7/10/2015 – A year has passed since the June 2014 release of the advocacy paper, “Louisiana’s Children are Being Placed Out-of-State“. Today I would like to remind you of that paper and provide an update regarding Louisiana’s current ability to care for its own children.

That we are still without a complete child welfare system in Louisiana was driven home to me recently in a conversation with a representative of one of the five Bayou Health plans which, beginning December 1, 2015, will be given responsibility for managing the Medicaid-funded behavioral health needs of Louisiana’s children and adolescents.

The current gaps in services are already influencing the network development activities of the five Bayou Health plans. At least one Bayou Health plan is already touching base with residential providers in their out-of-state network to ensure – if it is required – that there is capacity sufficient in other states for the needs of Louisiana’s children.

If Louisiana had a complete child welfare system, this would not be necessary. As it is, while it’s not a solution, I do applaud the preparatory work the Bayou Health plan is doing.

Louisiana still lacks needed Therapeutic Group Homes. As of July 7, 2015, there are now five (5) licensed Therapeutic Group Homes in Louisiana offering a total of 38 beds. (Oddly, on 7/7/15, two of these facilities were operating at half capacity. At least four had vacancies – which calls into question why we are not effectively using the few resources we DO have available.)

Back in 2011, Mercer, a consulting firm contracted by Louisiana’s Department of Health and Hospitals to help design the Louisiana Behavioral Health Partnership, determined Louisiana needs Therapeutic Group Home space for 340 children. Today, after four years, we have beds for only 11% of those children.

I know it’s complicated and, with the impending transition from one managed care organization, Magellan of Louisiana, to five, it will soon become even more complicated. I also know this: as long as Louisiana’s leaders are willing to accept gaps in services for children and willing to fund out-of-state placements, the child welfare system in Louisiana will continue to languish and our children will pay for it.

There must be sufficient services for children and families in Louisiana. There must be enough staff working with Louisiana’s children and families to make the system work for children and families. Without sufficient people, systems fail. It takes people to care for people.

(In the four year period from 6/30/10 to 6/30/14, DCFS staff was reduced by 20% [from 4,599 to 3,723] and DHH staff was reduced by 36% [from 11,996 to 7,659]. Together, the two state departments created to care for our state’s citizens have lost more than 30% of their employees, a reduction of 5,213 employees. See http://www.civilservice.louisiana.gov/files/publications/annual_reports/AnnualReport13-14.pdf and http://www.civilservice.louisiana.gov/files/publications/annual_reports/AnnualReport09-10.pdf)

All of this flows from the top. We must have a governor who makes the proper and full care of Louisiana’s children his or her priority. See Advocate for Louisiana’s Children and Families.

In a Request for Proposals released by Louisiana’s Department of Health and Hospitals in August of 2014, DHH proposes that the State Management Organization selected to manage the Medicaid-funded behavioral healthcare of Louisiana’s citizens will limit the number of youth it may place “in out-of-state facilities for treatment purposes” to 10 per contract year in the second and third year of the contract. In the first year of the three year contract, no corrective action plan will be required for placing more than 10 youth out-of-state during the year.

DHH is aware that Louisiana has a shortage of residential treatment options available for children in Louisiana. That a corrective action plan is required only in years two and three seems to indicate DHH expects the Bayou Health companies will – during their first contract year – successfully build a full network of needed residential resources in our state. Based on the previous three years of the Louisiana Behavioral Health Partnership, this is possible, but not probable.

As I wrote more than two years ago in, “Louisiana Needs Treatment Group Homes for Children“, there are steps that can be taken to begin filling Louisiana’s gaps in children’s services. Ideas include:

1. Provide start up funds for Therapeutic Group Homes. This is important and here’s why: before DHH Health Standards can issue a license for a level of care, the potential licensee must be fully staffed and fully operational. There are no startup funds available to cover the cost of staff who must be hired 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 a Provisional TGH the full TGH rate to help defray the costs of startup.

By contract, the Department of Health an Hospitals passes responsibility for recruiting TGH providers to the State Management Organization, Magellan of Louisiana – soon to the five Bayou Health Plans. If DHH cannot assist with startup funds, these Bayou Health plans are large, public corporations designed to generate profit for shareholders. There are funds available.

3. DHH and the Bayou Health plans must create supportive relationships with potential TGH providers which facilitate the creation of services. This is a generalization, but in my experience it holds true: by design, the Department of Health and Hospitals focuses more on regulations than on relationships. At the same time, the people who care directly for others – the potential Therapeutic Group Home providers – are relationship-oriented people.

4. Louisiana’s Department of Health and Hospitals must regularly and transparently report the number of Louisiana’s children who have been and who are being placed out of state for treatment purposes. 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 services that once existed were eliminated before replacement services were available within the Louisiana Behavioral Health Partnership. That replacement services have not become available in Louisiana means children will be placed out-of-state.

Providing residential care for children “in Louisiana” is important, too. The closer a child is to her or his family or foster family, the easier it is for family to participate in treatment. What we know for certain is that the more a family participates in treatment, the greater the chance of a successful outcome.

Also, by reporting all out-of-state placements, the State will create its own motivation to resolve the problem of the missing Therapeutic Group Homes. It will keep the issue visible until it is resolved.

Summary

So, to summarize this year’s update, we know the following:

Some number of Louisiana’s children are still being placed out-of-state because sufficient services and resources are not available within our own state.

Beginning December 1, 2015, the five Bayou Health plans will be contractually responsible to build their networks of service providers.

We have 11% of the Therapeutic Group Home beds required for Louisiana children.

There is still much to do.

Rick Wheat, President & CEO
Louisiana United Methodist Children and Family Services