s a f e c h i l d r e n , s ta b l e fa m i l i e s , s u ... nov 2nd...foster care placement 10% in...

Factors Impacting Placement Costs:

What Drives Placements, Strategies

to Control Costs, and Future

Challenges

November 15, 2017

S A F E C H I L D R E N , S T A B L E F A M I L I E S , S U P P O R T I V E C O M M U N I T I E S


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• Angela Sausser, PCSAO, Executive Director

• John Fisher, Licking CDJFS, Director

• Jody Walker, South Central JFS, Director

• Dan Downes, Marion CCSB, Business Manager

Today’s Presenters

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1. Responsibilities of counties to protect children

2. What drives foster care placement costs

3. Strategies to control costs

4. Preparing for future impacts

Objectives

Responsibilities of Counties to

Protect Children

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FEDERAL-MONITORED:

• US Dept of Health &

Human Services

STATE-SUPERVISED:

• ODJFS

COUNTY-ADMINISTERED:

• County Public Children

Services Agency (PCSA)

State vs. County Administered

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How Children Services is Funded in Ohio

$15 million/year was added to the SCPA for

SFY 18-19

Counties fund over half of children services expenditures

by relying on local government funds and dedicated

levies.

$352,392,067.00

$95,869,458.00

$490,016,450.00

Federal State Local

52%

10%

38%

SFY 2016, from ODJFS SACWIS special data runs for unduplicated count, October 2016 and

January 2017. Additional calculations by PCSAO.

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Ohio Ranks 50th in Nation for State Share

of Children Services Total Expenditures

SFY 2014, from http://www.childtrends.org/publications/child-welfare-financing-sfy-

2014-a-survey-of-federal-state-and-local-expenditures/

40%

7%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

National Average for State Spend Ohio's State Spend

2014 Comparison

Per Capita, Ohio is 15th in the nation for overall child

welfare spending

http://www.childtrends.org/publications/child-welfare-financing-sfy-2014-a-survey-of-federal-state-and-local-expenditures/

Children Services LeviesS A F E C H I L D R E N , S T A B L E F A M I L I E S , S U P P O R T I V E C O M M U N I T I E S

48 Counties; representing over 80% of

child population

Responsibilities of PCSAs

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Differential Response – In Home Services – Out of Home Services – After Care Services

SAFETY

- Intake- Investigations- Safety Assessment- Family Assessment- Case Plan

WELL-BEING

- Behavioral & Physical Health- Developmental Disabilities- Education- Delinquency/Unruly- Independent Living- Normalcy

PERMANENCY

- Reunification- Kinship Care- Adoption

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The Role of the Juvenile Court

PCSA

recommends:

• To keep at home

• To remove

• To reunify

• To terminate

parental rights

Judge decides:

• To keep at home

• To remove

• To reunify

• To terminate rights

Based on the “best

interest of the child”

Reasonable Efforts

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• County PCSA &…. Juvenile and probate judges County Commissioners Other court professionals Law enforcement Providers: MH, DD, Hospitals, Schools, etc.

Child Welfare System = Key Partners

What Drives Foster Care

Placements

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Child’s Strengths and Needs

Family Search and Engagement

Least Restrictive, Least Traumatic

Closest to Home, In-County

……What’s Available

Deciding the Best Placement

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Maintenance payments that cover the costs

of shelter, food, and clothing for eligible

children

Foster care placement services and

administrative costs related to foster care

Expenses related to training for staff and

foster parents.

Title IV-E Federal Funding

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1. Approximately 60% of children are IV-E

eligible

Those not eligible, 100% of expenses are

paid for with state or local funds

2. Approximately 63% reimbursement –

remaining matched with state or local funds

Title IV-E Federal Funding

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Type of Placement Aver. Per Diem1. Kinship Home: $0.00/day

2. Certified Foster Home: $58.18/day

3. Detention Facility: $172.75/day

4. Group Home: $210.50/day

5. Residential Treatment Center: $241.62/day

Cost of Care

Data provided by ODJFS, Special Request, Median Per Diem Costs as of 10/1/17

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• Differential Response

• Kinship Care

• Wendy’s Wonderful Kids / Permanency Roundtables

• ProtectOhio Waiver – Kinship, Family Team Meetings

Efforts to Reduce the Need for

Foster Care or Reduce Length in

Care

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• Ohio led the nation in safely reducing the number of children in foster care by 42% between 2002-2010.

IN FACT….

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Ohio’s Children Services System TodayMore children are in PCSA custody requiring a

foster care placement

10% in just 1 year – between

2016 & 2017

Source: ODJFS SACWIS special data run, October 2016. Additional calculations by

PCSAO.

12383

12654

13719

15052

11000

11500

12000

12500

13000

13500

14000

14500

15000

15500

2010 2013 2016 2017

children in custody

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Impact of Opioid Epidemic on Children

• 50% of children

taken into custody

in 2015 had

parental drug use

PCSA: county Public Children Services Agencies

Source: PCSAO Opiate Survey, April 2016

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Impact of Opioid Epidemic on Children

• 28% of children

taken into custody

in 2015 had parents

who were using

opiates, including

heroin, at time of

removal

Source: PCSAO Opiate Survey, April 2016

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Ohio’s Children Services System TodayChildren are staying in foster care longer due to

opiate recovery timelines and relapses

202

228

240

180

190

200

210

220

230

240

250

2010 2013 2016

Median Days in Temporary Custody (July 1)

Within 1 year of

recovery from

opiates, 90% will relapse

Source: ODJFS SACWIS special data run, October 2016.

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• Licking County• Marion County• South Central (Hocking, Ross, Vinton Counties)

How the Opioid Crisis has impacted

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While Opioids is impacting children

services so is….

Multi-System Youth:

A youth with significant mental health,

addiction and/or developmental delays who

is involved or at risk of being involved with

child protection and/or juvenile justice….

Multi-System Youth

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While allegations of abuse and neglect account for 82% of screened-in reports, 63% of children in agency custody are there for reasons other than abuse and neglect.

Abuse and Neglect

83%

Dependency5%

Family in Need of Services

12%

REPORTS SCREENED IN

Abuse and Neglect

38%

Dependency31%

Delinquency4%

Other27%

CHILDREN IN PCSA CUSTODY

Source: ODJFS SACWIS, calculations by PCSAO, SFY2016

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Nearly half (49%) in residential or group homes have a primary removal reason other than child abuse and neglect:

Source: ODJFS SACWIS data, 9/11/2014; 2,111 children in CRC or Group home on that day

6%

19%

24%

7%

9% 25%

10%

0%

10%

20%

30%

40%

50%

60%

Abuse and Neglect Unruly, Behavioral, andDelinquency

Dependency All Other

Unruly Status OffenderChild Behavioral ProblemDelinquencyAbuseNeglectDependencyOther

Primary Removal Reasons for Youth in Residential Treatment Facilities

Residential Care

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How Multi-System has impacted

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Ohio’s Children Services System TodayPlacement costs soaring due to more children in care

Source: ODJFS SACWIS special data run, January 2017. Additional calculations by PCSAO.

42% were substance abused-related cases

($138m) in SFY 16

$275,000,000.00

$330,575,009.00

$250,000,000.00

$260,000,000.00

$270,000,000.00

$280,000,000.00

$290,000,000.00

$300,000,000.00

$310,000,000.00

$320,000,000.00

$330,000,000.00

$340,000,000.00

2013 2016

Placement Costs for Foster Care & Residential Care (SFY 16)

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Breaking Down Placement Costs


60% placed in foster homes 14% in

congregate care

$180,762,258 $143,403,707(54.6% of total costs) (43.4% of total costs)

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Other Factors Increasing PCSA Costs

45% of foster home placements are

outside of placing county

23.8% are placed in a contiguous county

21.2% are placed in non-contiguous

counties

Source: ODJFS SACWIS special data run, 2017.

Only 7,200 certified foster homes

3,377 are certified by county PCSAs

Remember, there are

over 15,000 children in care every

day!

Strategies to Control Costs

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Increase State’s Investment In

Children Services

1. $15 million/year added to the State Child

Protection Allocation (ODJFS Line-600523) for SFY 18-

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2. $15 million/year from the TANF Block Grant to

establish a Kinship Child Care Program.

Multi-System Youth Recommendations

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Issued on June 29, 2016:

1. Establish a crisis stabilization fund to address unmet and

uninsured needs of MSY in crisis/unable to access care

2. Design a Medicaid-reimbursable service consistent with

High Fidelity Wraparound to coordinate care & supports

3. Establish a unified strategy for data collection and sharing

4. Develop youth and family focused peer support services

5. Modernize Ohio Family and Children First Councils

6. Fund an independent evaluation of timely access to

residential facilities

Multi-System Youth

Accomplishments

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1. Secured $5M in TANF Block Grant to establish a Crisis

Stabilization Fund for SFY 18-19.

2. OhioMHAS is required to make recommendations by the

end of 2017 on how data can be collected to track multi-

system youth

Reduce Reliance on Residential Care

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Goal: Develop more foster home options

and preventative, crisis-oriented community-

based treatment services so children do not

require residential care.

Children do better in families than in

institutions and it cost

less!

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Strategies to Control Costs:

Preparing for Future Impact

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Projecting Future Placement Costs


By 2020, Ohio will have 46%

more children in

care than in 2016

$275,000,000

$330,575,009

$375,585,681

$426,725,074

$484,827,560

$550,841,225

$0

$100,000,000

$200,000,000

$300,000,000

$400,000,000

$500,000,000

$600,000,000

2013 2016 2017 2018 2019 2020

Estimating Placement Costs2013 - 2020

Future Concerns = $$$

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1. Medicaid Managed Care – possible “cost shift”

2. Kinship Care -- potential to become a “paid”

placement

3. Reduction in Federal Funding (Title IV-E, Title IV-

B, Title XX, TANF, elimination of Protect Ohio)

4. Opioid Fatigue – less future investments (state,

federal)

Call to Action

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1. Support local Children Services levies

2. Advocate for additional State GRF support

3. Champion the need for more local foster homes

4. Work with Courts to change placing practices

and how it impacts county expenditures

5. Work with providers (MH, DD) to develop more

preventative and crisis-oriented community-

based services for kids

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Contact PCSAO for More

Information

Angela Sausser, Executive Director

(614) 507-3113; [email protected]

mailto:[email protected]

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