‘A Bed Is Not A Bed Is Not A Bed’: Building Up Child Welfare System To Deal With Looming Crisis Not A Simple Task
When the coronavirus pandemic and the accompanying economic shutdowns hit Illinois this spring, experts began to count up all of the ways in which COVID-19 would likely exacerbate an already rising level of need in the state’s child welfare system — a network itself long stressed by budget and leadership turmoil.
The state is barely three years out of a prolonged budget stalemate under former Gov. Bruce Rauner, which left Illinois’ human services sector severely weakened, and resulted in a surge of need in the child welfare system.
As child welfare needs have increased in Illinois, capacity has fallen. Between 2015 and 2019, Illinois’ shelter bed capacity was cut by 71%, from 159 beds to 46, according to DCFS. In that same time period, Illinois lost nearly 500 residential beds and 2,300 foster homes.
Gov. J.B, Pritzker’s budget projections from February — a month before Covid-19 entered the common vernacular — projected DCFS would see a nearly 20% rise in foster children entering the child welfare system by the end of the 2021 fiscal year next summer and planned for funding increases to address expanded child welfare needs.
But as COVID-19 spread, the actual increase of foster children in Illinois’ child welfare system has accelerated past those projections, with more than 21,000 kids in state custody at the end of the last fiscal year June 30.
To meet this increased need, the capacity of Illinois’ child welfare system needs to grow, but adding placements like foster homes and beds in residential facilities is not as simple as budgeting more money to the private child welfare agencies contracted with the state, which handle 85% of services for foster children and families identified by DCFS and courts as needing support.
Stressed families, stressed system
Children end up on the Department of Children and Family Services’ radar — and sometimes subsequently separated from their families on a temporary or permanent basis — for risk factors that could be amplified by a global pandemic and recession, including neglect, parental drug and alcohol addiction and financial stress.
Living through the COVID-19 era — with waves of mass unemployment, being cut off from normal social interaction and sometimes limited access to health or mental health services — is likely to bring many families to a breaking point, according to Illinois Collaboration on Youth CEO Andrea Durbin.
“We know that in times of distress, intakes [to the child welfare system] go up,” Durbin said. “If families are hanging on by a thread and the thread breaks, child welfare is one of the systems that picks up the pieces.”
Pritzker pushed for increased support to DCFS in his proposed budget, and lawmakers in May ultimately passed a $126 million — or 10% — boost to DCFS, some of which is passed on to private agencies that contract with the state to provide child welfare services, including residential placements for children.
Simply increasing DCFS’ budget and meting out more money to child welfare service providers is only the first step in the long process of actually increasing Illinois’ child welfare capacity — a process that may prove too slow to meet the rise in need as the Covid-19 pandemic wears on.
Not all beds created equal
When children are surrendered to DCFS, oftentimes as a result of abuse or neglect, the state is in charge of finding a place for them to live. Many times, they are placed with a relative but sometimes they have complex needs and require more advanced care, or they don't have family members who are able to take care of them. In those cases, they are sent to a residential facility like a shelter or a psychiatric hospital, or with a child welfare services provider.
However, it’s not as simple as placing a child in need in any open bed in Illinois.
“A bed is not a bed is not a bed,” Durbin said. “You can’t put a young child in a facility or in a wing with 17, 18-year-olds. You can’t put a girl in a boys wing. You can’t put someone who has history of sexually problematic behaviors with people who have a history of human trafficking.”
Ideally, a child would be matched with a residential setting tailored to their needs, including developmental or intellectual disabilities. Being nearby to family instead of on the opposite end of the state is also preferred.
However, especially in an emergency, beds that don’t match some or any of a child’s needs aren’t always immediately available, and children have ended up being placed in hotels, or even sleeping in DCFS offices.
Sometimes, children who have served their time in juvenile detention or finished a stint in a psychiatric hospital are held in those settings beyond the time they’re supposed to be there if there’s no bed available in a less restrictive setting.
According to DCFS’ own data, 17.5% of foster children in psychiatric hospitals were held “beyond medical need” in the 2019 fiscal year. Despite assurances from DCFS that figure would decrease after reporting on the issue from ProPublica, the 2020 fiscal year ended in July with 19.5% of children in psychiatric hospital treatment being held beyond medical need.
“Those places are not benign places,” Durbin said. “Being stuck in a hospital, prison, or detention center are not neutral experiences; it’s a traumatic experience…People don’t get back the days of their lives. You don’t get a do-over on your childhood.”
Building beds, building staff
Creating a brand new residential treatment program for kids on the autism spectrum has been a three-year journey for Lake Villa-based Allendale Association, which serves approximately 100 children across its residential programs.
Building out an “Autism House” on Allendale’s Lake Villa campus began with a single call from DCFS in 2017 asking Allendale to take an eight-year-old boy whose family was in crisis.
“We said yes in an emergency situation,” Allendale President and CEO Jason Keeler said.
A few days later, DCFS called Allendale again, asking if the center could take the boy’s two younger siblings on the autism spectrum who were nonverbal and still in diapers.
But when Allendale was asked to take on more children on the autism spectrum, Keeler said it became clear that the organization would have to “reshuffle the deck.” That meant moving a residential program for girls to an auxiliary site in Waukegan, moving the boys with autism to the girls’ old unit on Allendale’s Lake Villa campus, fixing up both spaces and getting approval from fire marshals and building inspectors.
“Even though we didn’t have a contract yet, we spent $60,000 on renovations basically on leap of faith,” Keeler said.
It also meant months of contract negotiations between DCFS and Allendale to set reimbursement rates and other agreements for the new program. After the contract was set, Allendale then made hires to adequately staff the small program. Keeler said even though the program will only serve up to six children, Allendale needed “twice the staffing because you can’t take your eye off them for a second.” In total, the creation of Allendale’s new program for kids with autism took 10 months.
Beyond negotiating contracts and upgrading physical space, expanding bed capacity in either a new or existing residential program will often mean making new hires. But recruiting and maintaining staff within the child welfare system has long been a struggle, made even more difficult in recent years.
Human service agencies have always struggled with major staff turnover, as some staffers inevitably move into higher-paying jobs within the corresponding agency in state government or out of the industry altogether. But Antwan Turpeau, Chief Operating Officer for Chicago-based child welfare agency One Hope United, says that during the budget impasse, a new competitor emerged: Amazon.
“When tech companies and service delivery companies like Amazon started to expand, a lot of people who lost their jobs in the nonprofit world went to Amazon and made so much more money and didn’t have to deal with the injuries [that come with serving some kids with trauma and complex needs],” Turpeau said.
Keeler agreed, pointing to the large Amazon distribution center in Kenosha, just across the Wisconsin border from Lake Villa. He said he understood the pressure on recent college grads to make rent and pay student loans, but said losing out on potential hires has put budgetary pressure on Allendale to increase wages.
Included in this year’s state budget is a cost of living rate increase for providers contracted with DCFS for only the third time in nearly 20 years.
Continuum of care
Child welfare practitioners largely agree that the best place for foster children is ultimately with a family, whether that’s reunification with a child’s own family or permanent placement with extended family or an adoptive family. But kids don’t always get there, and the next best placement is the one that’s “least restrictive,” Durbin said.
Beyond not having enough residential or foster family capacity to move children fluidly through the system after an initial stay in a therapeutic environment, Turpeau said the child welfare system is still feeling the effects of the budget impasse that decimated other parts of Illinois’ human services sector, which he called the “continuum of care.”
“All of those agencies who were providing real true, intimate community resources folded, then certain behavior health programs weren’t there,” Turpeau said. “If kids were discharged and ordered to receive intense family therapy, it didn’t exist, or didn’t exist in a convenient way for families who have means to travel to get that service.”
Charles A. Montorio-Archer, the president and CEO of One Hope United, said his organization chose to keep providing auxiliary services outside of residential treatment, despite the financial damage done by the budget impasse, in an effort to prevent children from having to regress back into residential care.
“If we want to live our mission, we had to…[work through] one or two, maybe three years of deficits,” Montorio-Archer said.
Turpeau pointed to a new federal law meant to discourage children languishing in residential placements — especially restrictive ones — beyond the time deemed necessary by caseworkers and mental health providers, but said the law will only work if there are enough community resources both inside and outside of the child welfare system to support families.
“You can build up more beds all you want,” Turpeau said. “That just means more kids are going to be stuck in those places if the other end is not developed in that community.”
Turpeau, Montorio-Archer, Keeler and Durbin all said DCFS could do more strategic planning for both residential capacity needs and resources outside of the community so that children in foster care are neither under-treated or over-treated.
DCFS spokesman Bill McCaffrey pointed to a planning process already in place within the agency to strategize around future needs.
“Residential capacity is determined under a centralized approach that utilizes DCFS data to review and evaluate specific needs, and that includes looking at clinical assessments and recommendations,” McCaffrey said. “The idea that there’s no centralized approach is so plainly wrong.”
The agency also cited a $1 million fund for construction grants for DCFS service providers with residential programs — the first time the state has offered such funding in years.