Report: Texas foster kids left in state psychiatric hospitals for weeks or months
Austin American-Statesman - 3/8/2019
March 08-- Mar. 8--Hundreds of Texas foster children are languishing for weeks or months in psychiatric hospitals because they have nowhere else to go, hurting them psychologically, endangering them physically and costing the state millions of dollars.
Nearly 600 foster kids in fiscal year 2017 spent a total of almost 14,000 days in psychiatric hospitals after doctors said they were ready to leave, according to a new report by Disability Rights Texas, an advocacy group for people with disabilities.
The consequences can be serious. While psychiatric hospitals provide medication and treatment, they can also be dangerous places where kids are assaulted by other patients or, sometimes, staffers.
Meanwhile, foster youth forced to remain hospitalized after they're stable sometimes become frustrated and revert back to their old behaviors, such as becoming violent or trying to hurt themselves. In one case examined by Disability Rights, a teen girl who had been waiting for a place to go for three months became so agitated that she was restrained 14 times and given emergency medication 16 times.
All this extra time in hospitals costs money. In fiscal year 2017, the state spent $8.8 million on medically unnecessary stays for 584 foster youth, about $643 per child per day, according to the report, obtained exclusively by the American-Statesman.
"These are kids that are being removed from society and forgotten about," said Cindy Gibson with Disability Rights Texas. "When we talked to these youth and got a sense of their hopelessness and resignation, we saw a compelling need for someone to speak out and wake people up to their need for inclusion versus institutionalization."
Officials with the Department of Family and Protective Services, which runs the state's foster care program, admit there is a problem and say they're working to fix it. The day-to-day mental health care of foster youth who are already victims of extreme abuse and neglect is a complex issue that involves numerous moving parts and multiple players, such as doctors, lawyers, judges and advocacy groups, agency spokesman Patrick Crimmins said.
"If ever there was an issue that belonged to all of the state, its public and private sectors, it's this one," he said.
DFPS has hired seven caseworkers who specialize in working with children in psychiatric hospitals and assigned additional staff to find placements for youth once they leave the mental health facilities. The agency is also constantly working with residential treatment centers to add more beds, which have decreased in the last year, Crimmins said.
Officials say their efforts are paying off. In January 2019, 35 foster youth stayed in state hospitals longer than medically necessary, down from 79 in January 2018.
Rep. Donna Howard, D-Austin, who has worked on foster care issues in the Legislature, said the hospitalization problem defies a simple solution.
"It appears there are issues every step of the way here that need to be addressed," she said.
The problem of foster kids being stuck in psychiatric hospitals is not new. Fourteen years ago, a Statesman investigation showed that between August 2004 and September 2005, at least 19 percent of foster kids in state psychiatric hospitals stayed longer than necessary. The state paid $257,000 for those extra days.
The Department of Family and Protective Services has tried to mitigate the problem over the years by relying on community-based services to keep youth out of hospitals and paying residential treatment centers -- which provide services and around-the-clock monitoring in a less restrictive environment -- more money to take in the most troubled children. But some kids have such severe problems, such as a history of sexual aggression, that both residential treatment centers and specialized foster homes refuse to take them.
The agency has struggled in the past with having to temporarily house foster children in state offices because there was nowhere else to put them.
Nowhere else to go
When foster children go into crisis, sometimes trying to hurt themselves or others, they are sent to psychiatric hospitals to be stabilized. The average stay is generally five to seven days, according to the Disability Rights report.
But some kids end up in hospitals for months after doctors say they can leave.
Sometimes it's because there isn't space for them at appropriate, less restrictive facilities. Sometimes it's because the foster parents or centers who admitted the kids to the hospital won't take them back after they're discharged, said Disability Rights attorney Beth Mitchell, who worked on the report.
"Child Protective Services did not know that foster parents were dropping them off and leaving them there," she said. "They would find out once the facility would call and tell them."
In September, DFPS began requiring residential treatment centers to take back any hospitalized youth once they were discharged, Crimmins said.
But Disability Rights blames much of the problem on DFPS, saying state caseworkers often send kids to psychiatric hospitals without looking for less-restrictive alternatives. Caseworkers are supposed to meet with these foster children weekly and often do not, the report states. In some cases, the caseworkers never meet the kids in person, relying solely on phone calls.
A lack of placements isn't the only thing slowing down foster kids' timely release from psychiatric hospitals, Disability Rights says. DFPS caseworkers often fail to arrange for psychological evaluations until after a home is found, sometimes delaying the move for weeks.
High employee turnover at the department is also a problem for foster youth in psychiatric hospitals, Disability Rights says. When people leave, it takes time for new caseworkers to catch up, slowing down the process.
Crimmins said blaming the agency's caseworkers won't fix the problem.
"Anecdotal criticism of our caseworkers is easy to do, but doesn't really contribute to solutions," Crimmins responded.
While psychiatric hospitals provide necessary services, they can be dangerous, Mitchell said. In recent years, mental health facilities across the state have had serious problems.
The Centers for Medicare and Medicaid Services recently threatened to pull federal money from Dallas Behavioral Healthcare Hospital in DeSoto because of medication administration issues, sex between underage patients and long waits for treatment. Sundance Behavioral Healthcare System closed three facilities in North Texas in December after a Tarrant County grand jury indicted the company for allegedly holding patients against their will.
The Texas Health and Human Services Commission fined the Georgetown Behavioral Health Institute$180,000 earlier this year after officials say it failed to monitor patients appropriately, which allowed two patients to have sex. At that same hospital, a teenage boy was punched in the face by a staffer. Disability Rights says he was a foster child.
Being forced to stay in psychiatric facilities longer than necessary can take a negative toll on foster kids, said Christine Bryan, vice president of information technology and public policy at Clarity Child Guidance Center in San Antonio, which offers psychiatric care for children ages three to 17. Some become depressed because they can't leave. Others start to regress in handling their own issues because they are surrounded by children who are unstable.
"They're around kids that are acting out, which may cause them to act out," Bryan said.
Keeping foster children longer means there's less room for others who need help, she said. Clarity has been working with DFPS to move kids out of the facility faster.
"DFPS has been trying case by case to try to help fix this but we still have a lot of work to do," Bryan said.
One solution is to keep kids out of the hospital in the first place by using and creating more community-based services for youth with severe mental health issues, Mitchell said.
Meanwhile, doctors screening youth for admission at these facilities should be psychiatrists, the Disability Rights report states. More than half of the doctors who completed the admission assessments reviewed by the advocacy group were internists, family doctors, anesthesiologists or practiced in other unrelated fields.
"We think there are ways we can keep them from going into hospitals in the first place," Mitchell said. "Then they would never get stuck there."
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