October 1st, 2013

DCYF grapples with cost of long-term placements

The Rhode Island Department of Children, Youth and Families (DCYF) has significantly reduced the number of children in state care sent to mental health treatment residential programs in other states over the last several years. But it’s not enough to avoid deficits as the state embarks on the second year of three-year, $107 million System of Care contracts with two non-profit networks.

Sixty-eight children were in residential treatment facilities out of state last May when the Senate Committee on Health and Human Services held an oversight hearing on DCYF finances at the State House in Providence. Most were in Massachusetts, Vermont and New Hampshire, according to DCYF Associate Director of Child Welfare Stephanie Fogli-Terry.

That number dropped to about 50 by mid-July, Fogli-Terry says. The children and teens sent to other states have issues ranging from hearing and vision impairments to eating disorders requiring hospitalization to reactive attachment disorder resulting from disrupted and foreign adoptions.

“In the past, those numbers have well been into the hundreds,” Fogli-Terry says. “What you see today is a significant reduction, however what we’re striving for is maintaining those children in state and developing the services that we need in state.”

Rhode Island has only two residential facilities for children with serious behavioral and emotional disturbances in need of specialized treatment and services: Harmony Hill School in Chepachet and St. Mary’s Home for Children in North Providence.

“What we need is a higher level of specialized care,” Fogli-Terry says.

The DCYF contracted with two networks – Ocean State Network for Children and Families and the Rhode Island Care Management Network – to save millions of dollars from the consolidation of administrative costs and standardizing rates, as well as serving more children in community-based programs instead of residential ones. But last spring after both networks acknowledged deficits, lawmakers approved a supplemental $2.4 million budget for fiscal 2013 for the networks to address shortfalls at the same time they reduced $626,000 from the DCYF’s administrative budget.

When the two networks took over in July 2012, there were approximately 45 Rhode Island children in out-of-state residential facilities. (Those numbers have fluctuated over the ensuing year).The $71.4 million fiscal 2013 budget for the networks was based on reducing residential placements by approximately five percent with savings used to develop evidence-based, community-based services.

Out-of-state residential placements between July 1, 2012 and Feb. 28, 2013, show decreased spending, $3.94 million, down from $5.16 million for the same eight-month period a year earlier, according to DCYF figures submitted during the May 15 Senate committee oversight hearing.

“It would be great to have them all back in the state of Rhode Island but there are very few resources,” says Regina Costa, Esq., the state’s child advocate who testified at the hearing. “Everyone believes that’s the best option for children but frankly there are some children that’s not really ever going to work for them because the ability to replicate the programs that they require in state would not be cost efficient.”

Costa told legislators the DCYF budget has been reduced by approximately $33 million since 2009. She urged lawmakers to increase funding to the agency but oversee how the money is spent. “I’ve been involved in the child welfare system for 30 years,” Costa says, “and I’ve never seen the relinquishment of the duties of the state to private entities in the way that I’m seeing it now.”

The committee hearing was called to develop a better understanding of performance measures, expenditures and policies to increase DCYF accountability and effectiveness, according to its chairman, Sen. Joshua Miller (Democrat – District 28, Cranston, Warwick). The committee drafted a report with recommendations over the summer that was expected to be released by September.

By Janine Weisman

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