Therapeutic Group Homes: Needed Programs in Danger from Family First Act

Greenacres
Image: Greenacrehomes.org

It is a fact universally acknowledged that some children cannot thrive in foster care. This includes children whose behaviors are so challenging that most foster parents will be unable to cope. These children often go through many foster homes before they are finally placed in a more appropriate placement, usually a therapeutic group home or residential treatment program.

One of the goals of the Family First and Prevention Services Act (FFPSA), passed last year as part of the Bipartisan Budget Act of 2018), was to reduce the use of placements other than relative homes and traditional foster care. However, FFPSA recognized that some children and youth cannot thrive in foster care and allowed for placements to meet their needs. Unfortunately, the many restrictions imposed by theAct mean that many of these young people may not able to access these facilities or will be prematurely removed from them.

Many youth who are placed in foster care have serious emotional and behavioral issues. Many have endured years of trauma, including physical and sexual abuse, severe neglect, and living in dangerous and chaotic conditions. Some have cognitive or neurological issues caused by drug exposure in utero or severe neglect. Some have violent outbursts, many are verbally aggressive, and many have difficulty in making attachments. As a result of these problems, many of these hard-to-place young people have been placed in ten or more foster homes.

High-quality therapeutic group homes are more able than foster families to work with challenging youth for a number of reasons described in an excellent video from the Sonoma County Juvenile Justice Commission. Their staff are trained in working with behaviorally challenging youth and often operate from a trauma-informed perspective. These facilities often have therapists and psychiatrists and other mental health personnel on staff. Good therapeutic group homes create a homelike environment, with young people living in cottages with a total of six or eight youths. Staff are dedicated and passionate about what they do. Unlike foster parents, these staff usually work shifts and thereby avoid burnout. Residents also draw strength from peers with similar issues, especially older peers who have improved and can serve as role models.

Some hard-to-place youth could thrive in the right kind of foster homes, those with training, time, and willingness to work with young people whose behavior is challenging. But many foster parents refuse to take teens or any or children with behavioral or mental health problems. Some states are trying to increase the availability of therapeutic foster homes, but funding and supply constraints mean that such efforts will be far too small to replace therapeutic group homes.

Unfortunately, the restrictions imposed by FFPSA may make it difficult to for many needed therapeutic group homes to continue operating. FFPSA allows the federal government to share the costs of treatment-based congregate care only at facilities that qualify as Qualified Residential Treatment Programs (QRTP). These programs must meet several criteria, including accreditation, a trauma-informed model, medical staff on call, and an aftercare program, among others. Accreditation especially is a long and arduous process that generally takes 12 to 18 months and some homes may not be able to accomplish it by the time the Act takes effect on October 1, 2019 (unless the state chooses to delay implementation for two years). Accreditation is a difficult and costly requirement for a smaller facility. It is important to ensure that only high-quality group homes retain state contracts, but accreditation may not be the best way to ensure quality for smaller programs.

Even more concerning are the limits on which children can be placed at these facilities and for how long. A child’s initial placement in a QRTP will not be reimbursed unless a “qualified professional” determines within 30 days of placement that the child needs to be placed in such a setting rather than a relative or foster family home.  This assessment must use an approved tool and be conducted by “a trained professional or licensed clinician who is not an employee of the State agency and who is not connected to, or affiliated with, any placement setting in which children are placed by the State.” The decision must be approved by a court within 60 days and must be reviewed at subsequent status hearings. Moreover, a child cannot remain in a QRTP for more than 12 consecutive months (or 6 months for a child under 13) without written approval from the head of the agency.

There are several problems with these restrictions. It is not clear that agencies can find enough qualified professionals who are not employed by the agency or connected to any placement setting used by the state. More concerning are the time limits. Many therapeutic group home professionals believe that most children with emotional and behavioral problems cannot be in and out of therapeutic residential settings in six months. Many will need to stay a year or even longer.

Without needed therapeutic group homes, many children will experience a string of failed foster home placements, with each one leading to further damage to the child, who may end up on the streets or in jail. As a director of a facility that closed in North Dakota put it, new policies mean that “You are only going to refer kids to (residential child care facility) levels of care after you have exhausted all the other less restrictive options of care. That means putting them with their families, in foster care and repeating failed foster care placements several times before a referral to this level of care would be entertained.”

Group homes have already been closing around the country as states have adopted policies against congregate care (and also due to failure to provide adequate funding) and some states are already seen bad consequences from these closures. In Baltimore, the number of children sleeping in offices shot up from less than five per six month period in 2015 to 130 in the first half of 2018 due to a shortage of foster homes and a dramatic reduction in group home capacity. In Hillsborough County, Florida, hard-to-place foster youths have been spending the night in cars for lack of appropriate placements. In the state of Washington, group homes have been shutting down for years due the state’s failure to keep up with the increasing costs of care. This has contributed to a crisis in care for older, harder-to-serve youth, who are being put up in hotels, offices and $600-per night emergency foster homes and being sent out of state for care. In Illinois, hundreds of foster youths were being kept unnecessarily in psychiatric hospitals as of last August because of a decline in licensed residential facilities.

The attempt to close congregate care facilities without providing an alternative is eerily reminiscent of the closure of institutions for the mentally ill in the 1960s. These hospitals were supposed to be replaced with community health services that were never funded. We are still reaping the consequences with the abundance of mentally ill people sleeping on the streets of America’s cities.

As I mentioned in last week’s post, FFPSA’s group home restrictions were not based on ideology alone. The cost savings from reducing federal reimbursement for group homes were necessary to offset the increased cost of funding services to prevent children’s placement in foster care. But penny-wise is often pound-foolish and the future costs of eliminating therapeutic residential options for foster youth may be much greater than the present savings.

It is not too late for Congress to amend the Family First Act to reduce restrictions on therapeutic group care. Until we have an abundance of qualified therapeutic foster parents willing and able to take the hardest to place youth, cutting down on therapeutic group homes is irresponsible, short-sighted, and a recipe for possible disaster.

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Supporting home-like residential settings: a needed correction to the Family First Act

CrossnoreWith the passage of the Family First Prevention Services Act as part of the Bipartisan Budget Act of 2018, much attention has been paid to Part I, which allows jurisdictions to use federal foster care money to pay for services to a family to to prevent a child’s entry into foster care. Part IV of the Act, which drastically restricts federal reimbursement for placements other than relative homes and traditional foster care, has received less coverage.

Placements that are not in the homes of relatives or foster families are often described as “congregate care.” The term is generally used to include group homes, residential treatment, maternity homes, and other placements that are not a family home. As these placements have fallen out of favor, this label has taken on a pejorative tone.

The Administration on Children and Families stated in 2015, that

Although there is an appropriate role for congregate care placements in the continuum of foster care settings, there is consensus across multiple stakeholders that most children and youth, but especially young children, are best served in a family setting. Congregate care should be a temporary placement for young people with behavioral or mental health issues who need therapeutic services in order to become stable enough to return to a family setting.

FFPSA enshrines this view by denying federal funding for placement in congregate care settings beyond two weeks, unless the setting meets criteria for a Qualified Residential Treatment Program (QRTP) as defined by the Act. These include accreditation, a trauma-informed model, medical staff on call, and an aftercare program, among others.

Moreover, a child’s initial placement in a QRTP will not be reimbursed unless a qualified professional determines within 30 days of placement that the child needs to be placed in such a setting rather than a relative or foster family home.  This assessment must use an “age–appropriate, evidence-based, validated, functional assessment tool approved by the Secretary”  and the conclusion must be approved by a court within 60 days and must be reviewed at subsequent status hearings. A child cannot remain in such a setting for more than 12 consecutive months (or 6 months for a child under 13) without written approval from the head of the agency.

Keeping all but the most troubled children out of congregate care would make sense in a world with enough great foster homes to accommodate all children, including large sibling groups. But we are far from having such a world. In most states there are not enough foster homes, even including bad and indifferent ones, to accommodate all the children in need. And that means some children staying in congregate care, some in hotels, and others bouncing from one unsuitable home to another.

The shortage of foster homes is no secret, which is why foster home recruitment has been such a big topic in child welfare circles. Unfortunately, there is no sign that any of the highly-touted and often-expensive new efforts taking place around the country will make a dent in the gap between demand and supply. Society is changing in many ways, including the influx of women into the workforce,  and there are simply not enough people who are willing and able to provide foster care in the same areas where it is needed.

Yet there is another model of foster care that has not drawn sufficient attention and is in great danger from the implementation of FFPSA. These are residential homes and boarding schools providing “residential (home-like) non-treatment related services to children living away from their families,” according to the Coalition of Residential Excellence (CORE), which represents such programs. These programs often consist of one or more cottage-style homes with live-in cottage parents, with or without an onsite school.  Some of the well-known examples are the Crossnore School and Children’s Home in North Carolina, the Connie Maxwell Children’s Home in South Carolina, the San Pascual Academy in San Diego, A Kid’s Place in Tampa Bay and the Florida Sheriff’s Youth Ranches.

Like QRTP’s, these residential programs are generally accredited, seek to involve families, and provide aftercare services, and they often have a trauma-informed model of care. But because these programs are not designed for children with severe behavioral problems who could not flourish in foster care, they cannot receive reimbursement under FFPSA.

So what is the problem? Couldn’t the children in these programs do equally well in traditional foster care?  There are numerous reasons why that may not be the case.

  1. There are simply not enough foster homes. If cottage-based residential facilities can no longer take children, that will worsen the situation and will lead to more stays in hotels, offices, sibling separations, and foster homes that are not well-matched to children’s needs. Unfortunately, FFPSA specifically says that “a shortage…of foster family homes shall not be an acceptable reason for determining that the needs of the child cannot be met in a foster family home.”
  2. Due to the scarcity of foster families, few jurisdictions can afford to be choosy enough about whom they accept and retain. And that is why we never stop hearing stories of abusive foster homes that were not closed despite numerous complaints. And that is why every foster care social worker (and former workers like myself) can tell you multiple stories about foster parents who simply don’t care. They may not be abusive or neglectful, but they won’t lift a finger to take the doctor, visit their schools, or drive them to and from extracurricular activities. Of course there are many great foster parents, who treat their charges as their own children but these are a minority. Many foster homes are only slightly less deprived or chaotic than the homes from which the children were removed. When you contrast these homes to the enriched environments of a place like Crossnore (with its house pets, rope-based adventure playground, on-site school, medical care, and 19 kinds of therapy (including equine assisted therapy), it is hard to imagine anyone preferring an indifferent foster home.
  3. Many children must be separated from their siblings because most foster homes cannot take larger sibling groups. Many residential cottage-based programs like Crossnore, the Florida Sheriff’s Youth Ranches,  and A Kid’s Place in Florida pride themselves on taking large sibling groups.
  4. Even the best foster parents can have trouble making sure the children’s needs are met in school and coordinating the wide variety of educational, mental health and medical services the child may need. Many of these residential facilities, benefiting from private donations, provide high-quality mental health services  and extracurricular activities on site. Those that have schools provide a seamless integration of home and school and education tailored to children’s needs and saving transportation time and funds.

Richard McKenzie, a professor of economics who grew up in an orphanage in the 1950’s, responded to the contention that children always do best in loving and responsible families as follows: “Well, duh! Clearly, families are the bedrock of all societies. The basic problem in child welfare is that many parents, biological and foster, are far from loving and responsible. Indeed, many are derelict in their duties.” (His article, The Success Story of Orphanages, is well worth a read.)

So why is Congress, along with other federal and state policymakers, so oblivious to the benefits of family-like residential settings? It is clear that the high cost of residential care contributed to Congress’ eagerness to restrict it. Savings from Part IV of FFPSA were needed to offset the cost of adding services under Part I. But cost comparisons are often deceptive and short-sighted.  Residential home-like programs provide therapists, case managers, after-school activities, and more. Moreover, they bring in substantial private funding in addition to state support. And the future savings that come from providing high-quality, trauma-informed care and education will doubtless reduce future expenditures caused by dropout, crime, and drug abuse.

CORE supports amending FFPSA to treat residential programs that use a house parent model as foster homes for the purpose of federal reimbursement. It is essential that Congress make this improvement this year before the provisions of FFPSA take effect in October. (A state can delay implementation for two years, which means it foregoes receipt of TItle IV-E funds for in-home services for the same period).

Cutbacks on residential programs have already resulted in sibling separations in states like California. From 2006 to 2015, Sonoma County Children’s Village was a haven for 24 foster children who lived in four homes, with surrogate grandparents living on campus. But after California began to limit group home placements to children requiring high levels of care, the village had to close.  Sixteen children, including a group of seven siblings, had to leave. Let us hope that Congress will have the compassion to prevent such senseless actions from taking place on a national scale.

Family First: A “Reform” that Isn’t

Family FirstBy now most readers will know that Congress passed the Family First Prevention Services Act (FFPSA) as part of the continuing resolution to fund the government until March 23. The passage of this major legislation as part of a continuing resolution marks the final victory of an ideological agenda that has taken over the child welfare advocacy community.

FFPSA was drafted in secret without feedback from stakeholders such as state and county child welfare administrators, many of whom expressed opposition to the bill or at least concern about its consequences.  After several failed attempts to pass the bill over a two-year period, it was finally passed as part of a continuing resolution that was urgently needed to fund the entire government and avert a shutdown.

If we had a more pluralistic intellectual landscape in child welfare, FFPSA might have looked very different. Any bill calling itself “child welfare finance reform” should have started by addressing the most egregious flaw in child welfare financing–the linkage between Title IV-E eligibility and eligibility for the long-defunct AFDC program, which was terminated in 1996.

As a result of this linkage, fewer children are eligible for Title IV-E assistance every year, and states spend millions of dollars on the useless exercise of verifying eligibility for every child entering the system, as described by Sean Hughes in the Chronicle of Social Change. Yet, the advocacy community, in its single-minded quest to reduce the foster care rolls, gave up the fight to de-link foster care from AFDC.

Instead, the goal of “finance reform” became expanding the use of Title IV-E funds to included what the Act calls “prevention services.” These are not services to prevent abuse and neglect, but rather to prevent a child’s entry into foster care once that abuse or neglect has already occurred. FFPSA allows the use of these funds to fund parenting education, drug treatment and mental health services for parents.

Most of these “prevention” services logically belong to other systems, such as drug treatment and mental health, and are also funded by Medicaid. But prevailing ideology favors diverting foster care funds to other purposes, ostensibly to encourage prevention. In the most recent display of this ideology, the President and CEO of Casey Family Programs testified last week that “for every $7 the Federal government spends on foster care, only $1 is spent on prevention.”

No footnote was provided, but it appears that Bell was restating a common refrain that compares Title IV-E foster care expenditures with spending under Title IV-B, that is used mostly for in-home services. This comparison fails to take into account all the services provided by other programs, such as Temporary Assistance for Needy Families, Social Services Block Grant, the Child Abuse Prevention and Treatment Act, Medicaid, the Maternal Infant and Early Childhood Home Visiting Program and the Comprehensive Addiction and Recovery Act. Most of these programs are insufficiently funded, but it makes sense to increase their funding rather than divert funds that were designed to help good Samaritans meet the needs of the children they have volunteered to care for temporarily.

This view that a foster home is always better than a congregate (non-family) placement is another part of the prevailing ideology in child welfare. Congregate placements also happen to be more expensive, making restrictions on congregate care a perfect offset to FFPSA’s increased costs. It’s very convenient when ideological correctness coincides with saving money! Unfortunately, restrictions on congregate care may be harmful to children when there is a foster home shortage and so many of today’s foster homes are inadequate, as I described in my last column.

The lack of robust conversation and debate in the child welfare advocacy community has resulted in a “reform” that will create more problems than it solves. Our most vulnerable children deserved a better outcome.

 

 

 

 

 

 

The Family First Act: A Bad Bill that Won’t Go Away

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Some bad ideas just won’t go away. The Family First Prevention Services Act (FFPSA) is rearing its ugly head yet again. The act, which failed to pass the Senate in 2016, has been incorporated into the continuing appropriations bill passed by the House of Representatives on February 6.

Chapter I of the Act, billed as “Investing in Prevention and Family Services,” would allow Title IV-E funds to be used to fund services meant to keep children out of foster care, including mental health and substance abuse treatment, parent training and counseling, and kinship navigator programs.

The general idea of allowing Title IV-E funds to be used for services to prevent foster care placement makes sense. (I prefer to call these family preservation services rather than “preventive services” because true preventive services would seek to prevent maltreatment before it occurred, rather than preventing removal from the home after maltreatment has already occurred.)  But the bill limits the list of services funded to mental health, substance abuse treatment, and parent education and training. It does not include services like domestic violence prevention, peer mentoring or support groups, crisis intervention, housing assistance, and many others that could be crucial to keeping families together.

Chapter II of FFPSA is billed as “Ensuring the Necessity of a Placement that is Not in a Foster Family Home.” This chapter would forbid federal reimbursement for a placement other than a foster family home (often called “congregate care”) beyond two weeks without an “age-appropriate, evidence-based, validated functional assessment” using a tool approved by the Secretary of Health and Human Services to determine that the child’s needs cannot be met “with family members or through placement in a foster family home.” Such placements must also be approved by a court within 60 days. The bill also establishes stringent requirements that must be met by agencies seeking to qualify for reimbursement, including on-site nurses, for example.

This approach is problematic for two reasons.

First, we don’t have enough foster homes. States around the country are reporting foster home shortages. Reports of children being housed in offices and hotels have come from California, Texas, Oregon, Kansas, and Georgia, Tennessee, and Washington DC. With group homes closed, this problem will only worsen.

The attempt to close congregate care facilities without providing an alternative is eerily reminiscent of the closure of institutions for the mentally ill in the 1960s. These hospitals were supposed to be replaced with community health services that were never funded. We are still reaping the consequences with the abundance of mentally ill people sleeping on the streets of America’s cities.

Nevertheless, the authors of the Family First Act made sure to specify that: “A shortage or lack of foster family homes shall not be an acceptable reason for determining that the needs of the child cannot be met in  a foster family home.” One wonders where these children should go but perhaps the sponsors don’t care. It is the states and counties that will find a place for the children, even if the federal government does not pay a share.

Second, we don’t have enough good-quality foster homes. Anyone who works with foster children and parents knows that a minority of foster parents do a spectacular job, treating their charges like their own children. But many of the other homes barely improve upon the abusive or neglectful homes the children were removed from.

I’m talking about foster parents that never visit the child’s school or transport them to activities, insist that the social worker to take them to the doctor and therapist, refuse to meet the child’s birth family, and siphon off part of the foster care payment for their own purposes. These children need extra love, support, and enrichment, not the bare bones of room and board and nothing else.

The widespread simplistic belief that a foster family home is always better than a non-family setting has been promoted widely with heavy support from ideologically driven funders and advocates including the Annie E. Casey Foundation and Casey Family Programs. These groups employ slogans like Every Kid Needs a Family, ignoring the fact that most children entering foster care do have a family that they want to return to, and would not necessarily prefer being placed in a family of strangers rather than an educational or group setting where they can receive the enrichment they need while awaiting reunification.

Research supports the idea that quality is more important than the type of setting, and that high-quality group care can have even better outcomes than high-quality foster home care. Moreover large sibling groups can often be kept together only by placement in a non-family setting.

It is hard to understand that anyone believe that a loveless, bare-bones foster home is better than an idyllic environment like the Crossnore School in North Carolina, where foster children  (including sibling groups) benefit from dedicated cottage parents, an onsite school, and multiple forms of mental health treatment, including equine-assisted therapy. But the bare-bones foster home has one advantage over Crossnore. It is much cheaper.

Clearly, legislators want the savings from eliminating non-family options to offset the increased costs imposed by the expansion of Title IV-E to include preventive services. The Congressional Budget Office estimated that the restriction on non-family placements would offset almost 70% of the costs of extending IV-E reimbursement to family preservation services, over a ten-year period.

It is not surprising that government officials in the three states with the largest foster care populations–California, New York, and Texas, have all expressed concern about or opposition to the Family First Act. Other states have expressed their opposition as well .

Aside from a pair of hearings that were orchestrated by the bill’s sponsors to support their vision for the legislation, there have been no hearings or floor debate on the Family First Act. Last year, it passed the House by voice vote, and its Senate sponsors tried to get it through without a vote before going on summer recess. They failed, thanks to courageous Senators who cared about children enough to resist pressure from the powerful coalition supporting the bill.

Lets hope that the same wise and courageous Senators make sure this dangerous legislation is not allowed to slip into law in the urgent effort to pass a continuing resolution. Lets not save money on our most vulnerable kids. Spending money on better placements now will surely reap savings down the road in crime, unemployment, and welfare receipt.

 

Grabbing the Wrong End of the Stick on Educational Stability for Foster Youth

vanFor decades, children in foster care have endured multiple school changes as they moved between foster homes and other placements. With each move there is another school placement, with some children and youth changing schools several times in the same year. This is not a satisfactory situation, especially because many children who are placed in foster care have already endured many school changes and long periods of absence from school, leaving them already behind academically.

But in order to bring about educational stability for foster youth, legislators  have grabbed the wrong edge of the stick. Rather than keeping foster youth near their original schools, Congress has passed legislation requiring education and child welfare agencies to transport children from new foster homes and placements to their former schools, no matter how long it takes and how much it costs.

The Every Student Succeeds Act  (ESSA) requires school systems to transport foster children to their original schools “whenever it is in their best interest.” There is nothing wrong with the legislation as written. Clearly, young people should be transported to their original schools if it is in their best interest. The question is, when is it actually in a child’s best interest to be transported to their original school?

Is it in their best interest to be in a van for up to four hours a day as the driver stops to pick up different children going to different schools? Is it in their best interest to be transported by a private services that gets them to school late daily? Is it in their best interest to be unable to participate in extracurricular activities because they have to be picked up right after school ends? Is it in their best interest to spend agency money that could be used for tutoring or therapy on transportation? These are all common problems that I observed as a foster care social worker in the District of Columbia when the children on my caseload were being transported to their original schools from their Maryland foster homes.

Some child welfare agencies, advocates,  and journalists seem to think that being transported to their original schools is always in the best interests of foster children.  But those who work directly with foster youth know better. As Margaret Henry, a Los Angeles Superior Court Judge, wrote in a powerful column, “Why spend money transporting children for hours to their home school, instead of working harder and more creatively to find them placements in their home school’s district?”

The contradictions of this backwards approach to educational stability are illustrated by a recent case that could have major implications for the education of foster youth nationwide, according to Dan Heimpel of the Chronicle of Social Change. “V. Doe” entered foster care in Rhode Island at the age of six in 2005 and had moved a dozen times by 2017. In May 2017, while she was living in a group home in North Smithfield, RI, the school district decided to move her to a special school for youths with disabilities and mental health issues after she had several altercations with other students at her high school.

Reportedly, V. Doe began to thrive at the new school and completed her junior year, hoping to graduate in 2018. But Rhode Island’s Department of Children, Youth and Families (DCYF) decided to move her into a foster home–a placement that soon disrupted. Rather than returning her to the original group home (perhaps it was full?), she was moved to a residential facility in another school district.

DCYF determined that it was in V. Doe’s best interest to stay in the North Smithfield School. The North Smithfield school district agreed but (reasonably) refused to pay now that V. Doe was no longer living in there (and had been there for less than a year). DCYF filed a petition with the State Department of Education arguing that the district’s action violated ESSA. The Education Commissioner agreed and required that she be re-enrolled immediately at the private school, with North Smithfield picking up the costs.

The advocates who are praising this solution seem to be missing some key points about what caused the problem and who is paying for the fix.

A DCYF youth who has bounced between foster homes and group placements a dozen times was finally thriving in a group home and a specialized school. Why did DCYF choose to move her out of the district just before her senior year in high school?  Could V. Doe be a victim of the fashionable assumption that “every child needs a family,” which not coincidentally happens to save money for the state as well? Unfortunately, V’s placement in the foster home did not last and now she was stuck in a new group home. The premature removal of young people from group care, to be placed in homes where they will be shortly kicked out, is also something that I observed as a social worker in foster care.

And then there is the issue of who pays the costs of DCYF’s mistake. V. Doe moved and out of multiple school districts in a demented game of musical chairs. The district that finally found a school that was right for her got stuck paying the costs until graduation. Wouldn’t it make more sense to have a centralized state fund (in either the education or child welfare department) for foster youth in this situation?

The backwards approach to educational stability embodied in ESSA is reminiscent of other false fixes for foster care, like legislation attempting to solve the shortage of foster homes by requiring more training for foster parents. It is not a coincidence that these approaches are often easier and cheaper (at least for the child welfare  agency) than policies that would get to the root of the problem. Instead, policies should aim at finding placements that are closer to students’ original schools . Readers wanting examples of better policies can see my recommendations and those outlined in Judge Henry’s column.

 

No place for the children: A therapeutic group home closes while foster children sleep in hotels and offices

In my last post, I wrote about Washington State’s critical shortage of foster parents, which is rRuthDykemanCenteresulting in children staying in offices, hotels, and by-the-night foster homes. One of my suggestions was to reinvest in quality group care settings. Unfortunately, the state (along with most of the country) is moving in the opposite direction.

KUOW, Seattle’s public radio station, recently  reported on the closure of a group home that provided therapeutic care to  foster children with “severe behavioral problems and emotional needs.” At the Ruth Dykeman Children’s Center in Burien, Washington 15 children lived in lakeside cottages supervised by staff members, with nurses and psychologists on call.

Unfortunately, foster care ideology has changed and now any family setting seems to be considered better than any  group  setting, regardless of the needs of the child and the quality of the placement. The fact that group settings are more expensive than foster family homes might have something to do with this new bias.

Unfortunately, the type of children that were housed at Dykeman don’t do well in family foster care. Children with behavioral problems and emotional needs tend to bounce from one foster home to another, their behavioral problems worsening with each move.

Nevertheless, group homes have been shuttered around the country. In Washington  state, according to Investigate West, “stagnant reimbursement rates have forced many facilities that contract with the state to reduce capacity or shutter altogether.”

The CEO of Navos, the mental health nonprofit running the Dykeman home, told KUOW that ending the contract for foster care was a source of great anguish to the leadership. But it was not financially sustainable. The nonprofit had been paying more than half the cost of running the home for years.

The Dykeman Center is not closing, but it is now off-limits for foster kids. It will now serve long-term inpatient psychiatric care, which is reimbursed at two to three times the rate, according to KUOW.

Now, the fragile children from the Dykeman Center will be competing with less troubled but still vulnerable foster youth for the dwindling supply of foster homes. Some may bounce from home to home, perhaps spending nights in hotels or pay-by-the-night foster homes where they have to be dropped off late in the evening and picked up early in the morning. Some have already been sent out of state, according to KUOW.

It is hard to conceive of a reality where this makes sense. But in the looking-glass world of foster care, ideology and money-saving work together to trump common sense and common humanity.

$600 for overnight foster care? Time to consider the alternatives

Washington State’s Children’s Administration (CA) is desperate. In order to avoid lodging abused and neglected children in hotel rooms or agency offices, it has increased to $600 per night the amount it is willing to pay foster parents to keep children in their homes for one night in emergency short-term situations, according to the independent news organization InvestigateWest.

Washington’s placement crisis is being driven by a large decrease in the number of available foster homes combined with an increase in the foster care population that coincides with a ballooning heroin and opioid addiction epidemic.

But even $600 overnight fees cannot generate an adequate supply of beds for Washington’s foster children. The state reported a total of 236 hotel stays in August 2017, at the remarkable cost of about $2,100 per night including the cost of paying two social workers and sometimes a security guard to supervise the children.

Washington may be unique in paying $600 per night, but the same combination of increasing foster care caseloads and decreasing or stagnant supply of foster parents can be found in most parts of the country. Governing Magazine reports that 35 states saw an increase in their foster care caseloads between 2012 and 2015.

Reports of children being housed in offices and hotels have come from California, Texas, Oregon, Kansas, and Georgia, Tennessee, and Washington DC. Children newly entering the system, and those with behavioral issues who are repeatedly kicked out of foster homes, seem to bear the ones most affected.

In addition to the incredible waste of government funds, the warehousing of already traumatized young people in temporary and non-therapeutic environments is the antithesis of the therapeutic care they need.

Another casualty of the desperate need for foster parents may be the reluctance to revoke the licenses of neglectful foster parents. In my five years as a social worker, I begged my agency not to renew the licenses of foster parents who refused to take their children to the doctor, never met their therapists and never visited their schools, even to pick them up when they were sick. I never got my way.

The recent congressional investigation of the for-profit MENTOR foster care agency illustrates the worst-case scenario of foster parents who killed the children who had been entrusted to their care. While severe maltreatment by foster parents is extremely rare, the continued licensing of unacceptable foster parents reflects in part the desperate need for their services.

We cannot rely on traditional foster care to solve a placement crisis of this magnitude. Alternatives must be considered, particularly for new entrants to the system and older and more challenging youths.

For children who have just been removed from their homes, the answer is clear. Temporary assessment centers need to be reinstated as the first step for children entering foster care. In the last few decades, many states closed their emergency shelters and assessment centers in the belief that institutional settings are bad for children.

The elimination of shelters and assessment centers resulted in the phenomenon of middle-of-the night placements that I described in a previous column. This system results in an almost random assignment of child to home based on who answers the phone at 3:00 AM. This is no way to match a child with the most appropriate placement.

For children older than elementary school age, particularly those with more challenging behaviors, we need to consider an array of alternatives to traditional foster care. Some of these options are on the border of family foster care and group care.

On the family side, these include programs in which professional parents receive a salary for caring for foster kids. To make professional foster care economically feasible, foster homes must be larger and serve anywhere between four and eight children. I have written about several such programs. These include Neighbor to Family, which provides professional foster care to sibling groups in the same home.

Some of these programs provide housing to foster parents in “foster care communities” which provide the added benefit of community support and programmatic  resources on site. These include SOS Children’s Villages in Illinois and Florida, and  Pepper’s Ranch in Oklahoma.

On the other side of the artificial foster home/group home divide are group homes that are structured like families, with live-in houseparents. These include Boys Town, homes following the Teaching Family model, the Florida Sheriffs Youth Ranches, and many others.

Residential schools, such as the Crossnore School in North Carolina or San Pasqual Academy in Escondido, CA, also have many advantages. Students live in cottages run by house parents and benefit from enriched educational opportunities, extracurricular activities, and medical and mental health services.

All of these programs have the added benefit of keeping larger sibling groups together, a major and often unrealized goal in child welfare. San Pasqual Academy, which provides only high school on campus, will even accept middle-school-age siblings to live in its residences and attend community schools until they are promoted to high school.

Child welfare leaders at all levels need to begin a conversation about alternatives to standard family foster care. Many of these models are more expensive than traditional foster care. But considering the short-term and long-term costs of temporarily housing foster children in offices and hotels for days or weeks at a time, the money would be well-spent.