Buried within a wonky “needs assessment” report recently released by the Texas Department of Family and Protective Services (DFPS) is a finding that should raise alarm bells around the state. And perhaps around the country.
Facing a looming cut in federal support for residential care settings while dealing with internal shifts in state policy, DFPS projects that by 2021 it will have just 39 percent of the foster homes it needs for youth who qualify as “specialized” or “intensive,” children who need round-the-clock care for their medical, behavioral, mental health or substance use problems.
The agency forecasts shortages in all 11 regions of Texas, but in some areas, it is expected to be severe. In Region 9, which includes Midland and Odessa, it’s estimated that 110 youth will qualify as specialized or intensive — and the region, with just 12 therapeutic foster homes and zero residential treatment centers, will have just 3 percent of the needed placements for the region.
Many of these youth can be served either in congregate care settings like residential treatment centers, or in therapeutic foster homes, which require a full-time caregiver with specialized training and few foster children in each home.
According to DFPS projections, the state will have about 89 percent of the beds it needs to house this population of foster youths in 2021. But only about 43 percent of the supply of placements for specialized and intense-level kids will come from therapeutic foster homes; the rest will be from group homes and institutions, options commonly referred to as congregate care.
Congregate settings are about to get more expensive for states to use because of a recently-passed federal law that seeks to limit their role in child welfare. Under the Family First Prevention Services Act that recently took effect, federal funding for placing kids in congregate care settings is limited to no more than two weeks. Texas, like most other states, has opted for a permitted delay on the law until 2021, the year of its projected shortage.
Family First does make a few exceptions to fund group care beyond that time frame, including for providers with the newly created designation – Qualified Residential Treatment Programs (QRTP), a clinical model meant to serve children with acute health needs. To be accredited as a QRTP, providers must demonstrate specific traits including a trauma-informed model of care, a licensed nursing staff and a process for planning and delivering after-care services in the child’s home.
DFPS has not yet begun the process of identifying a network of providers that qualify under this new designation. But some of the state’s residential treatment centers have already begun the process of pursuing accreditation, and at least one has obtained it.
Lauren Rose, director of public policy at Texas Network of Youth Services, an advocacy organization whose membership includes residential treatment centers around the state, says the shortage of placements for high-needs children should mean trying to keep as many facilities operating as possible.
“If the discussion is going to be around reducing capacity that’s concerning,” Rose said. “We’re not necessarily meeting the residential placement needs of the youth today.”
Kate Murphy, senior child welfare policy associate at Texans Care for Children, said the state should not count out increasing training to foster homes to become equipped to handle high-needs children when addressing the shortage.
“Kids in general do better when they are living with families,” Murphy said. “What Texas could do and I think what they should do is focus on building out treatment or therapeutic foster care options, and then as a supplement to that figure out how many RTCs we need.”
Texas has already been struggling with meeting the supervision requirements that a federal judge ordered to be put in place in 2015 as a result of a class-action suit against the state’s foster care system. In October, U.S. District Judge Janis Jack chastised the state for stonewalling her order to implement the 24-hour awake supervision she first gave four years ago. “The state of Texas lost this case,” she said at the hearing, where she threatened to fine the state $100,000 a day if it did not quickly comply with the orders. “The longer and stronger the state resists these court orders, the costlier it’s going to be for the state,” Jack said.
And with the upcoming Family First guidelines holding millions of dollars on the line — in 2017, Texas RTCs took in $37 million in federal Title IV-E funds — the pressure is only increasing.
“It depends on how Texas decides to handle it. There is no new law saying that RTCs have to meet these guidelines. The rule is that you can’t use federal funding to pay for those centers,” Murphy said. “Texas could pay for those with general revenue and they could stay open — or not. It depends on what the legislature will decide.”
That leads to another problem: The Texas Legislature meets every other year, and won’t meet again until 2021, which gives the state mere months to implement whatever changes the legislature makes before Family First takes effect in October of that year. “We’re probably going to have a little bit of a lag before we can take advantage of the federal dollars, and will probably take a little bit of a hit on the financial side,” Murphy said.
Rose said the major hurdle to implementing these new guidelines is financial. “The cost of meeting those requirements would be detrimental to many of the residential operations without support from the state to get to the QRTP level,” she said.
Complicating matters even further — as Texas moves toward privatizing its child welfare system through a “community-based care” model, more emphasis will be made to place children within 50 miles of their homes. It will be a performance measure for the private nonprofits that receive the contracts in their regions, which will also be tasked with building capacity for children with specialized or intense designations in their areas. But in places like West and South Texas, where there are virtually no residential treatment centers, youth with those needs will likely have to leave to get the services they need.
“We are constantly trying to increase capacity for high-needs children,” said Patrick Crimmins, media relations manager for DFPS. “Community-based care is being expanded in Texas, and under that model the contractor selected by the state is responsible for increasing the capacity, quantity and quality, in that area.”
Keith Bradbury, the co-placement director at Pegasus Schools, a residential treatment center in Lockhart that deals exclusively with male youths with sexual behavior issues, says their operation gets about 65 percent of their placements from the juvenile probation department and the remaining placements from CPS.
“The 50-mile rule — that’s all fine and good if the services the kids need are located in that radius,” Bradbury said. “We actually have more licensed sex offender treatment providers here at Pegasus than some have in entire counties.”
Pegasus Schools proactively decided to pursue accreditation, which is a major step on the way to becoming a QRTP. In September, Pegasus received accreditation after a 16-month process; Bradbury said that residential treatment centers should update their protocols as new best practices are established. Pegasus treats about 165 youth each year, though, and gets a significant amount of funding through channels outside DFPS. Smaller operations focused solely on CPS placements will likely feel the financial impact disproportionately.
“It was not cheap to go through the accreditation process, and you wonder how that’s going to affect the smaller facilities,” he said. “Those with capacity for 12-14 kids, between the night watch and the accreditation, I can see this causing smaller facilities some issues.”
Some, like Bryan Mares, a public policy fellow at Texas Court Appointed Special Advocates, worry that if the legislature doesn’t mandate that all RTCs rise to meet QTRP standards — and fund it — then there will be an even bigger stratification between top-shelf residential treatment centers and those that provide substandard care.
“Because Texas relies heavily on RTCs to meet capacity, we fear the possibility of Texas having a two-tier residential care system,” Mares said.
Still, Bradbury said that being in the business of treating vulnerable kids means consistently moving the benchmark forward as new standards develop. “It really comes down to performance,” he said. “Are you providing the services that these kids need?”