Ten years ago, 1,257 Colorado foster children lived in group homes and institutions, the kind of places where children and teens line up to take medicine and eat after hours. fixed meals in a cafeteria.
That number has now dropped to 339, a cheerful statistic that means hundreds of children are instead living in homes with parents and foster families.
This change is the premise of the Family First Prevention Services Act, a federal law that overhauled child welfare funding and required states to rethink programs to place more emphasis on preventing out-of-home placements. foyer. After years of planning, the October 1 deadline for complying with the law is within a week.
But for state and county child welfare officials, the job is not done. As Colorado has successfully referred children to “parents” and other foster care, and has stepped up a host of abuse and neglect prevention programs in preparation for Family First, critics say the change is coming. happened so quickly that Colorado is now running low on residential beds. psychiatric centers and establishments for young people with the most acute mental health problems.
More than 20 residential centers have gone out of business over the past decade, in part because they have seen government money diverted from so-called collective care to support children in their own homes or communities. The bed shortage has become so severe that the state legislature this year passed a funding program to increase daily reimbursement rates to centers willing to take in young Coloradans with severe behavioral health issues instead of children. other states that pay more.
Over time, however, Colorado and other states focused on keeping families intact will need less residential beds, state officials and prevention experts say. In one study, the Washington State Institute of Public Policy found that by investing in therapy, including for children at high risk of being placed in foster care, the state would dramatically decrease the need for prison beds within 10 years. In fact, Washington would no longer need to build a new prison if it spent more aggressively on prevention, according to the report.
Home therapy targets troubled children
Colorado has spent the past few months researching prevention programs now on the approved list, or pending approval, to receive federal and state child welfare funding.
Among the home-based programs that should receive a boost from Family First is multisystem therapy, which targets children aged 12 to 17 who are at high risk of entering the foster or justice system. for minors due to behavioral problems. This includes teens who fight in school, join gangs, steal, or bring guns to school. It also includes young people who are depressed or suicidal or who have emotional problems so severe that they are beyond their family’s control.
The program has been around in Colorado for years, but with insufficient funding, said Suzanne Kerns of the Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, on the University of Colorado medical campus at Anschutz.
Therapists are reimbursed for the hour of in-person therapy through the state’s Medicaid program. But this falls far short of the cost of preparing for work or traveling to family homes, up to an hour and a half apart in rural areas.
With Family First, mental health centers offering multisystem therapy can be reimbursed for their actual costs, which in turn, state officials hope, will mean more centers across the state will start offering the service. home.
It’s called multisystem therapy because the goal is to understand why the child is acting – whether it’s family issues, school factors, mental health issues, or all of the above. . Problems are addressed through personal and family therapy and sometimes involve school staff. In one case, Kerns said, a therapist asked a school resources manager to chat with a boy on the way to class so the child wouldn’t keep going out the back door and out of school each day. morning.
About two-thirds of referrals to the program, which works with around 600 families a year, come from the child welfare system or juvenile justice system – after children already have problems. As the program grows under Family First, Kerns hopes most referrals will eventually come directly from families, school counselors and pediatricians – before those responsible for child welfare or justice are involved.
A multisystem therapist has only three or four families at a time and works intensely with them for about four months, visiting them several times a week.
âWe want to keep them at home and we want to do it in a way that is sustainable over time,â Kerns said. âHow can we really make sure the family is ready for the challenges? “
The toll is remarkable, with around 90% of children remaining with their families after therapy ends, she said. The therapy – with about seven other programs now on Colorado’s approved list to receive Family First funding – won’t completely end the need for residential treatment beds, but it will reduce it, Kerns said.
“No program is going to 100% alleviate the need for beds,” she said. âThere are going to be situations you can’t handle. If I had one wish for Colorado, it was to try to figure out how to deploy these programs in the areas that need them the most.
So far, only around 200 residential beds are making the move
Family First’s deployment in Colorado is a work in progress that will continue through next year, said Minna Castillo Cohen, director of the state’s office for children, youth and families. The goal is to get the right number of places for children across the entire ‘continuum of care’, which ranges from therapy and parenting classes to keeping families together, to foster homes, to nursing homes. residential, psychiatric establishments and juvenile detention centers.
Much of the Family First transition involves not only qualifying therapy services to receive federal funding, but also requiring residential treatment centers and group homes to meet new federal standards in order to participate.
Residential programs for youth in foster care must become âqualified residential treatment programsâ to receive federal reimbursement. This means that they offer so-called âtrauma informedâ treatment that focuses on past trauma and involve siblings and other family members in their treatment plans. In addition, they must provide six months of follow-up treatment after a child’s release.
So far, only 124 of the state’s residential center beds are changing to meet the new qualifications by next week’s deadline, with a further 82 expected to transition in the coming months. Child protection advocates say this is not enough to meet current needs.
On the prevention side, Colorado has eight programs – including multisystem therapy – able to withdraw federal dollars. The list is expected to grow in the coming months, Castillo Cohen said.
The changes are expected to channel an additional $ 2.1 million per year into the child welfare system for prevention programs, therapeutic foster homes and residential treatment. The state spent $ 11 million in 2019-2020 to prepare.
âWe see Family First as this huge opportunity to change as a nation and to really build on the work we have done,â said Castillo Cohen. âThere are huge opportunities to help create services.
âWe are so ready for this. ”
Over the past decade, Colorado has decreased the number of children removed from their families even as the state’s population has grown. In 2011, more than 6,100 children were placed outside the home, a number which now stands at around 4,000.
The drop came as the state was allowed to use federal money to pay for home services meant to keep families together, a change from previous decades when public child welfare services did not receive federal money unless children are taken from their parents and placed in foster care.