WILLMAR -- At least 18 full- or part-time positions were eliminated last week at the Child Adolescent Behavioral Health Services hospital in Willmar.
The cuts follow a decline in patient numbers at the acute psychiatric hospital, said Dr. Read Sulik, assistant commissioner for chemical and mental health services.
The staff reductions -- which are affecting about 22 individuals including some long-time employees who have worked at the hospital for more than two decades -- are also being made as the Minnesota Department of Human Services implements a plan to redesign the inpatient facility to cater to children with highly specialized mental health needs.
When the re-tooling of the hospital is complete this fall, it will have fewer beds and less staff. Employees were notified in April of the job cuts.
But it will also be the only state-operated facility in Minnesota that will offer specialized mental health treatment for children and adolescents in the areas of neurodevelopment, traumatic stress and emotional disregulation, said Sulik.
Located on the MinnWest Technology campus, the hospital had been staffed 24-hours a day for 26 beds to treat children and adolescents with a wide array of mental health needs, he said.
The daily census during the last 12-18 months, however, has been 8 to 12 children, said Sulik. As a result, the number of beds will be decreased to 16.
The census indicates the demand isn't there, said Sulik. "We've had to make adjustments."
"We're obviously concerned when there are less options for treatment modalities for children," said Jay Kieft, director of the Kandiyohi County Family Services. But he said the state is making decision on how to effectively provide services. "I know there's a trend toward specialization," said Kieft.
There's been a lack of referrals of both private and public entities that have used the facility in recent years. Sulik said he doesn't know "what's behind the absence of referrals" but believes there's been "great confusion about what the program really is and who it serves."
Kandiyohi County hasn't referred many children to the facility for some time, in part because the admission guidelines have been difficult to meet, said Carmen Clementson, a supervisor with the Kandiyohi County Family Services who specializes in mental health.
"We always look at resources close to home when they're accessible to us," said Clementson,
The admittance criteria includes medical necessity as determined by a doctor, if children were not functioning at their current location or if they could not be managed in a less restrictive setting. Meeting those guidelines can be as narrow as an "eye of a needle," she said.
When the changes are implemented, the types of mental illness cases accepted at the hospital will become even narrower, but Sulik said the trend for specializing services will serve un-met needs in Minnesota's mental health care system.
A gap analysis that was conducted by interviewing providers showed a "specific pattern of needs" that Minnesota's current system isn't serving, said Sulik.
From that analysis, a new plan for a new system of delivering care was created that includes redesigning the Willmar Child Adolescent Behavioral Health Services hospital by Sept. 1 that will serve children and adolescents from all over Minnesota.
Under the plan, the Willmar hospital will focus on three areas, including children with neurodevelopment issues like autism, Asbergers syndrome and aggressive behavior. Sulik said there's currently not an in-patient program in Minnesota that specializes in this.
The program will also provide care for children with traumatic stress-related issues. This could help children, for example, who have been sexually or physically abused, had "horrible disruptions with care providers" or have witnessed other traumas, said Sulik.
Again, he said, there is no current state program like this.
The final area will address children with severe emotional disregulation. These complex mental health issues go beyond depression and anxiety, said Sulik, and may include those who are bipolar, are unable to regulate their emotions and need treatment like dialectical behavioral therapy to become stabilized.
Besides the "re-identity" of the Willmar facility becoming a specialty hospital, Sulik said the state also intends to create a partnership with community programs in the state to open up three partial hospitals or out-patient clinics in the state to provide step-down care to help a child make the transition from an inpatient hospital back to their own community.
The locations for the new facilities are yet to be determined but could be located in the northern part of the state and one in the metro area, said Sulik.
Willmar currently has a partial mental health hospital for youth at Woodland Centers. Sulik said another facility could possibly be located in the southern part of the state. The first of these facilities could be open by Jan. 1.
Interactive video between clients and a doctor may also be used during the transition process to better utilize the limited number of child psychiatrists in the state, said Sulik.