When it comes to finding help for Hamilton County's most troubled teens, five public agencies spend more money on out-of-town services than they do for local treatment.

        The spending imbalance reflects a shortage of long-term, intensive services for teens that was detailed Dec. 3 by the Enquirer. And it raises questions about how best to spend millions in local tax money.

        Many parents and experts say teens with severe mental illness and substance abuse problems would benefit if Greater Cincinnati had more local residential treatment options. They say some teens have such complex and extreme problems that they need to live for months, even years, in carefully controlled settings.

        But some agency leaders say that expanding residential services in Hamilton County would be difficult and expensive — so expensive that it could require tax increases.

        “Yes, we need more residential services for what we call high-end kids. But how many more beds, I can't say,” said James Mason, executive director of Beech Acres, one of the county's largest youth service agencies.

        “The level of disturbance in these kids has risen over the years. And the sheer quantity has grown, here and throughout the U.S.,” Mr. Mason said. “But do these kids have enough common problems? Can a local facility be sustained?”

        Local concern about mental health services for teens comes amid a nationwide re-examination of mental health services for children. Today, the U.S. surgeon general is scheduled to release a national “action agenda” on childhood mental health.

        Hamilton County, the area's most populated county, has the biggest problem with finding services for troubled teens. But it is hardly alone.

        The lack of local services means that agencies in every other county in Southwest Ohio and Northern Kentucky also need to send troubled teens out-of-town if they need residential treatment.

        Since 1998, Beech Acres has managed an unusual program called Creative Connections. The program pools nearly $12 million a year from five Hamilton County agencies: Department of Human Services, Juvenile Court, Mental Health Board, Alcohol and Drug Addiction Services Board, and the Mental Retardation and Developmental Disabilities Board.

        While these agencies collectively serve several thousand children a year, the money going to Beech Acres pays for the 286 most complicated cases.

        Of more than $11 million spent by Creative Connections in fiscal 2000 (ended June 30), more than $6.6 million, or 59 percent, was spent sending 58 youths to Louisville, Columbus and other out-of-town treatment centers.

        Four youths received residential treatment in Hamilton County.

        Creative Connections spent the rest on 224 other children, who received daylong counseling, in-home treatment and other types of outpatient service.

        Consumer advocates have said local residential treatment is better for teens and families because it is easier for parents to visit children, to participate in group counseling and to arrange follow-up care.

        Local programs might be cheaper than out-of-town agencies.

        But even if local services do not save money, expanding the programs would still result in sending less local tax money out of town.

        Whatever the potential benefits, those interested in expanding residential treatment face several challenges, said Patrick Tribbe, president and chief executive of the Hamilton County Community Mental Health Board:

        • A residential program has to hire hard-to-find expert staff. For every child psychiatrist in the United States, there is enough demand for three more, according to a White House Conference on Mental Health held last year.

        • Burnout is common among social workers. In some agencies, turnover among social workers is as high as 60 percent per year, Mr. Mason said.

        • A new residential treatment center has to find a location that won't stir controversy among neighbors.

        Then it has to make ends meet.

        So far, Beech Acres has lost money running Creative Connections, Mr. Mason said. It gets about $12 million from the five county agencies but spends nearly $18 million on the program.

        The gap has been covered by Beech Acres' private endowment, but that support cannot last indefinitely, Mr. Mason said.

        The high cost of treatment, plus future concerns that America's growing teen population will increase the demand for services, raises the question of tax increases. A five-year levy for children's services comes up for another vote later this year. A county mental health levy comes up for a vote in 2002.

        Right now, the mental health board is debating how to pay for high-end teen care while still serving the growing number of families that cannot afford treatment for children with less severe emotional and behavioral problems, Mr. Tribbe said.

        It remains too early to say whether the Mental Health Board will seek a tax increase, Mr. Tribbe said. But one way or another, society pays for dealing with troubled teens, be it treatment or jail, public subsidy or private insurance, in-town or out-of-town care.

        “In the early 1990s, we didn't do the job we should have been doing for kids. Now, we're starting to learn what the costs really are,” Mr. Tribbe said. “We all have some decisions to make ... the county commissioners, the public, and the private insurance system.”

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