The past eight months have seen a steady increase in pediatric Baker Act admissions at Golisano Children’s Hospital in southwest Florida.
While Golisano Children’s Hospital is not a Baker Act receiving facility, they do receive pediatric patients who may need medical care. Many of those cases include intentionally injecting things and becoming very sick when attempting suicide, or other forms of self-harm that require medical attention. Golisano Children’s Hospital of Southwest Florida Chief Nursing & Operations Executive Alyssa Bostwick said many arrive at the hospital. Golisano Children’s Hospital when they pose an immediate danger to themselves or others, requirements for involuntary evaluation and admission under the state’s Baker Act.
“If they are medically cleared, they may be discharged, then transferred to the nearest Baker Act open-bed facility,” she said.
The average length of stay for Baker Act is three and a half days as some children entering the hospital require medical attention and some are in critical care. If they are in the ICU, the stay can last from days to weeks.
Bostwick said that for the children who come through the emergency department but do not require medical care, they can send them to a shelter before being admitted. For children who don’t need medical care, they can usually have them placed within 24-48 hours, depending on bed capacity in Lee County and the state, she said.
The primary receiving facility in Lee County is SalusCare. Some patients have to be sent to Orlando as it is the closest facility with open beds.
“It is a national problem. Many of these reception facilities have their capacity,” said Bostwick.
When comparing year-over-year stats on Baker Act volume, they’ve seen a nearly 500 percent increase in the first eight months of this year. Bostwick said there was a small drop in the summer, which she says is the result of dramatically increased, high numbers compared to last year.
There has been an “incremental increase since school started,” Bostwick said.
There were 126 pediatric Baker Acts in the month of May, 88 in June, 73 in July, 50 in August and 79 in September. In February of this year, the numbers began to rise dramatically.
The youngest pediatric Baker Act patient is 5 years old.
“We’re watching to see if we have any trends on what’s coming in,” she said. “Really across the board, we haven’t seen any specific trends.”
Child admissions come in a number of ways.
“They come from different places,” Bostwick said. “We performed a manual chart audit in April 2021 that revealed the following breakdown of a total of 94 patients assessed:”
– 37% arrived by the police, all these children were away from home
– 25% transferred from SalusCare with a medical need
– 62% were away from home
– The remaining 13% came from a combination of school and/or group homes
– 31% had previously founded OP Mental Health Services
– 31% had previous emergency room visits in the past 3 months
– 50% had no medical necessity on arrival
District spokesman Rob Spicker said in an email that school personnel do not have the authority to do the Baker Act. He said they depend on law enforcement to make that decision.
Bostwick said that with the increase in children’s mental and behavioral health, this has caused problems as Golisano often provides patients with a bed in the hospital as a safe place until beds become available at a receiving facility.
She said that while it is difficult to pinpoint what is causing the increase, the pandemic has had an impact on children. That impact has led to social isolation, change in social dynamics at home and stress and burden on families, especially for parents who are unemployed and struggling financially.
“We hear of many children coming in. . . they see the stress and burden of the family and take it upon themselves,” Bostwick said.
Further consequences can be how children have been to school, peer pressure with masking and not masking, vaccine or no vaccine.
“That tension exists not only in adults, but also in children,” she said, adding that this year and a half “has had a really big impact on our children.”
The primary message to the community, Bostwick said, is “mental and behavioral health problems in children are real.” If a child talks and says they need help, listen to them and find someone to determine what kind of health care they need, she added.
Parents can also call the mobile crisis unit, find an ambulatory health center or take them to the Golisano Children’s Hospital in a crisis situation.
“We’ve just come out of the last three months of our wave here. Even during some of our highest volume days, our wait times weren’t incredibly long. We’ve got a really great process here at Golisano. We’re doing a really great job getting kids through getting that much-needed care,” Bostwick said.
If the safest place to bring the child is Golisano Children’s Hospital, Bostwick said, bring them.
Golisano Children’s Hospital offers an outpatient behavioral health program.
Unfortunately, the demand for the program is very high and it can be difficult to get into therapy. Bostwick said they will continue to recruit psychologists on a monthly basis with the goal of recruiting 16 psychologists over the next year and placing them in the community.
“We’re looking at Bonita, Cape Coral and Lehigh to try to increase access,” she said.
If the Golisano Children’s Hospital cannot see the child in time, they will provide other community resources.
“We’re working with the community to make sure they can get the care they need,” Bostwick said. “It does require a village. This is really a community effort to address this problem, mental and behavioral issues. Mental and behavioral health is an issue across the board. Pediatrics has seen a very rapid increase in the past eight months. It takes a village, the community to make our heads about what is happening to provide services.”
That community effort includes Golisano Children’s Hospital which has partnered with the Lee County School District on weekly phone calls, including pediatricians, that have begun due to COVID.
“We are discussing what we can see with COVID and children. What we’ve been seeing for many weeks with mental and behavioral health in children,” she said.
The silver lining in this pandemic, Bostwick said, is that it blew the barriers out of the water and brought everyone together to do what needed to be done.
“Those relationships have continued and I have no doubt that they will continue in the future. It’s a very big positive result for a very stressful year and a half,” she said.
The Baker Act Reporting Center at the University of South Florida is tracking the shooting statewide.
According to the latest annual report, there were 210,992 Baker Act exams for 2018/2019. The report also notes that Baker Act exams have increased statewide by 19.20 percent for all ages, 24.80 percent for children under the age of 18, and 15.45 percent for children aged 18 to 24 in that reporting period. from fiscal year 2013-2014 to fiscal year 2018-2019. From fiscal year 2017-2018 to 2018-2019, Baker Act exams increased statewide by 2.53 percent for all ages, 5 percent for children, and 1.23 percent for 18- to 24-year-olds.
For Baker Act exams in the 2018-2019 fiscal year, 17.95 percent were children and 73.33 percent were adults 18 to 64 years old. The investigations initiated by law enforcement officers were 51.34 percent and 46.45 percent imitated by a professional certificate. The report also noted that 65.54 percent of non-psychiatrist physicians were the most common health professional to initiate the exam.
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