Local pediatric Baker Act numbers up
The past eight months have shown a steady increase in pediatric Baker Act admissions at Golisano Children’s Hospital of Southwest Florida.
Although Golisano Children’s Hospital is not a Baker Act receiving facility, they do receive pediatric patients who may require medical care. Many of those cases include intentionally injecting things and becoming very ill at attempting suicide, or other means of self harm resulting in the need of medical care.
Golisano Children’s Hospital of Southwest Florida Chief Nursing & Operations Executive Alyssa Bostwick said many arrive at Golisano Children’s Hospital when they are an immediate danger to themselves, or others, requirements for involuntary evaluation and admission under the state Baker Act.
“When they are medically cleared, they are OK to be discharged, they are then transferred to the closest Baker Act facility with open beds,” she said.
The average length of stay for Baker Act is three and a half days, as some of the children who come into the hospital need medical attention, and some are in critical care. If they are in ICU, the stay may be anywhere from days to weeks.
Bostwick said for the children who come through the Emergency Department, but do not require medical care, they can send them to a receiving facility before being admitted. For children who do not require medical care, they usually are able to 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 because it is the closest facility with open beds.
“It’s a national problem. Many of these receiving facilities are at capacity,” Bostwick said.
When comparing year-over-year statistics regarding Baker Act volume, they have seen nearly a 500 percent increase in just the first eight months of this year. Bostwick said there was a small decline over the summer, which she said stems from drastically 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. The numbers started drastically increasing in February of this year.
The youngest pediatric Baker Act patient has been 5 years old.
“We do keep our eye on if we have any trends on what is coming in,” she said. “Truly across the board, we haven’t seen any specific trends.”
Child intakes arrive in a number of ways.
“They come from a variety of places,” Bostwick said. “We did a manual chart audit in the month of April 2021 that revealed the following breakdown out of a total of 94 patients reviewed:”
• 37% arrived by law enforcement, all of these children were from home
• 25% were transferred to from SalusCare with a medical need
• 62% were from home
• The remaining 13% were from a combination of school and/or group homes
• 31% had previously established OP Mental Health Services
• 31% had prior emergency department visits in previous 3 months
• 50% had no medical need upon arrival
District spokesperson Rob Spicker said in an email that school personnel do not have the authority to Baker Act. He said they rely on law enforcement to make that decision.
Bostwick said with the increase in pediatric mental and behavioral health, it has caused issues because often times Golisano provides patients a bed at the hospital as a safe place until beds become available at a receiving facility.
She said although it is hard to pinpoint what is causing the increase, the pandemic has had an impact on children. That impact has resulted in social isolation, change in social dynamics at home and stress and burden on families, especially for parents who are out of work and financially struggling.
“We are hearing from a lot of kids coming in . . . they see the stress and burden of the family and are taking it on themselves,” Bostwick said.
Further impacts can be how kids have attended school, peer pressure with masking and not masking, vaccine, or no vaccine.
“That tension not only exists with adults, but with kids,” she said, adding that this last year and a half has “had a really big impact on our kids.”
The primary message to the community, Bostwick said is “mental and behavioral health struggles in children is real.” If a child is talking and says they need help, listen to them and seek out someone to determine what kind of health care they need, she added.
Parents also can call the mobile crisis unit, seek out an outpatient health center, or bring them to the Golisano Children’s Hospital in a crisis situation.
“We did just come off the last three months of our surge here. Even during some of our highest volume days, our waits were not incredibly long. We have a really great process here at Golisano. We really do a great job in getting kids through that 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 on the program is very high and it can be difficult to get into therapy services. Bostwick said they continue to recruit psychologists monthly with the goal of bringing on 16 over the next year and placing them out in the community.
“We are looking at Bonita, Cape Coral and Lehigh to try to increase access,” she said.
If Golisano Children’s Hospital is not able to see the child in a timely fashion they provide other community resources.
“We are working with the community to make sure they can receive the care they need,” Bostwick said. “It does take a village. This really is a community effort to try to tackle this issue, mental and behavioral issues. Mental and behavioral health is an across the board issue. Pediatrics has just had a very rapid incline in the last eight months. It is going to take a village, the community to wrap our head around what is happening to provide services.”
That community effort includes Golisano Children’s Hospital working with the School District of Lee County in weekly phone calls, which also includes pediatricians, which began because of COVID.
“We discuss what we may be seeing with COVID and kids. For many weeks, what we are seeing with mental and behavioral health with kids as well,” she said.
The silver lining in this pandemic, Bostwick said is it blew the barriers out of the water and pulled everyone together to do what needs to be done.
“Those relationships have continued and I have no doubt it will continue into the future. It’s a very big positive outcome for a very stressful year and a half,” she said.
State statistics
The Baker Act Reporting Center at the University of South Florida tracks admissions statewide.
According to its last annual report, for 2018/2019, there were 210,992 Baker Act examinations. The report also states that the statewide Baker Act examinations increased in that reporting period 19.20 percent for all ages, 24.80 percent for children younger than 18 years old and 15.45 percent for those 18 to 24 years old from fiscal year 2013-2014 to fiscal year 2018-2019. From fiscal year 2017-2018 to 2018-2019 statewide Baker Act examinations increased 2.53 percent for all ages, 5 percent for children, 1.23 percent for 18 to 24 year old.
For Baker Act examinations in fiscal year 2018-2019 17.95 percent were children and 73.33 percent were for adults 18 to 64 years old. The examinations that were initiated by law enforcement was 51.34 percent and 46.45 percent imitated by professional certificate. The report also stated that 65.54 percent physicians who are not psychiatrists were the most common health professional to initiate the exam.