Dallas, Texas –
Jose Garcia: I don't know what to do
Sujata Dand, KERA News: Jose Garcia takes the cap off of his head. He crumples it in is hands as he tearfully tells his son's story.
Garcia: So sad.
Dand: 17 year old Oscar has been using cheese-heroin for the last two and a half years. Last summer, he went through detox at Timberlawn Mental Health Hospital in Dallas. Afterwards, his insurance company would only pay for out-patient therapy. Garcia says his son relapsed immediately - was arrested - and now is in a juvenile detention facility waiting for his day in court.
Garcia: My wife is very sick - crying everyday, very depressed, because when I go to see my son he's crying very much and como se dice repentido.
Dand: He's repenting, says Garcia. And, the family is concerned Oscar will be sentenced to the Texas juvenile correction agency. Garcia says his son needed residential treatment, but he only qualified for out-patient counseling through Value Options. That's the state subsidized insurance company contracted to run Dallas County's mental health care program. Value Options rejected Garcia's numerous requests to have Oscar placed in a residential treatment facility. The managed care company isn't sure residential treatment is always the best option - especially when the patients are so young. Jack Szepenawoski is the CEO.
Jack Szepenawoski, CEO, Value Options: I think we've developed a lot of programs throughout our history of the system and provided a lot of access, but this presentation is truly very unique clinically so we've been scrambling in terms of looking at their kinds of outcomes we need to look at to attach appropriate interventions and its not strictly a funding issue.
Dand: To better explain the company's decision-making process, Szepenawoski asks the medical director for Value Options Conway McDanald to join us.
Conway McDanald, Medical Director, Value Options: I think the misunderstanding is - just an extended period of time for all individuals in residential is more effective. There really is no data to support that.
Dand: Dr.McDanald points to research that suggests there are no conclusive long-term benefits to inpatient care versus out patient care. He says the recidivism rates are equally high.
McDanald: At some point, whether you choose, one week in a supervised 24 hour program or 30 days, you're still discharging a very vulnerable kid back into the community. So, what we're having to ask ourselves is what is the best way to continue treatment of this child in their environment that allows them to stay abstinent or free from drugs once they leave a structured program.
Dand: Residential treatment is also more expensive. Value Options pays three times more for residential services compared to out-patient treatment.
Michelle Hemm, Phoenix House, Director: The child will get treatment and some level of care. In our opinion they're not getting the proper level of care.
Dand: Michelle Hemm is the director of the Phoenix House - an adolescent residential treatment center in Dallas. Half of the beds are empty, here. And, Hemm doesn't understand why. She says she receives calls everyday from parents like Jose Garcia who are desperately seeking help for their heroin-addicted children, but when they present those cases to doctors at Value Options - most of the kids are prescribed out-patient care.
Hemm: When you're a heroin user and you're surrounded by other heroin users. You need to be in a residential treatment center. At the very least to be isolated and to just stabilize before you're put back into your environment We're putting kids into outpatient- they're getting high everyday. They don't show up. And, they're failing on that level and so basically we have to wait until they fail in outpatient and hope that they don't die during one of their days of using and then maybe we can get them into residential.
Dand: Hemm says most medical experts say kids need to be in a residential treatment program for about 120 days Value Options has set a 30 day limit. Craig Nuckles - the CEO of Timberlawn Mental Health Hospital in Dallas - says that's not adequate.
Craig Nuckles, Timberlawn Mental Health Systems, CEO: If this isn't taken as the deadly, serious, disease that it is, then relapse is a given.
Dand: And, that's exactly what's happening. ER doctors say they are seeing some of the same kids in the hospital after overdosing for a second time. Nuckles believes Value Options is being selective because they lack funding from the state. Texas ranks in the bottom 5 in nation when it comes to mental health funding.
Nuckles: The real question is children and adolescent's ability to access services they need. Funding often times makes decisions clinicians should be making.
Dand: Dallas County Commissioner Ken Mayfield lobbied state health officials to double the funding for mental health services for children. The additional half a million dollars will go to Value Options earmarked for additional residential treatment.
Ken Mayfield, Dallas County Commissioner: You can not treat those with a heroin addiction in their home, in their community and in their neighborhood. They need to be isolated; they need to undergo the treatment that's available in order to rid themselves of this addiction. I mean there's no question about that.
Dand: Meanwhile, Oscar Garcia remains in a juvenile detention facility. His attorney believes he will be sentenced to Texas' Youth Commission for about a year at a cost of more than 58 thousand dollars. A 120 day stay in a residential treatment program would have cost the state 18 thousand dollars. - For KERA News, I'm Sujata Dand.