High cost of placing children to be examined

As the Washington County Department of Jobs and Family Services merges with the county’s Children Services, the plan is to audit at least once a year whether children placed in high-dollar care still need those treatment settings.

This intention was explained to the commissioners this week by DJFS Director Flite Freimann, before the Children Services Board voted Thursday evening to reject the commissioners’ plan to redesignate DJFS as oversight over Children Services, which would remove the fiscal oversight from the appointed board.

Now the commissioners may only continue with the redesignation if they can achieve a unanimous vote by Dec. 27 and if the Children Services Board does not file for an injunction to stop that vote from occurring.

If the merger takes place, those audits will be a priority, Freimann said.

“There is no incentive for residential treatment providers making $300 a day per kid to call and say (a child) doesn’t need us anymore,” said Freimann at the commissioners meeting.

But previously, placement specialists at Washington County Children Services indicated that children bounce between high dollar placements and steps down in care like group homes and therapeutic foster homes at varying rates but always dependent on the needs of the child. As of Friday, 83 children were in the custody of Children Services.

“In fact, we’ve had expensive providers call and tell us they’ve done all they can for a child and it’s time for them to be moved into another sometimes less restrictive or different kind of care,” said Alice Stewart, assistant director of children services, on Friday. “Many of the top dollar places have waiting lists and we are often turned away because we’re told they don’t have a bed right now when we call to place a kid there.”

Traditional foster homes, keeping children mostly local to Washington County, cost between $20 per day and $35 per day.

Therapeutic homes cost between $40 and $95 per day. Those are the third level of care focused still within a family home but meant to provide for more trauma-related or medical-related needs of a child.

Group homes, the fourth level of care, cost between $100 and $250 per day and tend to be a placement for teenagers learning life skills.

And residential centers range in cost based on a caregiver-to-client ratio, medical needs, psychiatric needs and other services from $180 to $385 per day, per child.

One challenge in placement beside bed availability though is a lack of consistent parameters or qualifications to merit a higher level of care.

Children Services has a safety needs assessment completed by caseworkers, but it can be influenced by the ages of the children removed. Then once granted permanent custody, though a child may not need more intensive services, the lack of availability in traditional foster homes may automatically place that child in a higher level of care.

“But there’s also a challenge in the research of who does best in which care situation, there’s no blanket answer,” said Dr. Bridget Freisthler of the Ohio State University College of Social Work. “The goal has been all along what’s the least restrictive placement you can have for a child, but unfortunately we do not have an outlined and consistent threshold. A lot of these decisions are made on the behaviors exhibited and medical needs of a child.”

She said the decision to place a child in a therapeutic home focuses on the training of the parents and whether they have been trained to handle trauma or have more medical experience.

“But one, it’s hard to train for every eventuality…for example, suicidal ideation is not a mandatory topic in foster care training but you’ll often see teens in traditional foster homes who have threatened or attempted suicide,” she said. “And kinship caregivers (below the traditional placement model in cost) do not have to go through any training.”

She said studies that show the results of kinship placement as children staying in that level of care longer than other placements must be taken with a grain of salt.

“You also don’t see parents work as hard to get their children back because they know the kid may be fine with grandma or aunt so-and-so. We can say kinship placement may be a more stable placement and kids may feel more safe, but many don’t have to pass a drug test either,” Freisthler said.

With her primary research surrounding child welfare and currently the impacts of the opioid crisis on the child welfare system in Ohio, there’s also a challenge in studying the higher level placements.

“It’s difficult to access the data concerning behavior and the notes of caseworkers, no one takes notes the same way,” she said. “You’re left with looking at demographics and risk assessment tools, although those are not consistent either and are not mandated across the board.”

But what is accomplished in these higher care placements?

“Some kids absolutely need residential treatment, others need the kind of structure and boundaries I give them here,” said Donald Jones, owner of The AttaBoy Group in Dayton. “My kid from Washington County now has a job, he’s working and he’s able to handle more than people even thought he could.”

Jones’ program runs under a group home model, which typically is set aside for those ages 12 and older to learn life skills and build independence in a setting that prepares for their emancipation.

“We’re humans trying to fix other humans so we’re flawed to begin with at any level, but if we can reintroduce you back into society and teach you how to deal with rejection, how to cook for yourself and how to see the world is larger than the trauma you’ve experienced, all while loving you hard, then we can accomplish some truly great things,” he said.

Jones said he takes young men of different backgrounds, those who are sex offenders, those who have been neglected or been victims of domestic violence and others that have been assigned myriad labels.

“But many are labeled prematurely and that label should change once they’re in a stable environment. Yes, some absolutely need the structure but group homes teach you how to operate in normal society,” he said.

At a glance:

• Foster care placement costs vary by type of care.

• In Washington County, the rates for placement include:

• Traditional foster homes, keeping children mostly local to Washington County, cost between $20 per day and $35 per day.

• Therapeutic homes cost between $40 and $95 per day and are the third level of care focused still within a family home but are to provide for more trauma-related or medical-related needs of a child.

• Group homes, the fourth level of care, cost between $100 and $250 per day and tend to be a placement for teenagers learning life skills.

• And residential centers range in cost based on the caregiver to client ratio, medical needs, psychiatric needs and other services; $180 to $385 per day, per child.

Source: Washington County Children Services and Ohio State University College of Social Work.

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