Residential Treatment Centers Child Care Licensing Regulation and Child Protective Services Placements | Presented to: House Human Services Committee

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Residential Treatment Centers Child Care
Licensing Regulation and Child Protective
Services PlacementsPresented to House Human
Services Committee

• Anne Heiligenstein, Commissioner, Department of
  Family and Protective Services
• June 30, 2010

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• Residential Treatment Centers Historical
  Perspective

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DFPS Reform I

• Senate Bill 6, 79th Legislative Session (2005)
• Increased the minimum qualifications for Licensed
  Child Care Administrators
• Required residential operators to self-report
  more serious incidents
• Increased background check requirements for
  residential child care employees
• Required drug testing for residential child care
  employees
• Required residential operators to provide
  emergency behavior training approved by
  Residential Child Care Licensing (RCCL)

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DFPS Reform II

• Senate Bill 758, 80th legislative session (2007)
• Created the Committee on Licensing Standards
• Required RCCL team inspections
• Increased number of RCCL staff
• Created new rate category for foster children
  immediately after discharge from psychiatric
  hospitals
• 4.3 rate increase for residential care providers

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Strengthened Residential Treatment CenterMinimum
Standards - Effective January 2007

• Staff to child ratios dropped from 18 to 15
• Raised minimum age of caregiver from 18 to 21
• Raised minimum qualifications for Treatment
  Director
• Increased training requirements for both
  caregivers and professional staff

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Residential Treatment CentersRCCL oversight

• At every RTC, on average, RCCL conducts the
  following activities each year
• 16 inspections
• 12 investigations

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Capacity Challenges

• As recently as 2007, CPS faced significant
  placement challenges
• Number of foster children grew faster than the
  number of placements available.
• Increases in both regulation and enforcement at
  residential facilities resulted in RTCs being
  reluctant or unwilling to admit children with
  high-risk behaviors. The increased serious
  incidents and resulting investigations created
  liability concerns for RTCs.
• As a result, children were spending nights in
  DFPS offices or other locations.

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• Residential Treatment Centers
• Current Challenges and Potential Solutions

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Residential Treatment CentersWhere are they?
Region Number of Licensed RTCs Number of Contracted RTCs
1 - Lubbock 2 2
2 - Abilene 1 1
3 - Arlington 7 6
4 - Tyler 4 4
5 - Beaumont 2 2
6 - Houston 37 33
7 - Austin 13 9
8 - San Antonio 12 8
9 - Midland 0 -
10 El Paso 1 -
11 - Edinburg 1 1
TOTAL 80 66
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CPS Use of Residential Treatment Centers

• As of June 1, 2010, DFPS had 1,583 children in
  RTC placement.
• This represents 9.5 of children in paid foster
  care placement.
• Out of 66 DFPS contracted RTCs, 33 or one-half
  are located in the Houston region alone. Many
  children are placed into these facilities from
  other regions.
• Six out of ten children placed in Houston region
  RTCs are from other regions across the state.

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Children in RTCs

• Because children in the conservatorship of DFPS
  are victims of abuse and/or neglect, the trauma
  that they have endured can result in significant
  treatment needs. These children experience not
  only the trauma, but great loss by being removed
  from their homes, schools and friends. Also, the
  children often have serious underlying medical
  and developmental needs.

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Children in RTCs

• 17 year old female-removed from the home due to
  sexual abuse.
• Reports hearing voices telling her to hurt
  herself
• History of verbal and physical aggression,
  including homicidal threats
• Suffers from depression, suicidal ideation, and
  self-mutilation
• Diagnosed PTSD and Bipolar with an IQ of 89
• At her last placement, she assaulted an RTC staff
  with the leg ripped from an overturned table.
  The staff lost her eye.
• This youth has had 26 placements since coming
  into care.

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Children in RTCs

• 17 year old Female
• Physically aggressive to both children and adults
  
• History as a sex offender against a sister in her
  adoptive home
• History of suicidal thoughts, running away,
  property destruction, and making false
  accusations
• Bipolar Disorder, ADHD, PTSD, Fetal Alcohol
  Syndrome, and Oppositional Defiant Disorder with
  an IQ of 90
• Referred to juvenile authorities at least 5 times
  for theft, sexual assault and assault
• Since 2005 has had over 42 placements including
  multiple stays in psychiatric hospitals, RTCs,
  and emergency shelters. She considers the
  hospital to be a "safe place" and will do
  whatever is necessary to be hospitalized.

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Challenges for RTCs

• Both RTCs and DFPS face the challenge of
  balancing
• Privacy rights of children with supervision and
  security needs
• Need for older children to learn independent
  living skills while still keeping them safe
• Risk of physically preventing a child from
  running away or hurting themselves or others
  versus the risk a child will face on the streets
  or incarcerated
• RTC workforce challenges turnover, training,
  ratios

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New Minimum Standards Rules Changes

• Minimum standards revisions to be proposed for
  adoption in July
• New rule clarifying that RTCs must operate at all
  times as if 100 of their children receive
  emotional disorder treatment services, whether or
  not the children are eligible or qualify for
  those services
• Requiring facilities to document and assess
  childrens high-risk behaviors at the time of
  admission for each child
• Clarifying in rule that employees, contractors,
  volunteers, etc. are required to report suspected
  abuse, neglect, or exploitation directly to DFPS,
  and may not rely on the facilitys administrative
  staff to make the report

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System ImprovementChanges for Child Care
Licensing

• Immediate plans for improving RTC enforcement
• RCCL will conduct enforcement team conferences on
  all RTCs
• RCCL will follow-up on any findings of
  abuse/neglect and any serious deficiencies with
  an unannounced inspection within 30 days of the
  initial finding or citation
• RCCL has implemented more rigorous protocols for
  RTC staff and child interviews to be used during
  all team and follow-up inspections

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Law Enforcement Notifications

• DFPS is required by Texas Family Code 261.105(b)
  to notify law enforcement of any report it
  receives that concerns suspected abuse or neglect
  of a child.
• In FY09, Statewide Intake staff conducted 251,115
  notifications to law enforcement. In FY10, DFPS
  projects that the number of law enforcement
  notifications will rise to over 281,000.
• SWI is routing notifications to over 1,000 law
  enforcement jurisdictions

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System ImprovementLaw Enforcement Notifications

• Interim storage solution Extended the storage
  time for confirmation of sent and received faxes
  from 30 days to 45 days.
• Permanent storage solution By July 15 DFPS will
  implement system changes to electronically
  retrieve fax confirmation data and store it in
  the DFPS case management database system
• By August 1 Statewide Intake staff will contact
  all law enforcement jurisdictions currently
  receiving faxes and encourage them to convert to
  email notification using a generic mailbox.   
• This will reduce the number of changes due to
  staff departures in law enforcement settings.

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System Improvement Foster Care Redesign Current
Equation

• (Childs Needs) (Lack of Community Resources)
• Placement Outside of Home Community
• Increased Number of Changes in Placement
• Separation from Sibling(s) and Family
• Lack of Educational Continuity
• Fractured Social Support System

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System Improvement Foster Care Redesign
Redesigning the Equation

• (Childs Needs) (Adequate Community Resources)
  
• Placement in Home Community
• Decreased Number of Changes in Placement
• Placement with Sibling(s) in Close Proximity to
  Family
• Educational Continuity
• Strong Social Support System

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System Improvement Foster Care Redesign

• Final recommendations will be made by December
  31, 2010.  Recommendations will include
• How to obtain, contract, and pay for foster care
  services in a way that promotes desired outcomes
  for children.
• Policy, programmatic, fiscal, and practice
  implications of system changes and
• A mechanism for balancing foster care services
  demand and supply.   

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System Improvement Foster Care Redesign Public
Private Partnership (PPP)

• Representative of Key Stakeholder Groups
  including
• Foster Youth Alumni
• Providers
• Child and Family advocates
• Judiciary
• DFPS Advisory Council
• DFPS Executive Leadership
• Role in the Redesign Effort
• Provide guidance to the initiative
• Serve as conduit of communication between
  constituents and peers
• Propose recommendations to DFPS Commissioner

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System Improvement Fostering Connections

• Fostering Connections will help move children out
  of foster care and into permanency with relatives
  thereby reducing the trauma of foster care and
  allowing children/youth to connect with family. 

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• DayStar

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DayStar Recent Activities

• CPS workers conducted safety checks on all CPS
  children and continue to have an increased
  presence at the facility
• Standard by Standard Inspection
• Deployed RCCL resources from other regions to
  support intensive monitoring effort
• Significantly increase unannounced and team
  inspections, including evenings and weekends

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Child Protective Services DayStar Safety Plan

• CPS Placements have been suspended
• Safety checks on all children at Daystar
  completed
• Contracted for a monitor to be onsite at Daystar
• Star Health will provide trauma-informed training
  for Daystar staff.