Kentucky child welfare officials place too many children with mental health problems in institutions for too long when they could be better served by relatives or foster families, according to a leading child advocacy group.
“If we want children who have experienced abuse or neglect to thrive, we need a quality continuum of care that gives every child the opportunity to grow up in the care of a family," said Terry Brooks, executive director of Kentucky Youth Advocates. "We need to try to keep families safely together before looking at other options. Beyond that, other family placements-be that with kinship caregivers or in quality foster families-are the best alternative. Residential treatment facilities may be necessary short-term interventions for some children with intense treatment needs, but they're at the far end of the spectrum."
“.. For too long, Kentucky has done the convenient which has been bad for kids and bad for the state budget.,” Brooks said. There were 955 children in the facilities as of Dec. 6, state officials said.
At their most expensive, foster family placements can cost from $92 to $140 per day, compared to the upper end for residential treatment facilities at $219 to $274 per day, according to an issue brief released by Kentucky Youth Advocates.
Anya Weber, a spokeswoman for the Cabinet for Health and Family Services,said about 12 percent of Kentucky’s foster children are placed in a residential program, which is slightly below the national average of 14 percent.
The Kentucky Youth Advocates brief said that 33 states are using such residential treatment centers at a lower rate than Kentucky.
The Kentucky Youth Advocates brief said children should be placed in the centers only when they need treatment and not because there is a lack of other options.
Michelle Sanborn is the president of Children’s Alliance, the non-profit organization representing Kentucky’s private residential treatment centers that contract with the state. The focus of Sanborn’s organization is to ensure that Kentucky has quality private residential treatment facilities.
Given that, Sanborn acknowledges that the state child welfare officials do not focus efforts on keeping children out of those institutional settings as much as it “should or could.”
She said that state welfare officials should offer more services while children are with foster families or their own relatives so that they don’t continually fail and require residential treatment facilities.
“We do not want children to fail up to residential services. And that’s whats happening to our children today,” she said.
Sanborn said children in the custody of state welfare officials who need intensive mental health treatment are moved from foster home to foster home before landing in the residential treatment centers.
“They are moving and moving and moving and they have to have so many moves before they get to residential” care, she said. Sanborn thinks state officials could offer more services” in the biological home or with relatives to ensure the child doesn’t even have to be removed.”
She said the private treatment centers also offer services to reunify families.
Sanborn said her organization has worked with the Cabinet for Health and Family Services to reduce the number of children in the residential treatment centers, but she also wants to make sure that Kentucky has beds at the treatment centers if they are needed and that the state has all levels of services available. Sanborn said the highest number of children in residential treatment centers that she was aware of since 2003 was 1344 in 2007.
In response to the Kentucky Youth Advocates concern, Weber, the spokeswoman for the Cabinet, said that residential programs provide specialized treatment services for children whose needs are best addressed in a structured environment. The safety and security provided in residential programs allows children to receive intensive therapeutic services that address their behavioral and mental health needs, she said. In Kentucky, residential services are seen as a temporary rather than a permanent placement option for a child.,she said.
Children in residential treatment facilities have a higher likelihood of testing below basic skill level in English and mathematics, dropping out, and failing to graduate from high school, compared to children in family placements, the brief said..
Cabinet officials are working on the issue, said Weber. They want to ensure that the children placed in residential settings are those that need intensive treatment.. Over the past two years,Weber said state child welfare officials have been working to reduce the number of children in residential care facilities and other out of home placements.. Cabinet officials have been working with managed care organizations to enhance services to increase successful reunifications of children with their families..
Weber pointed to new programs that prevent child abuse and neglect, reduce time in foster care and improve a child’s safety.
Cabinet officials announced in early December a pilot program that will be in Fayette County and paid for with federal funds. It will help children that the state removes from their homes get more immediate, precise treatment when they have behavioral health issues. State officials think that should ultimately lead to better outcomes.
The brief from Kentucky Youth Advocates confirms that the state has been moving towards using residential treatment facilities less. From 2004 to 2013, the use of residential treatment facilities fell by approximately 29 percent. However, Brooks said there is still much more work to do.
Kentucky law allows children under age six to be placed in a residential facility as long as it is licensed to provide emergency shelter services. Increasing the minimum age would bring state policy more in line with what is best for a child’s development, Brooks said.
Brooks said Gov. Matt Bevin and other policy makers should increase family preservation and reunification efforts, provide more support to grandparents and other relatives who step in to help when children are removed from their parents, increase quality foster homes and use residential treatment centers only for children with intense clinical needs.
State child welfare officials should establish manageable caseloads, hire more workers and use technology and data to track what happens to children in the system, Brooks said.