Palo Alto's Lucile Packard Children's Hospital, Mountain View's El Camino Hospital and Kaiser Permanente could partner to provide inpatient psychiatric services to teens within Santa Clara County's borders, something the area hasn't had for more than two decades.
The three healthcare organizations submitted a joint response to a Request for Information (RFI) Santa Clara County issued in February to solicit "suggestions, ideas, and/or potential approaches on a non-competitive and non-binding basis" for a child and adolescent inpatient hospital unit," the RFI states.
The joint Lucile Packard-El Camino-Kaiser response proposes opening an 18-bed, "state-of-the-art" facility that would serve 12- to 17-year-olds with a range of psychiatric conditions at El Camino's Mountain View campus.
Three other Bay Area healthcare organizations also submitted responses to the county request: Fremont Hospital, which currently operates a youth inpatient facility but would open a new additional unit in Santa Clara County; EMQ Families First, a statewide nonprofit that offers mobile crisis services in Santa Clara County and also operates a small short-term crisis stabilization unit in Campbell for suicidal children and teens; and Bay Area Children's Association (BACA), a San Jose nonprofit that provides child and adolescent psychiatric services. BACA jointly responded to the RFI with PrairieCare Medical Group, a Minnesota-based psychiatric healthcare system.
Santa Clara County has not had an acute-care, inpatient psychiatric unit for youth for more than 20 years, so an average of 20 adolescents each day are receiving inpatient psychiatric care outside of the county, from San Mateo to Sacramento, according to Supervisor Joe Simitian. Simitian called the local lack of beds a "real and significant need" when he first brought the issue to the board last May.
Teens in psychiatric crisis who seek emergency care at local hospitals are sent outside of the county to be hospitalized, with the closest available beds to Palo Alto at Mills-Peninsula Health Services in San Mateo. Teens from all over the county can be sent to farther-flung hospitals in San Francisco, Berkeley, Fremont, Vallejo, Concord and even Sacramento. Adolescent inpatient psychiatric units in the Bay Area run as large as 34 beds (Alta Bates Summit Medical Center in Berkeley) and as small as 17 at Mills-Peninsula.
Parents with such teens have spoken publicly about the toll that this takes on their children and families, and, frequently, the shock they felt when they discovered one of the largest counties in the country, home to renowned facilities like Stanford Hospital and El Camino, does not offer these services to adolescents.
"I've been at many of these meetings over the past few months with parents of commercially insured children who have serious mental-health issues and our message has been clear: 'When our children are in crisis and most in need of medical care, we have nowhere to go,'" Sarah Gentile, a Los Altos resident whose son was hospitalized in 2014 at Mills-Peninsula, told the Board of Supervisors at a December meeting.
Mental-health professionals and hospital officials say that operating an adolescent inpatient facility is challenging and costly; demand ebbs and flows with the school year, decreasing in some cases to zero over the summer. The number of inpatient beds for teens as well as child and adolescent psychiatrists have also declined throughout the state in recent years. (Read: Why so few hospitals beds for teens?)
After several months of conducting research and gathering community input on the issue, the county Board of Supervisors in December directed staff to issue the RFI. Staff eyed an ambitious goal of having beds available in Santa Clara County by this June.
Forming a partnership is key to providing a "world-class level of treatment" to teens in Silicon Valley, the Lucile Packard, El Camino and Kaiser response reads.
"The organizations are in the process of defining a partnership which, if successful, would provide a unified approach to an inpatient and partial hospitalization facilities to treat, at least initially, youth ages 12-17, and locate the facility on the campus of El Camino Hospital," the response states.
The proposed facility would serve youth diagnosed with mood disorders, thought disorders, adjustment disorders and anxiety conditions including post-traumatic stress disorder (PTSD) and substance abuse. Youth would be served regardless of their ability to pay.
The facility would offer partial hospitalization, inpatient hospitalization and outpatient services. El Camino already offers an in-demand intensive outpatient program, After School Program Interventions and Resiliency Education (ASPIRE), that is intended to help teens who are struggling with depression and anxiety, and are showing significant behavioral and emotional symptoms.
The proposed inpatient program would include psychiatric assessments; individual, group and family therapy; expressive arts, recreational and leisure activities; educational services; full access to any needed medical services at El Camino; and strong connections to community and school providers to plan for discharge and follow-up care, among other services.
The program's design and services will "minimize stigmatization and support wellness, and include outpatient services so that youth can integrate quickly into the necessary levels of care with no risk of fragmentation," the response states.
While the goal is to open the facility in 2020, nine beds could be placed in a "special section" of a new mental-health building set to open at El Camino in January 2018, according to the response.
Michael Fitzgerald, executive director of mental health services for El Camino, told the Palo Alto Weekly that the RFI is "early stage" and "there have been no agreements or decisions made."
"Because a range of services across the continuum of care is needed, we believe a collaborative approach with key stakeholders would be most effective in meeting the needs of this vulnerable population," he wrote in an email Monday. "Adolescent inpatient mental health is a complex service to provide, and would require significant investment and collaboration between major health care providers."
Fremont Hospital, for its part, is proposing to open a "hospital within a hospital" inpatient facility for children and adolescents at Santa Clara Valley Medical Center in San Jose.
At Fremont's existing inpatient acute psychiatric hospital, there are 40 beds available for children and adolescents. Youth patients there present a range of conditions, from schizophrenia and PTSD to major depressive disorders, according to the hospital's RFI response.
In exchange for a long-term lease at Santa Clara Valley Medical, Fremont would provide the funds necessary to build out the space for a treatment unit. Fremont would contract with Santa Clara Valley Medical Center to provide day-to-day staff and support services at the inpatient unit.
Fremont Hospital has both the experience and infrastructure in place to "achieve economies of scale" to run a unit throughout the year as demand increases and decreases," the response states.
Fremont Hospital would also find space near the proposed unit to operate a partial hospitalization program and intensive outpatient program, according to the response.
EMQ Families First, in partnership with Telecare Corporation, an Alameda-based mental-health organization, is proposing opening an inpatient as well as partial hospitalization program for children and teens at its Campbell campus.
The campus houses EMQ's short-term crisis stabilization unit, which was opened in September 2014 with the goal of preventing unnecessary hospitalizations. After a patient arrives at the seven-bed unit, a team of nurses, psychiatrists and family specialists work with a timeline of 23 hours and 59 minutes to evaluate and release the patient with a plan for further care.
EMQ also operates a 24-7 mobile crisis unit in Santa Clara County for children and adolescents experiencing an acute psychological crisis. The unit's staff perform "5150" hold assessments (a 72-hour involuntary psychiatric hold for individuals believed to be a danger either to themselves or to others), often at the request of school staff or families; take patients to emergency rooms and link families to agencies that offer longer-term mental-health services in the community.
The new, proposed facility would serve youth 4 to 17 years old. The partial hospitalization program would provide intensive day treatment services and supervision from 8:30 a.m. to 2:30 p.m., Monday through Friday, and family therapy during evening and weekend hours, according to EMQ's response.
Services would include individual, group, and family therapy; medication evaluation and management; psycho-educational groups; wellness and recreation groups and educational support. "Careful attention" will be paid to cultural and language needs as well as the needs of particular populations in Santa Clara County, including LGBTQ youth; Latino, African-American and Asian youth; and children on the autism spectrum, the response states.
Bay Area Children's Association and PrairieCare's preliminary proposal, BACA Executive Director Tom Tershis wrote in an email to the Weekly, is to open an inpatient facility "somewhere between San Jose and Palo Alto."
"For over twenty years, Santa Clara County has done without a children's psychiatric hospital," the BACA-PrairieCare RFI response states. "This has posed serious problems for families but has also presented opportunities for innovation."
The next step in the process will be for the county to issue a Request for Proposal; staff said it will be released this month.