The Department of Children, Youth, and Families (DCYF) works closely with the Office of the Family and Children’s Ombuds (OFCO) and I have great respect for their work. The Ombuds’ responsibilities are largely focused on responding to complaints about DCYF service provision. OFCO brings attention to areas where DCYF has not met reasonable expectations and helps the agency and the complainant resolve their concerns. In many cases, OFCO has helped us find patterns in our work that we use to systemically improve. This year’s report summarizes that aspect of their work, and I have no concerns about it other than the fact that it details places where we are not meeting our own standards. Transparency about the complex and difficult nature of our work is critical to making it better.
For several years in a row, OFCO has rightfully excoriated DCYF about a growing problem that children and youth in our care face – hotel and office stays. I share Patrick's concern and can assure you that it has our full attention. In addition to our attention, we need additional resources both for DCYF and for our sister social service agencies to successfully resolve the problem.
In normal times, there are infrequent occasions where a child enters foster care too late at night for the social worker to find a satisfactory placement, and the social worker and another adult stay overnight in a hotel with the child. Infrequently, this is not a large problem and is probably better than disrupting an entire series of families at 2 a.m. looking for an appropriate placement.
If it happens all the time it is most certainly not OK, and multiple “placement exceptions” for a single child are terrible. OFCO reports a growing problem over the past several years, and their research into the origins of it has similar results to our internal analysis.
Characteristics of the children who have repeated stays (and 24 of the children result in more than 75% of the thousands of nights of placement exceptions) point to the need we have for placement options for children with complex and severe behavioral health challenges. Those risk factors include criminal justice involvement, past runaway history, suicide or self-harm incidents, disability-related medical needs, mental health diagnosis, substance use disorder, co-occurring substance use and mental health disorder, pervasive developmental disorder, and multiple mental health and developmental diagnoses.
There are a number of practice changes we are making as an agency in response. A full report with details will be released later in December 2020. These will help, but will not be sufficient to resolve the problem without new placement resources for these children. One practice change that we are particularly excited about is therapeutic foster care beds – normal foster homes with extensive wrap-around mental health support. We expect to have 15 beds available by the end of the first quarter of 2021 partially funded by a federal grant.
Last year, the Legislature allocated funds to do two things:
- Raise the rate paid to Behavior Rehabilitation Services (BRS) providers by 45%, matching the actual costs of providing the service. As a result, we stopped a long-term slide in available slots and have added 27 new slots this year.
- Add a category of care (we’re calling BRS+) with a higher level of service. Due to the pandemic, we have been slower than I would like to release the service, but expect to release a request for proposal (RFP) on Dec. 16, 2020, with service starting in March of next year.
These are great improvements, but problems remain. Parents often face the terrible choice of either abandoning children they do not have the capacity to care for or putting themselves or their other children at risk of harm. The state will wind up caring for these children one way or another, and we should do so in a way that is most humane, least expensive, and that does not require fit parents to abandon children they love. In reviewing the 24 cases with the highest incidence of placement exceptions, I saw that this was too often the case. To solve this problem, the state needs a number of additional resources:
- New inpatient mental health capacity for children and youth with complex behavioral health needs, including some high-end CLIP beds. Department of Social and Health Services (DSHS) (CLIP beds) and the Health Care Authority (community inpatient) need at least 70 to 80 beds for these youth. It’s important to note that many other young people in the state need this level of service, but have not yet found their way into hotel stays, so additional capacity will need to be found above and beyond the few in the statistics today.
- The Developmental Disabilities Administration (DDA) in DSHS needs additional placement capacity for at least 50 developmentally disabled youth. The same caveat about additional capacity is true here.
When DCYF provides care for a child that has not been removed by a court from their family due to abuse and/or neglect, it does so at 100% state general fund cost. The same care provided by the Behavioral Health Administration (BHA) or DDA gets 50% Medicaid match, cutting the cost in half, reducing court involvement, and not tragically putting an abandonment on a parent’s record. The abandonment can result in a future inability for the parents to get an occupational license, volunteer in their child’s school, or anything else requiring a background check. The formal involvement of DCYF also makes it more difficult to find a relative or appropriate other who can care for the child.
These shortfalls are a symptom of an inadequately funded system that is supposed to provide support for children with complex needs. Too many young people struggle without the support they need, and the hotel and office stays we do to make up for that lack is both penny-wise and pound-foolish.
Ross Hunter, Secretary
Department of Children, Youth, and Families