By its own count, Louisiana needs at least 34 Therapeutic Group Homes (of no more than 8 beds each per DHH) located throughout our state. Today Louisiana has only one: Parker House in Baton Rouge is a Therapeutic Group Home for young girls and boys 13 and under. There are no TGHs for adolescents in Louisiana.

It is critical that Therapeutic Groups Homes be made available for Louisiana’s children who require more intensive treatment than can be provided in a Non-Medical Group Home. Everyone agrees this is true, but Louisiana’s managed care system for behavioral health has tied itself in knots with regulations that are too restrictive relative to a TGH’s location and with a reimbursement rate that is too low to entice current providers.

As it happened, all the pre-Bayou Health Group Home providers were given a choice between seeking licensure as a Therapeutic Group Home or continuing their operations as Non-medical Group Homes. It was a forced choice. What Louisiana left off the table to encourage the former Group Home providers to step up to TGH licensure were funds to cover the cost of the transition.

(The three Methodist children’s homes in Louisiana faced a similar scenario, but because we care for more than 16 children at each of our locations, our only option permitted by Louisiana was licensure as psychiatric residential treatment facilities. We will not be reimbursed the cost of making the transitions from our former DCFS Class A Child Residential licenses to the DHH Psychiatric Residential Treatment Facility licenses. Baton Rouge warned that providers would be required to “bring more to the table” – it did not seem possible it would have been so much.)

Now, potential Therapeutic Group Home providers find themselves in a similar bind. The difference is that many of them do not possess the financial reserves to cover the cost of a transition from Non-Medical Group Home to Treatment Group Home.

As I wrote in “Two Missing Steps“, “Unfortunately, the per diem reimbursement rate is too low to allow a provider to ever recoup the start-up costs. Figuratively speaking, a new TGH provider will start out in a hole and never climb out.”

There are always solutions, but they will require movement on the part of state bodies such as the Department of Health and Hospitals, the Coordinated System of Care, and the Office of Behavioral Health.

Here are some ways DHH, CSoC and OBH might use to recruit current Non-Medical Group Home providers who wish to become Treatment Group Home providers:

1. Provide start up funds to cover the cost of the transition. This is important and here’s why. Before DHH will issue a license for a level of care, the potential licensee must be fully staffed and fully operational. There is no reimbursement for the cost of staff who must be added in order to acquire the license.
2. Create a Provisional Therapeutic Group Home license for providers who are diligently seeking Therapeutic Group Home licensure. Pay group home providers the Provisional TGH per diem rate to help defray the costs of the transition.
3. Myers and Stauffer, the accounting firm contracted by DHH to establish the reimbursement rates for the various levels of care, chose different rate setting mechanisms for the different levels of residential care. More than a year has passed since CSoC kicked off. Only one provider has stepped up to pursue TGH licensure. Perhaps the per diem rate is too low to entice significant interest. Reconsider the rate setting mechanism.
4. By contract, Louisiana’s Coordinated System of Care passed responsibility for recruiting TGH providers to the State Management Organization, Magellan of Louisiana. Magellan has recently posted Requests for Proposals for potential Therapeutic Group Home providers. Magellan’s RFP process is a good thing and should continue, but I believe, until the funding issues are addressed by DHH, Magellan’s repeated RFP releases will take much too long to generate the 34 Treatment Group Homes Louisiana requires for its children in out-of-home care.
5. After a year of CSoC operation without any Therapeutic Groups Homes for adolescents in Louisiana, perhaps it’s time for the state officials who planned CSoC to gather again with residential providers to learn what is not working and to explore solutions to the barriers that exist. There were several provider meetings before CSoC kicked off. It’s probably time for another meeting.
6. Begin transparently reporting the number of Louisiana’s children who are being placed out of state for residential care. If the number is 0, report it. If the number is 40, report it. Whatever the actual number is, Louisiana’s children have been placed in facilities out of state because the authorized CSoC services have not been available in Louisiana. This is important. The closer a child is to her or his family, the more family can participate in treatment. The more a family participates in treatment, the greater the chance of a successful outcome.

   By reporting all out-of-state placements, CSoC will create its own motivation to resolve the problem of the missing Therapeutic Group Homes.

Finally, you may wonder why Louisiana United Methodist Children and Family Services is advocating so persistently for the creation of Therapeutic Group Homes, a service we do not provide. It’s simple: Louisiana’s children need them.

The Louisiana United Methodist children’s homes provide Louisiana’s most intensive levels of residential care in Ruston, Sulphur, and Mandeville. (We have the bootstrap, heel and toe of Louisiana’s boot covered.) Most of our children who are ready to leave our care cannot return home and the step from our psychiatric residential treatment facilities into a non-medical group home is much too far.

Many of our children who cannot return home require continued care in the next logical, less-restrictive level of care: Treatment Group Homes. Our children need Therapeutic Group Homes.

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