Q&A for Parents about Out-Of-State Placements for Residential Treatment

Following the creation of the Louisiana Behavioral Health Partnership and continuing under Healthy Louisiana (formerly, Bayou Health), Louisiana children began being placed in other states for residential care for the first time since the 1970’s.

The placement of children from one state to another is currently a hot button topic in child welfare. Some states have allowed the practice to grow out of control. For example, news reports from California indicate out-of-state placements there are out-of-hand. Some states like Montana, on the other hand, do a fine job regulating and monitoring out-of-state placements. (In fact, Montana has model legislation to ensure out-of-state placements are made only when necessary, are monitored, and reported to that state’s Legislature for reasons of accountability.)

This Q&A is designed to answer common questions parent have about out-of-state placements for Louisiana children.

Q. Is it ever appropriate for a child to be placed out-of-state for treatment?

Yes. There are rare times when an out-of-state placement is the best option because a child or adolescent requires a type of treatment that is not available in Louisiana.

Q. What is a Residential Treatment Center (RTC)?

A Residential Treatment Center provides intensive, active treatment to children and adolescents whose needs cannot be met in other settings. Residential Treatment Center services include active treatment planning with family participation, mental health treatment, educational services, daily living, recreation, and medical care. In Louisiana, Residential Treatment Centers for more than 16 children or adolescents must be licensed by Louisiana’s Department of Health under its “Minimum Licensing Standards for Psychiatric Residential Treatment Facilities”.

Q. How are the 3 Methodist Children’s Homes licensed?

Last year we cared for 280 children and adolescents in our three children’s homes: Louisiana Methodist Children’s Home in Ruston, Methodist Children’s Home of Southwest Louisiana in Sulphur, and Methodist Children’s Home of Greater New Orleans in Mandeville.

Each of our three children’s homes is licensed by Louisiana Department of Health’s Health Standards Section as a Psychiatric Residential Treatment Center. Because we care for more than 16 children in each location, this is the only license Louisiana allows us to hold for our children’s homes. In each home we provide a full array of services designed to care for children and teens who cannot be cared for in less intensive settings.

We have significant expectations regarding family participation in treatment and we even created a no-cost Family Lodge to ensure hotel costs do not interfere with treatment at our largest children’s home. Active family participation is important because treatment is much more effective!

Q. Are Out-of-State Residential Treatment Centers Licensed Like Those in Louisiana?

No, not necessarily.

Residential Treatment Centers in other states are not held to the same standards as those in Louisiana. In fact, Louisiana’s Department of Health maintains no minimum licensing standards for out-of-state facilities. For children whose care is covered by Medicaid and managed by Healthy Louisiana (formerly, “Bayou Health”), Louisiana’s Department of Health permits Louisiana’s managed care organizations to make their own decisions about placing children out-of-state.

In doing this, Louisiana’s Department of Health relies on licensing agencies of other states to regulate services in their respective states.

Q. Must Out-of-State Facilities Meet the Same Standards of Care as Louisiana’s Group Homes?

No. At this time, Louisiana does not prohibit placement of children in substandard out-of-state facilities.

One reason Louisiana’s Department of Health began licensing Psychiatric Residential Treatment Centers was to facilitate the closure of Louisiana’s public psychiatric hospitals for children and adolescents. Consequently, Louisiana Department of Health regulations require Louisiana’s Residential Treatment Centers to maintain a safe staffing ratio.

A simple comparison of required staffing ratios (the number of professionals required to be present with a child throughout the 24 hours of each day) makes the differences between Louisiana children’s homes and facilities in other states very clear. Louisiana requires a 1:3 during the day and a 1:4 staffing ratio during sleep hours.

Texas, to use our neighboring state for comparison, requires only a 1:5 staffing ratio during the day and 1:15 during the night. That means one staff member supervising 15 children. This difference is striking. Texas requires significantly less staff than Louisiana.

Q. Why Would a Managed Care Company Wish to Place My Child in Another State?

Managed Care Organizations are generally large, public corporations with shareholders and investors. Every dollar a managed care company does not spend on operations or service for members is a dollar the company retains toward profit. This creates value for shareholders. A managed care company may increase profit by placing children in less regulated, cheaper services.

(Also remember, there are some conditions that cannot be treated in Louisiana because treatment requires specialists who do not practice in this state. If a required service is not available in Louisiana, then an out-of-state placement is in the child’s best interest.)

Q. I Do Not Want My Child Placed in Another State. What Can I Do?

First, just say, “no”. Whatever state you are in, make your voice heard. Here in Louisiana, tell the Healthy Louisiana care manager who is talking with you about your child’s treatment that you want your child placed close to your family so you can participate actively in treatment. If your child must be placed out of state, make sure your travel to participate in care is covered by your managed care organization.

Second, contact Louisiana Department of Health’s Office of Behavioral Health and inform the staff of your desires.

The Office of Behavioral Health web page is: http://new.dhh.louisiana.gov/index.cfm/subhome/10

The phone number is: 1-855-BAYOU4U / 1-855-229-6848

The email address is: healthy@LA.gov

Third, contact your Louisiana State Senator or Representative. Our Legislators are often tied up in work related to budgets and business, but the Senators and Representatives I’ve met also want to do what some of them call “the people’s business”. They know there is nothing more important to people who are parents than their children. If Louisiana does not have the resources available for your child, your Senator and Representative need to hear from you.

Remember this: as your child’s parent, you DO have a voice regarding the care your child receives. Use it!

Rick Wheat, President and Chief Executive Officer
Louisiana United Methodist Children and Family Services

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