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Changes to keep foster kids with mental health issues in home settings longer takes effect Friday; lawmakers still calling for adjustments

The Gazette - 9/30/2021

A new federal law, the Family First Prevention Services Act of 2018, takes effect Friday, with changes that boots-on-the-ground workers like Brian James say will prevent foster kids from falling through the cracks .

“We did away with group homes, so there’s no in-between,” said James, who runs a therapeutic foster home in Colorado Springs for six teen boys. “This gives us the leeway to keep more at-risk kids for a longer time in foster care and help them with their issues.”

New models include therapeutic foster homes, instead of group homes with fewer services, and short-term, rather than extended, stays in institutionalized settings for intensive treatment.

The federal government has tried other modifications to the nation’s child welfare system, but this overhaul should make a substantive difference, said W. Lee Oesterle, co-chair of the Family First working group in Colorado and executive director at Kids Crossing, a Colorado Springs child placement agency.

“We’ve known for 30 years we need to keep kids out of residential (group) care,” he said.

“Research has shown that children and youth do better when they’re in family-level care versus residential care, which should be used as an intervention when they’re having a mental health crisis, to get them stabilized, and not long-term.”

Heidi Baskfield, vice president of population health and advocacy at Children’s Hospital Colorado, calls the Family First act a “landmark bill” that “makes positive changes to the residential step-down facilities that some of our patients need after they stabilize in the hospital, ensuring these facilities provide better psychiatric treatment in a more home-like setting.”

Family First also funds support services for parents and guardians, to keep children at-risk of entering foster care at home with their own families while they work on challenges, Baskfield noted in an email.

Family First represents “a significant change,” said Catania Jones, deputy director of Children, Youth and Family Services for the El Paso County department of Human Services, “because of the collective push to break down silos and communicate better as systems for getting the right service or intervention at the right time.”

Therapeutic foster parents like James are being trained to address the trauma that often follows foster care children into adolescence and can lead to school truancy, running away, using drugs and criminal activity.

“They’re from deep-rooted issues related to trauma from childhood with their parents or other adults,“ James said. “They act out because of that, and they require more of your time with those type of issues.”

Reimbursement for therapeutic foster families in Colorado has been set at $99 per day for expenses related to care, Oesterle said, a higher rate than traditional foster care.

The working group set rules for therapeutic homes and established the higher financial payment as an incentive to draw foster parents.

“I think more people will consider doing it because it can be a full-time job,” Oesterle said.

In comparison, as of July 1 traditional foster parents receive $39.34 a day for newborns to age 8, $50.34 a day for, 9- to 13-year-olds and $61.34 a day for ages 14 and up.

Therapeutic foster homes likely will have children for 3 to 6 months, with the goal of them returning to their families of origin, after parents have corrected the reasons the children were removed from the home, Oesterle said.

Some officials believe further adjustment is necessary before the updated system will meet the goals of maintaining children in home settings with higher levels of care, providing proactive services and matching kids’ needs with the best fit.

For example, Congress is considering exempting congregate facilities, such as Griffith Center for Children and Cedar Springs Hospital in Colorado Springs, from a 16-bed limit on Medicaid reimbursement.

Lawmakers introduced the Ensuring Medicaid Continuity for Children in Foster Care Act of 2021 in August. The Colorado Association of Family and Children’s Agencies, a statewide organization representing residential facilities impacted by the capacity constraint, is among 600 organizations nationwide that signed its support for the bill.

As many beds as can be designated are needed for children requiring advanced mental health treatment, said Becky Miller Updike, executive director of the Colorado Association of Family and Children’s Agencies.

More than 40 such facilities have closed in Colorado since 2007 in Colorado, equating to at least 800 beds lost, she said. Some shut down because of licensing violations, Updike said. Others went out of business on their own accord.

The state now has 50 licensed facilities, she said, and further reducing beds would add strain to the already overburdened system.

“Today, we find ourselves in a very serious crisis of capacity to serve our highest needs young people,” Updike said in an email. “There is no evidence that any specific number of children in care is the best number for successful outcomes.”

Said Children's Hospital's Baskfield, “Without this capacity, children and youth end up overstaying in hospitals past the point of medical necessity, or are sent out of state for care and treatment.”

The intent with more home-based mental health care is to keep kids from reaching a crisis and needing emergency treatment, running away or becoming homeless, Oesterle said.

Prevention measures come at a time when Colorado’s behavioral health services for youth are strapped, officials say.

Youths are facing unprecedented mental issues from the COVID-19 pandemic, said Dr. Kevin Carney, associate chief medical officer for Children’s Hospital Colorado.

He reported on trends during a Sept. 23 presentation to the Behavioral Health Transformational Task Force, a group making recommendations to state lawmakers on how Colorado should allocate federal coronavirus relief funding for behavioral health initiatives.

Children’s Hospital Colorado announced in May a mental health state-of-emergency based on high volumes of patients showing up in emergency departments with suicidal thoughts and actions.

“Unfortunately, things have gotten worse,” Carney said. “We continue to have full in-patient psych units.”

Children are waiting days for inpatient placement to be treated for acute psychiatric crises, he said, with some being sent to out-of-state facilities.

“What it looks like on a daily basis is breathtaking,” Carney said.

Children’s Hospital Colorado operates four emergency departments, including one in Colorado Springs. At times, half of patients seeking care are there for strictly psychiatric issues, Carney said, many of whom need to be admitted.

“We’re having to ration psychiatric care for these patients, through a daily process where we meet as a team, decide who is the most acute and where they can go,” Carney said.

Under safety protocols, children are kept in rooms without televisions or windows and are not allowed cell phones or other electronic devices or other external items. While they are supervised and given activities to do, they are not receiving the therapeutic psychiatric care they need, Carney said.

"They’re waiting days while we watch them and try to keep them safe and distracted and occupied so their mental health condition doesn’t worsen," he said.

“It’s overwhelming, it’s heartbreaking, and it’s tragic.”