
The shelter problem
Rainbow House Executive Director Jan Stock said that 120 people between 16 and 21 have applied to the agency's Homeless Youth Program this year. Of the 120, 27 were turned away due to severe mental illness, because Rainbow House does not have the licensed staff to treat them.
Stock said that Rainbow House can handle “run of the mill” problems, but cannot accept people who would make the living environment unsafe.
Applicants with mental health issues such as hallucinations, bipolar disorder, major depression, major anxiety and suicidal or homicidal thoughts would be turned away, and there is no long-term inpatient psychiatric facility for children in Boone County.
This problem is not unique to Rainbow House.
The four residential programs in Boone County that are eligible for funding from the proposed sales tax — Rainbow House, Children's Foundation of Mid-America, True North and Coyote Hill Christian Children's Home — do not have licensed medical staff to treat severe mental health disorders.
These services are eligible because they fall under the spending categories of crisis intervention, transitional living and temporary shelter. Spending categories are outlined in the state law that authorizes the proposed tax.
The law does not allow revenue to be used for inpatient hospitals or residential care "in the traditional sense," said Christine Corcoran of Putting Kids First.
For example, Missouri Psychiatric Center, formerly Mid-Missouri Mental Health Center, would not be eligible. The center is the only inpatient psychiatric hospital for children in Boone County and offers short-term care for three to seven days.
Great Circle, formerly Boys and Girls Town, would also not be able to use tax revenue for its residential treatment program.
Providers of eligible services, though, could use the money from the tax to hire additional staff and create new programs that would enable kids to stay in Boone County for shelter and treatment.
Stock does not see the creation of a new shelter with licensed mental health staff in Boone County's immediate future. She said the problem could be lessened, though, by increasing access to psychiatric evaluations.
Many of the clients turned away from Rainbow House would be eligible if they could just get an evaluation and appropriate medication, Stock said. Rainbow House accepts children with mental health issues if they are on medication and stable.
A professional psychiatric evaluation can be done by any psychiatrist and costs $360 at Missouri Psychiatric Center, said Laine Young-Walker, the head of the child psychiatry division for the MU Department of Psychiatry. The process involves an interview with the patient, as well as family members and possibly school teachers.
Price is not a problem for the children covered by Medicaid, a benefit that ends at age 19, Stock said. But psychiatric evaluations also can involve waits.
Stock said revenue from the proposed tax could fund emergency psychiatric evaluations, so wait times could be hours or days instead of months.
*Annie Juve, vice president of operations for Burrell Behavioral Health, said the average wait for psychiatric evaluation at her facility is two to three weeks.
"Over the past year and half, the average wait has been 30 calendar days, with one month that spiked up to a two-month wait," Juve said.
The wait has been shortened by the opening of an access center that offers free walk-in screenings for children and adults — not with a psychiatrist, but with a clinician who can then schedule the psychiatric evaluation with a shorter wait than before.
Children’s Foundation of Mid-America serves troubled children and adolescents in Missouri. Many have been abused or neglected and are now in the custody of the state. Others come to Children’s Foundation through the Missouri Department of Mental Health and are working toward family reunification.
The primary focus of the central and northeast Missouri region, which includes Boone County, is a residential care program for older adolescents in the custody of the state, said regional vice-president Anita Kiessling-Caver.
The program has three houses in Boone County, serving a total of nine clients with 24/7 supervision. Licensed therapists oversee the clients' treatment, and most of the residents have already had psychiatric evaluations.
Kiessling-Caver said the program only turns people away when it is full — which is 80 percent of the time.
The biggest problem at Children's Foundation is when residents "age out" at 21, they leave the system without getting the right connections to adult services such as food stamps, Medicaid and mental healthcare, she said.
Many former residents end up homeless or in jail within months of aging out, and Kiessling-Caver blames the gap between child and adult services.
“It’s like crossing a canyon with no bridge," she said. "Someone has to help you get up onto the other side."
Kiessling-Caver would like to use the sales tax to create what she calls a "transition program," with caseworkers helping children in residential care get connected with adult services long before they age out.
Children's Foundation has never had the funds to create such an initiative, and she does not know of one ever existing in Boone County.
True North provides emergency shelter for victims of domestic abuse and has room for 25 women and children. Some stay overnight, and others stay several months, as they look for new living situations and make career changes, said Executive Director Barbara Hodges.
If clients are in need of mental health professionals, True North makes referrals to local hospitals and services that could help.
"We don’t have a staff that handles some of those issues," Hodges said. "We have counseling, but that’s mainly focusing on the domestic violence issues and their impact on an individual."
In the past, True North has not had a child counselor on staff. The shelter offers children's programs, in which kids do art projects and play together, but has always referred children to outside agencies for counseling.
Soon, though, an MU graduate student will start to come a few hours a week as an intern and provide individual counseling for the kids, Hodges said. This will last for six to eight months, and Hodges hopes to get started in early November.
Hodges said that if the tax were passed, True North would continue to work with the agencies where it currently refers children with mental health issues, and the revenue would help these agencies expand.
"This community is so good with working together," Hodges said. "If we need to get those services, we do that by collaborating."
Coyote Hill Christian Children's Home
Coyote Hill Christian Children's Home is a shelter for abused and neglected children 20 miles north of Columbia, near Harrisburg. The county line actually crosses the property, and site director Bill Atherton is not sure how that will factor into the home's eligibility for tax revenue.
Like Rainbow House, Coyote Hill schedules psychiatric evaluations for new clients who exhibit symptoms of mental illness.
But the evaluation is not a requirement to live there, Atherton said. Kids can stay at the home while they wait for their appointments, because it might be months.
Coyote Hill has turned away applicants with records of disruptive behavior, though. These include chronic fire-starting and sexual perpetration, he said.
Most of the Coyote Hill clients are already on medication when they arrive, Atherton said. But wait times are a problem for these clients also. When prescriptions run out, the agency has to scramble to get them in for evaluations, he said.
Atherton said that if Coyote Hill were to get a share of the tax revenue, the money would go toward counseling programs, both individual counseling with kids and counseling that includes the child's family.
"To expand therapeutic services to children or to their families has always been the need and continues to be the need,” he said.
Next: Public school counselors report a shortage of services for kids with mental health issues that could be reinforced with passage of a Proposition 1, a quarter-cent sales tax on the Nov. 6 ballot.
Supervising editor is John Schneller.