Child Welfare officials offered welcome news last fall in a report to Gov. Kate Brown: It had been weeks since they placed a foster child in a hotel.
The development was an improvement for the state Department of Human Services, which weathered a firestorm of criticism and a civil lawsuit in 2016 after it was revealed Oregon foster care children were being placed in hotel rooms.
Many of those children struggled with mental, behavioral and psychiatric issues, but the state didn’t have anywhere else to put them.
But in the report, it seemed agency officials were making headway in finding placements for some of the state’s more vulnerable children.
“We continue to build capacity to fit the needs of the children we are serving,” they said in the report to Brown and other lawmakers.
But what the agency didn’t tout: As the number of children in hotels has dropped, the number shipped out of the state has risen sharply.
Oregon is sending children — once again some of the most vulnerable, those with mental health and psychiatric issues — across state lines to Utah, Arkansas, Indiana, Iowa, Wyoming, Pennsylvania and Tennessee, to name a few.
They aren’t sent away to be close to family or live with foster parents. Typically, the state confirmed, they are being shipped to locked psychiatric residential treatment facilities.
And they are being sent across state lines primarily for one reason: Oregon has no room for them.
There are currently 84 foster care children in treatment facilities scattered across 11 states. Some are as young as 9. The average is 15. The oldest is 18.
If the children are sent somewhere close, such as Idaho, a state employee drives them. Otherwise, they fly. On average, the children spend 11 months in the out-of-state treatment facilities.
Relatives are allowed to visit. But the children are removed from their communities, their social networks and the world they know.
State Sen. Sara Gelser, D-Corvallis, who chairs the Senate Committee on Human Services, was sympathetic that Child Welfare faces a huge challenge. There are simply not enough appropriate placements — either foster homes or therapeutic beds to house children in Oregon. However, the recent spike in sending children out of state concerns her.
“I worry that the focus on hotels could have unintended consequences that are worse for kids,” Gelser said, “whether it’s pushing them into a shelter program that isn’t particularly high quality or safe for kids or sending them out of state or leaving them in an unsafe situation.”
Keeping Families Together
In an interview in November, Marilyn Jones, the state’s child welfare director, told OPB Child Welfare’s No. 1 goal is to keep children with their families.
“Our first and ultimate goal is to keep the kids at home,” she said. “If we can’t … we still want them [the children] to have full access to their families and have services.”
The children who have been sent out of state often have therapy sessions over Skype with their parents or guardians.
Sara Fox, who oversees the program sending kids to other states, said the Department of Human Services works hard to identify the correct spot to send children.
“Our preference would be to not send any children out of state,” she said, adding later, “I know we ultimately want our kids home.”
Fox said there are many reasons why children are being shipped away. The main problem is a lack of psychiatric treatment beds available in Oregon, she said. Many of the children have complex needs and require a high level of care. Some of them are exhibiting aggressive behaviors or have been diagnosed with multiple conditions from post-traumatic stress disorder, to reactive attachment disorder — when a child hasn’t established a secure relationship to an adult caregiver — to ADHD.
When asked about what kind of oversight Oregon has over the out-of-state treatment facilities, Fox said most of the programs are visited at least once every 30 days by either a caseworker, a family member or a third-party independent.
The state sends caseworkers when needed but primarily relies on a third-party independent contractor to check in with the children.
In a follow-up question, OPB asked for more specifics about the criteria the state uses when selecting where to send children and which facilities qualify.
A spokesman responded in an email: “The Department goes through an extensive check for any facility, including reviewing information at a state’s licensing body, making sure the facility is in good standing, verifying Secretary of State business records, and conducting other research.”
The facilities where Oregon foster care children are sent are privately run.
Not A New Practice, But A Growing One
Oregon has been sending children to out-of-state facilities for years. But the numbers have risen dramatically recently.
In 2014, just one child was sent away. In 2017, that rose to 33 kids. Last year, 82 children went outside Oregon.
The state declined to name the facilities where the children are being sent, citing privacy issues.
But we do know that out-of-state care isn’t cheap.
From October 2018 to December 2018, the state spent about $2.5 million on sending kids out of state. One reason for that high price tag: The facilities being used offer wrap-around treatment services for the children, such as drug and alcohol support and counseling.
Here’s how that looked in a three-month breakdown: In December 2018 the state spent more than $850,000 on costs associated with sending 83 people out of state.
The monthly tally was similar for October of that year: about $826,000 for 73 children and November: $807,384 for 80 children.
Systemic Issues To Overcome
Gelser, the state senator, said the problem can’t solely be fixed by the Child Welfare department.
The entire system — from schools to juvenile justice courts to mental health providers treating children — faces immense challenges.
George Aiken, with Salem Health Hospitals & Clinics, recently told lawmakers their emergency rooms are packed with people facing hardships. They don’t necessarily need emergency health services; in some cases, they simply have no other place to go, he said. That includes young people.
“We had a recent example of a youth, an autistic young man, who was in our emergency department for just shy of three weeks … waiting for an appropriate resource and placements from DHS,” Aiken testified. “His initial behavioral crisis was resolved shortly after his visit to our emergency department.”
A task force focusing on children and youth with specialized needs has been meeting and is pushing legislation this session to help “the approximate 500-800 children and youth who are inappropriately placed … not considered necessary or consistent with the needs of the child,” according to the task force’s agenda.
As part of the lawsuit settlement agreement, the state has agreed to slowly reduce the number of kids in hotels by 2020. They are still placed in temporary lodging, such as hotels.
Gelser spoke of the importance of creating a more integrated system that supports Child Welfare to offer children the placement and resources they need. And said it's important to be thoughtful about giving mandates to the Department of Human Services. It's not enough to tell them to stop putting kids in hotel rooms.
“We need to take the next step of asking ourselves: ‘Well, if they don’t do that, what will they do instead?” Gelser said.