Paradigm Shift Brightside Shuts Down Residential, School Programs Due to Low Demand

Over the course of 130 years, any community health program will shift its focus multiple times to meet changing needs. Brightside for Families and Children is no different, says Mark Fulco.

Specifically, Brightside — the West Springield-based arm of the Sisters of Providence Health System (SPHS) that provides behavioral health and education services for young people — will cease operations in its residential and school programs by April 2. The decision is due largely to what Fulco, senior vice president of Strategy and Marketing for SPHS, calls a “paradigm shift” in the way child-welfare programs are structured and delivered these days.

“There has been a precipitous drop statewide in referrals to longer-term, residential facilities like Brightside,” he told The Healthcare News. “In 2005, we had more than 1,200 placements, but that dropped to 700 in 2008. And it’s not just Massachusetts; we’ve seen this in other states as well.”

These latest placement numbers, he explained, represent a fraction of Brightside’s capacity. And despite extensive efforts to increase referrals to Brightside, SPHS does not expect the a reversal of that trend.

“Over the past two years, the Brightside management team has worked tirelessly to reduce overhead and operating costs, and find new sources of program funding and referrals to maintain the census level and viability of those services,” Fulco explained. “But it appears that the census levels can never improve to viable levels, and the funding sources just are not there to place children in residential programs and school programs like those operated by Brightside. That’s the harsh reality.”

Times Change

Brightside was born in 1881 as an orphanage, and has grown over the years to become a prominent provider of residential and outpatient services for children with behavioral or family issues. But in recent years, Fulco explained, 75{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all children requiring such services from the state have been placed into foster care or treated in their own homes, and reliance on residential-care services such as Brightside’s has been on the decline.

“Even our long-term residential program has always operated with the goal of assimilating children back into the regular school system and back into their homes. That’s always been the goal,” Fulco said. “What the child-welfare system has changed is that long-term residential care is no longer seen as a principal modality. What they prefer to do is utilize community-based placement for children, whether that’s back into the home or foster care. The child stays in the public-school system, and services are wrapped around that community setting.”

“So we’ve seen a preference for keeping children based in the community, utilizing foster care and other placements,” he said. “But we’ve also seen a growing need for community services like our Family Stabilization Team.”

The FST is what Fulco called the “third leg” of Brightside services, and the only one that will remain intact after the closing of the residential and school programs. The FST provides outpatient services in conjunction with the inpatient Child and Adolescent (CHAD) and Acute Residential Treatment (ART) programs at Providence Behavioral Health Hospital, another Sisters of Providence facility.

“Rather than long-term residential care, there still is a need for short-term, or acute, residential treatment for children being released from a psychiatric facility or at risk of being admitted to a psychiatric facility,” Fulco said. “We operate, through Providence, the state’s only inpatient psychiatric facility for children west of Boston, and we’ll continue to provide that service. We’ll continue to provide the third leg of Brightside’s programs, community-based programs, through the Family Stabilization Team.”

Transition Game

The decision to shutter the residential and school programs, which Fulco called “difficult but necessary,” most immediately affects two groups of people — current residents and employees — and SPHS is taking steps to ease the impact on both.

The transfer of all of Brightside’s residents and students to alternate settings will be completed by the beginning of April, he explained, adding that the best interests of the children continues to be the top priority, and transitioning them to a safe environment will be accomplished in a minimally disruptive manner.

“Our primary concern at this point is for the safety and well-being of the children currently at Brightside,” Fulco said. “We’re working with the applicable state agencies to care for the children and ensure quality education for the children currently in our care and ensure that the transition to an appropriate setting for each child is as seamless and well-coordinated as possible.”

The matter of 133 Brightside employees losing their jobs is another challenge the health system is taking seriously, he added. “In addition to making sure the needs of the kids are met, we’re very involved in providing assistance to our employees. They’ve been invited to apply for other positions within SPHS, and we’re also helping them identify new opportunities outside SPHS with significant outplacement services.”

Once these two challenges have been addressed, Fulco said, the health system will set about examining how to restructure the child and adolescent services that remain.

“The Family Stabilization Team, the third leg, will continue to provide existing services,” he said. “Providence includes an acute residential treatment program, and that must be integrated into the Family Stabilization Team and the remaining Brightside operations. It needs to be a very logical integration of programs that allows us to continue to provide mental-health and family-support services.”

That can wait, of course, until the current residents find new homes.

“Our primary focus is transitioning the children and providing assistance to our employees. Then we can really shift attention on restructuring Brightside services in conjunction with Providence and the ART,” he said.

“We’ve done some planning for how to restructure our services, and SPHS remains committed to providing care for children afflicted with psychiatric, behavioral difficulties. The structure is going to change a little bit, but the safety, health, and well-being of the kids is our primary concern.”

Continuing Mission

Fulco asserted that the work of the Family Stabilization team will remain relevant because demand for that type of outreach has grown alongside the drop in demand for residential services.

“Brightside has repeatedly evolved to meet the changing needs of children in the community,” he told The Healthcare News. “Today, the realities of how those programs are delivered and how those services are funded requires a significant shift in Brightside’s organizational function, and a dramatic change in our approach.

“Brightside’s commitment to caring for children afflicted with psychiatric, emotional, and behavioral difficulties will continue,” he added, “by responding to the current demand for short-term acute services and those designed to avoid longer-term residential stays.”

The Brightside story, in other words, is still being written.