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An Open Letter to the Louisiana State Legislature
Thursday, February 16, 2017
Dear Honorable Senators and Representatives of Louisiana,
This morning you will begin your fourth day of the 2017 First Extraordinary Session called by Governor John Bel Edwards. You are working diligently to address the necessary adjustments to appropriations. If I follow correctly, the budget plans proposed so far appear to leave funding for Louisiana’s Department of Children and Family Services intact. Thank you!
Thank you for realizing the importance of maintaining at least the current level of funding for the care of Louisiana’s foster children. In case there are any among you who doubt how critical it is that Louisiana fund the services of the Department of Children and Family Services, I will share my view from the field.
For nearly 30 years I have worked in Louisiana’s child welfare system. Today, I serve as Chief Executive Officer of Louisiana United Methodist Children and Family Services. For 115 years, our organization has provided care to children and families from every parish of our great state.
During my career, I have seen our state’s successes and her failures related to the care of foster children. Never have I been as concerned for Louisiana’s foster children as I am today.
I remember when Louisiana’s child welfare system had the respect of the nation. Believe it or not, professionals from other states visited Louisiana to observe, ask questions, and tour our state to learn how to do it right in their own states. Staff from Louisiana’s Department of Social Services (as it was called at the time) were invited to national conventions to share what we in Louisiana were doing correctly.
Clearly, those days are behind us. Today, Louisiana’s Department of Children and Family Services sits like a small boat tossed by a hurricane. Her sails in tatters, she is barely afloat and, at any given time, she carries the lives of 4,800 foster children.
During former Governor Jindal’s administration, those of us who care for our state’s foster children watched as Louisiana’s child welfare system took the proverbial blow to the head during a storm. As a consequence of that wounding, Louisiana remains a bit cross-eyed about how it cares for foster children. With fuzzy vision, we do not yet see clearly what was once plain – that “child welfare” is much broader than “behavioral health”.
With the creation of the Louisiana Behavioral Health Partnership, there was a sudden and intense blurring of the line between behavioral healthcare and child welfare. (Some of us in the field even feared the former Governor’s plan was to subsume the Department of Children and Family Services into the Department of Health and Hospitals.)
Today, Louisiana’s leaders must understand that “behavioral health” is NOT “child welfare”. While behavioral health is important, Louisiana’s Department of Children and Family Services is the state agency responsible for the care of our state’s foster children.
In Louisiana, “Behavioral health” is a subset of Medicaid-funded services designed to address the mental health, psychological and psychiatric needs of adults and children. Behavioral health is an important responsibility of Louisiana’s Department of Health which manages behavioral health services at arm’s length through the five Healthy Louisiana insurance/managed care organizations.
“Child welfare” is a much broader endeavor which must ensure the total daily protection and comprehensive care of foster children whose lives have been entrusted to the State of Louisiana, Department of Children and Family Services, because a judge determined the children were victims of physical or sexual abuse or neglect – or were at risk of imminent harm from their families.
The Department of Children and Family Services, which is responsible for Louisiana’s child welfare services, must always have resources available to it which are sufficient to meet the entire range of needs experienced by 8,000 foster children each year. These needs include housing, food, family support, education, socialization, case management, transportation, extracurricular experiences, instruction in life skills, dental care, emotional support, supportive and persistent relationships, medical care, and behavioral healthcare. Foster children require everything every other child requires – and then a bit more.
Louisiana’s Department of Health and Hospitals was tasked by former Governor Jindal to create a “Medicaid managed care system for behavioral health”. The system was created quickly to allow Louisiana to “pull down” additional federal Medicaid money.
There have been consequences. From my perspective, the continuing impact upon the Department of Children and Family Services has left Louisiana’s foster children to pay the costs.
Funds once used for child welfare are now tossed into a pot of “blended and braided funding” used by Louisiana’s Department of Health to bring additional Medicaid funds into Louisiana. Certainly, Louisiana has been successful in using child welfare funds to pull additional federal funds into the state – but not necessarily to benefit foster children.
In fact, today, important services for foster children no longer exist in Louisiana because significant pieces of our state’s former child welfare system sank in the Medicaid storm surge. Here are examples of what Louisiana lacks today:
• We lack enough foster families. Today, Louisiana’s foster parents receive the same daily support to care for foster children in their homes that they received 10 years ago: $16.70 a day. With no increase in payments to foster families during the last decade to cover the costs of caring for a foster child, Louisiana’s foster parents are $100/month behind inflation and stuck at a daily rate that was too low a decade ago. (According to ChildTrends, even six years ago in 2011, the daily rate of $16.70 covered only 70% of the cost of foster care in Louisiana.) Consequently, we have too few foster families for Louisiana’s 4,800 foster children.
• Today, Louisiana’s foster children are without Emergency Shelter Care in most regions of our state. This is unacceptable! Without Emergency Shelter Care, foster children have had to spend nights in state office buildings.
• Today, group home and foster care beds are not available in sufficient numbers. Children with the greatest needs are concentrated into these limited beds. Consequently, foster children with acute needs are overwhelming the limited resources which remain available for their care.
• Today, long-term intensive residential care services are no longer available in Louisiana for foster children with developmental disorders and psychiatric diagnoses. Successful programs which once existed were closed by regulation or underfunding. DNP no longer exists in southeast Louisiana. The CAB and WINGS programs are gone from north Louisiana. As a result, some of Louisiana’s foster children are now being placed in other states.
• Today, Louisiana no longer has long-term placements available for children whose behaviors preclude care in foster homes. With the medicaidization of child welfare elements, Louisiana lost access to special residential environments which provided children time and relationships long enough to encourage the development of attachment skills and which provided on-site alternative education and vocational education services for older foster children who were expelled from public schools.
• Today, InterQual and “computer algorithms” used by LDH’s Healthy Louisiana managed care organizations – and not DCFS Regional Placement Specialists, Case Managers, Social Workers or Therapists – determine when a foster child has “met maximum benefit” in Louisiana’s children’s homes. As a consequence of using computer-based “artificial intelligence” to “manage care”, foster children now experience more placement disruptions. Every new placement is experienced as rejection and loss.
• Today, Louisiana’s Department of Children and Family Services must track a category of children designated as “Dwellers”. These are foster children for whom there is no next placement available so they remain in their current placements without financial support. Frequently, the care which these foster children require is disrupted by what I call the friction of managed care.
• Today, there are not enough Therapeutic Foster Care beds available for Louisiana’s foster children who have significant needs. The former largest provider of Therapeutic Foster Care left Louisiana at the end of 2015 because continued operations in our state were untenable. (We created Methodist Foster Care and stepped into the gap.) Today, Louisiana’s Therapeutic Foster Care providers are underfunded and only those with sufficient charitable funds can afford to do active recruiting of new families in a state that desperately needs more Therapeutic Foster Homes.
• Today, while other Southern states move to actively and appropriately address the transitional living needs of foster children, Louisiana’s foster children are literally released to the streets at 18 and unprepared for adulthood. (Last month, even North Carolina extended services to foster children up to 21 years of age. Louisiana struggles to support foster children to 18.)
Today, children in your community are living with the consequences of insufficient child welfare resources. Foster children are placed, discharged, and re-placed. This process repeats until age 18 when Louisiana places these children on the street. For a foster child, every new placement is a broken attachment. And for every child, each new placement represents another broken opportunity for love.
I ask you to see clearly what must be done: for the sake of Louisiana’s most desperate children, fully fund the operations of Louisiana’s Department of Children and Family Services. Louisiana’s foster children need a state legislature with the continued courage and determination to say, “whatever else happens, Louisiana will care for her foster children!”
Protect funding for DCFS because it is the right thing to do. Do it because Louisiana’s foster children need your help. Do it because you were elected to do what no one else can do: work with all your colleagues in the Legislature to protect Louisiana’s most fragile children by fully funding Louisiana’s Department of Children and Family Services.
President and Chief Executive Officer
Louisiana United Methodist Children and Family Services