by Heidi French for United Counseling Service

Emergency Departments across the state of Vermont face a challenge. This past year, more than 10,000 Vermonters, including children, accessed the Hospital Emergency Departments (EDs) during mental health crises.

This kind of overutilization leads to backups that can last for days, creating stressful conditions for patients, family and the hospital staff who have limited resources to treat psychiatric conditions. EDs struggle as they too often become the first response in mental health.

Perhaps most concerning is the rising number of children who present in the ED. Some children, removed by law enforcement from classrooms due to disruptive behavior, have been taken to EDs for evaluation. This experience is traumatizing and often unnecessary.

In reviewing available data, United Counseling Service (UCS), the state’s designated agency for Bennington County, and the Southwestern Vermont Medical Center (SVMC) discovered that in the fourth quarter of 2018, 294 child and adolescent crisis assessments were completed in the SVMC Emergency Department.  Tragically, 82% of all children and adolescents who presented in the ED in a crisis were discharged home without a treatment plan with the average length of stay being 20 hours.

Mental health professionals know that it is more effective and far less traumatic to keep those in the midst of mental health crises out of emergency departments. “The crisis intervention so often provided can be more traumatic than the original condition, and crisis services can strain emergency departments” said Lorna Mattern, Executive Director of United Counseling Service (UCS).

To address this issue, UCS and SVMC leadership began collaborating in 2018 to create a better response to children in crisis. Together, UCS and SVMC received a $125,000 Innovation Grant through One Care Vermont to create a pilot program. On September 10, 2019, PUCK opened its doors.

What is PUCK?

PUCK, or the Psychiatric Urgent Care for Kids (PUCK), is a child and family centered, recovery oriented, trauma-informed approach to mental health treatment. It is designed to provide a therapeutic environment and the right level of care, mitigating unnecessary utilization of EDs and reducing costs.

Children may be referred to PUCK for a variety of reasons ranging from behavioral dysregulation to suicidal ideation or self-injurious behavior. The common theme is that these children in crisis cannot safely remain in their current settings, often schools, and so are need of an alternative to the Emergency Department.

Once a child has arrived at PUCK, typically through the Family Emergency Crisis Team, they have access to a sensory room which offers tools to help regulate emotions and calm anxiety. This allows for quiet despite the stormy emotions.

PUCK staff includes Master’s level clinicians. They provide a host of services, including mental health screenings and assessments, supervision and structure, consultation to the sending school, information and referral, crisis plan development, consultation with the child’s primary care physician (PCP), and more.

The UCS Psychiatric team works closely with PUCK to provide consultation and direction to staff. That way if it is determined that a patient should receive a medication consult it can occur immediately, including follow-up with pediatricians and family physicians.

At PUCK, parents and family are an integral part of the team. PUCK’s complete array of services are on offer to both child and family upon their first visit to PUCK, and full intake for on-going services can be completed if appropriate.

“We are now able to provide the right care in a therapeutic environment that improves outcomes for children and reduces costs,” says Lorna Mattern.

Close to home

One day early in the fall, a UCS staff member was meeting with her supervisor. During this time, she received an urgent call from her child’s school. The school was calling to request her presence because her child was facing extreme difficulties regulating his behavior in the classroom.

The supervisor recommended that the employee (the child’s mom) allow for the school to call FES.  The employee chose to follow this advice, and a FES crisis worker went to the school.

Upon arrival, the crisis worker determined that the child could benefit from PUCK services. The crisis worker transported the child to PUCK. Once there, he was assessed and screened for anxiety and depression by a master’s level clinician and his behavior was observed. A PUCK case manager was able to work with him and he accessed the sensory room for calming.  The child was seen by the psychiatric team for medication adjustment, received an intake into UCS services, assigned a case manager for on-going service, and referred for an autism assessment. He was even able to access some of his schoolwork so he didn’t fall further behind his peers. All of this happened in less than 6 hours in a comfortable and calming environment.

“I never really knew what it was like to be the parent in a situation like this,” the employee said.  “No matter what you know or what experience you have, nothing prepares you for your child to struggle in this way. I was amazed at how quickly we were able to access the services and the support my child needed and I’m grateful for the difference it’s already made in his life.”

Is it making a difference?

In the short time the program has been open, it has been utilized 43 times. In addition to that, the Family Emergency Service crisis team has received 5 times more calls than last year at this time.  As a result, only 23% of the children seen have had to go the ED and there is a 40% decrease in ED utilization for children in a mental health or behavioral health crisis.

The need for additional space and additional staff is already apparent. How to keep this program going and expand to a greater range of ages needs to be explored. Funding has not been obtained, but there is no doubt the program is having positive results in the children and families it serves.

UCS executive director Lorna Mattern and medical director Alya Reeve, talk with Bennington Assistant Police Chief Lieutenant Camillo Grande, left, and Chief Paul Doucette. Photo by Caroline Bonnivier Snyder/Bennington Banner

Kheya Ganguly, the Assistant Director of Youth and Family Services at UCS directly oversees the PUCK program. “It has been amazing to see the sheer effectiveness of this program. I cannot overstate what a difference it has made for children, families and schools.  This is a safe place for children who do not need to be at the ER but do need support to be able to regulate themselves,” says Ganguly.  She recalled speaking to a local principal and asking about the children sent to PUCK. “The principal told me before PUCK every child that was sent to the program would have been sent to the ED. In addition, that school has not sent any children to the ED this year.”

PUCK is changing the way the police and the community respond to children in crisis. “Puck is a true asset to the community and will continue to be successful,” said Chief Paul Doucette with the Bennington Police Department. “There is no doubt other communities in Vermont, and surrounding areas, will use the PUCK program as a model helping to establish a youth crisis program in their respective areas.  My staff and I will continue to support this program bringing about positive change for children in crisis.”

Currently the program serves children through 8th grade in Bennington County, with the long-term goal to serve individuals throughout their life span.

United Counseling Service (UCS) is a private, non-profit community mental health center that has played an essential part of Bennington County’s integrated healthcare system since 1958. The organization has been designated as a Center of Excellence by Vermont Care Partners.

UCS promotes healthy lifestyles through all its programs and offers care at 15 different facilities, including two primary outpatient facilities in Bennington and Manchester. UCS provides outpatient counseling and addictions services, emergency mental health services, extensive rehabilitation services, home and school-based services, employment services for people recovering from mental illness or with developmental disabilities and Early Childhood Services.  For more information about UCS visit