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Morrison County Social Services had a smaller caseload in Children’s Mental Health last year, but the level of service needed went up.

Likely due to the COVID-19 pandemic — which resulted in fewer school-based referrals in 2020 and 2021 — the overall caseload dropped from 177 in 2019 to 160 last year. In order to be eligible for children’s mental health services through the county, a child must be between ages 0 - 21 and have a designation of “serious emotional disturbance” from a mental health professional.

That diagnosis means they “have difficulty functioning in their home, school or community,” according to Social Services Supervisor Melanie Erickson.

Of those 160 cases, 25 qualified for Community Access to Disability Inclusion (CADI) waivers. That is up from 17 in 2019 and only four in 2015.

To be eligible for a CADI waiver, one must qualify for medical assistance based on a disability or other eligibility status, be assessed using MnCHOICES to need the level of care provided in a nursing facility or have an assessed need for supports and services beyond those available through the medical assistance state plan. In a May 18 report to the Morrison County Board of Commissioners, Erickson said it is an option her office has used more and more in recent years.

“That not only is about placement, but a lot about community supports — additional community supports we’ve been able to put into homes,” she said. “People that can assist with the hands-on parenting in the home, or some specialized services, too. That we’ve also used. That has been something that has really helped us manage some of the more difficult needs that we’ve had with families and kids.”

As that number has gone up, so too has the number of child welfare and child mental health clients being referred to residential treatment. Eleven children in Morrison County accessed residential care in 2020, compared to six in 2019 and seven the year before that.

Twelve clients receiving a CADI waiver are currently placed with a voluntary, intact family member compared to just two who are state wards. Five children in residential care had similar placements, which is equal to the number who are now wards of the state. There were also 22 volunteer placements in 2020 from intact families.

“We have been experiencing much more of that,” Erickson said. “We have a screening process, and we try very hard to try all kinds of other things before we take those steps of placement. But, there are times when kids — and we’ve seen more of that lately — when they have a lot of suicidal ideation, and we just cannot keep them safe in the home.”

She also attributed that, at least in part, to the pandemic. She said many people deferred accessing services that may have prevented a mental health situation from becoming a crisis.

Erickson said one of the goals her team has is to find more alternatives to residential treatment.

“We have to come up with some other alternatives other than sending kids out of the community,” she said. “We’re continuing to work on that.”

In cases where needs aren’t as high as those needing a CADI waiver or residential placement, the Children’s Mental Health Office is focused primarily on education and helping both children and their families connect with outside supports within the community. Once they reach that level of having a “serious emotional disturbance,” Erickson said one of the most popular services is respite care, which gives short-term relief to primary caregivers.

“Really, our goal is to help youth transition into enjoying as many of their regular youth activities as they can within their family, and their school, and learning those social skills,” Erickson said. “Then, also, transitioning to productive citizens in our community that can hold employment and feel like they’re contributing to their community and (having) a sense of belonging.”

Challenges the organization faces include a lack of services for kids in the county. Erickson said crisis respite care is “very difficult to come by,” with the nearest day treatment facilities located in Brainerd and St. Cloud. Intensive, home-based therapy has also been decreased in the past year because of COVID-19.

She added that there is a “constant need” for local providers to provide in-home service, which Erickson said is the most effective service in the field of children’s mental health.

“We’re really focused on person-centered planning, service that is really engaging the child and the family into — ‘This is your life. We want you to be empowered to make your decisions.’ — really educating them, because we really believe that prepares them to close their case with us eventually, hopefully,” Erickson said. “Or, be able to transition to adult a services, and they’re also person-centered. It’s about helping them understand what’s happened to them with their trauma history, and what they can do about it.”

She pointed out that county staff members in Children’s Mental Health have continued to make home visits throughout the pandemic. They did so as long as the family was comfortable with them entering their home. Erickson said that was a credit to her employees and their dedication to the children they serve.

“It’s been a tough year on kids,” said Morrison County Social Services Director Brad Vold. “It’s been a tough year for schools, so I’m anticipating that this program continues to grow given what we’ve experienced over the past year with the pandemic. Hopefully the summer’s a little better, but we know in collaboration with the schools that it’s been a tough year for schools and kids.”

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