In order to keep Tyana safe, Hunter sets alarms on her doors and windows to alert her if Tyana tries to leave. But on this day, the alarm wasn’t set, and Tyana jumped from the second-floor apartment window. Tyana wasn’t physically harmed, but Hunter was at a loss for how to keep Tyana safe. Hunter called Tyana’s social worker.

“They told me to take her to the hospital,” Hunter said.

Hospitals don’t offer the type of care Tyana requires: that is, staff trained in helping kids with autism; and safe spaces for bathing and exercise. But Tyana spent five days in the emergency room, nonetheless. And, with nowhere else to go, she’s been back to the emergency room about five times since that event.

One part of Hunter feels relieved when the ambulance shows up. She knows that Tyana will be physically safe in the emergency room, with someone guarding her to make sure she doesn’t run away. But Hunter also knows that the hospital is not equipped to take care of Tyana’s complex needs.

“You have no other choice,” she said.

Tyana’s experience in the hospital is known as “boarding.” The kids in these situations fall into two categories: those with developmental disorders, such as autism and attention deficit hyperactivity disorder (ADHD); and those with mental-health conditions, such as depression and anxiety. When parents or guardians call 911 in response to a child in crisis, an emergency department will admit the child. (It’s a federal law.) But most hospitals do not have the resources or expertise to care for these patients.

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When kids are boarded, as Tyana was, they’re kept wherever the hospital can find space: in a windowless exam room meant for short-term stays; in a hallway; in a room on the pediatric medical floor; etc. They will receive 24/7 supervision for their physical safety–and perhaps no other treatment.

The number of children and adolescents boarding in Minnesota hospitals has climbed steadily over the past several years and shows no signs of slowing. In 2023, over 1,000 kids in the Twin Cities boarded in emergency rooms operated by the major health systems: Allina, Children’s, Fairview, and Hennepin Healthcare.

Experts say a disproportionate number of these kids are in the foster-care system or county custody, and a disproportionate number are Native American or Black.