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Another DCFS disaster exposed

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Illinois

* This ProPublica story produced with the Atlantic is a must-read…

Here’s how the system is supposed to work: After children are admitted to a psychiatric hospital, staff psychiatrists assess them and try to stabilize them, develop treatment plans that usually involve managing their medications, and then initiate a course of treatment to be followed with an outside doctor. After that, they’re typically released. Psychiatric hospitals are designed for short-term stays—days or a couple weeks—and staff often start planning for a discharge the day a child arrives.

Any long-term treatment is supposed to occur elsewhere, during appointments with outside doctors or at residential treatment centers, where psychiatrists and therapists have time to develop relationships with the child and address the deeper issues that led to the hospitalization and DCFS’s involvement

* But that’s now how the system actually works in Illinois…

I analyzed thousands of pages of confidential records and obtained data from DCFS under the Freedom of Information Act covering all of the nearly 6,000 psychiatric hospitalizations of children in DCFS’s care between 2015 and 2017. In that period, nearly 30 percent of all children in DCFS care who were hospitalized were held beyond medical necessity, for a collective total of more than 27,000 days—that’s nearly 75 years—waiting and watching the outside world from behind the thick panes of hospital safety windows because DCFS has too few beds in other facilities where they could be more appropriately treated. On average, more than one in five days spent in a psychiatric hospital, the records indicated, were not medically necessary.

In the vast majority of those cases, children were held long past when they were cleared for release, not just a day or two beyond. Eighty percent of the more than 800 children whose stays became medically unnecessary between 2015 and 2017 were held for 10 days or more beyond when they should have been released. More than 40 percent were confined for a month or longer; 15 percent had to wait two months or longer.

In 2014, 88 psychiatric hospital admissions went beyond medical necessity, but that figure jumped to 246 the following year—a surge DCFS has struggled to explain, but that officials at the agency suggested could be due to the cases becoming more complex. Since then, the number of those admissions has continued to rise, though more gradually—from 292 in 2016 to 301 last year, according to DCFS statistics.

The result: Every day since July 2015 through the end of December 2017, at least nine children—and sometimes dozens—were unnecessarily held in psychiatric hospitals. There was a girl who spent so much time in one that hospital staff were asked to bring her a winter coat. She had been admitted in the summer.

Go read the whole thing.

posted by Rich Miller
Tuesday, Jun 5, 18 @ 10:56 am

Comments

Problems identified included insufficient community services and rates. Over the last 3 years, our social services network has been decimated by Rauner’s impasse. Vote accordingly.

Comment by Norseman Tuesday, Jun 5, 18 @ 11:24 am
You can’t provide services without money. and “In 2016, a federal judge signed off on a plan aimed at keeping more children in family-like settings and out of psychiatric hospitals and other institutions.” This really needs money, and, really? constantly with the community services thing with kids. it can’t always work. we have to find ways to keep kids some place when they can’t go home. and there are fewer families to take in foster kids, and smaller family like setting cost lots. so we’re back to money we don’t have. Early intervention….diagnosis early on, helping parents learn early on….may help. Docs need increased recognition, mass trainings for parents on a variety of parenting needs, can’t wait until they are past 10.

Comment by Amalia Tuesday, Jun 5, 18 @ 11:39 am
===we have to find ways to keep kids some place when they can’t go home===

Judy Baar Topinka advocated re-opening state orphanages. Not sure if that’s a solution, but it might be an improvement over their current situation.

Comment by Rich Miller Tuesday, Jun 5, 18 @ 11:40 am
Before moving over into government, I worked as a mental health specialist at some of these hospitals. The issue is not with DCFS, the issue is that it is difficult to find placement for these children. Often waiting months for a bed to open at a group home. Rarely do family members or foster parents step up to house these youth. It is a difficult population to say the least. Also, many homes would place children from downstate because they fear kids from Chicago more for some reason.

Comment by Anon Tuesday, Jun 5, 18 @ 11:45 am
Many of these children couldn’t get into a group home or orphanage — they might be getting better clinically, but they’re not there yet and you can’t put them in a home where other children might be at risk.

One solution would be to fast-track DCFS investigations for children who are hospitalized and have an option to return home. If there is an investigation open in a hospitalized child’s home, the child can’t be returned there — even if the investigator knows the case will be unfounded.

All it takes is a hotline call from a mandated reporter over a possible issue. Investigations can take 3+ months before they’re complete and the paperwork is submitted for the child to return home. Often an investigation is started because the child’s meltdown led to a concerned neighbor calling the police or the hotline.

Comment by Stuff Happens Tuesday, Jun 5, 18 @ 12:09 pm
This story exposes one terrible consequence of a system that has been permitted to decay over years and decades. Child welfare funding to the private sector providers who serve more than 80% of the children in DCFS’ care has not changed in 15 of the last 17 years, and with this FY19 budget, that trend continues. As providers must manage with rates that were established at the beginning of this century, the purchasing power of their resources has eroded over time, and now we see the impacts being felt on system capacity. At a meeting in early May, DCFS reported that 458 beds in residential treatment centers and group homes had been lost since 2012, along with 208 beds in transitional living facilities and independent living options. Nothing has been done to rebuild that system capacity and now today, Illinois ranks worst in the nation on important measures of permanency and length of stay in the system. This problem did not happen overnight and it won’t be fixed overnight either. Getting youth out of psychiatric hospitals and into appropriate treatment programs in the community is only part of the problem. We can do better than this, but the system as it stands is not sustainable. The budget that was signed yesterday does nothing to reverse this problem either. But the youth in the system only have us to rely upon.

Comment by Andrea Durbin Tuesday, Jun 5, 18 @ 12:32 pm
After years and years of tracking these young people we are relieve that people are looking at this story. Anytime that a young people is held in these inappropriate placements it is a direct violation of their constitutional rights, as well as a number of a number of state laws. The Foster Care Alumni of America Illinois Chapter drafted a bill (HB 4964) that would allow these young people a private right of action ageist the Department but AFSCME 31 was in oppostion to the bill so it did not receive enough votes to move it to the Senate. We need to do more to protect these kids. Leaving them stranded is almost as bad as the abuse that half of them experienced from their care givers.

Comment by James McIntyre Tuesday, Jun 5, 18 @ 12:43 pm
@Rich Miller, could be one solution to take in kids who would be good in that kind of a situation, maybe free up other facilities.

Comment by Amalia Tuesday, Jun 5, 18 @ 12:52 pm
Someone should look at the number of days IDJJ holds youth after their availabile release date for DCFS, because DCFS can’t find any placement. Children are being held in prison.

Comment by Czar of Programming Tuesday, Jun 5, 18 @ 1:36 pm
@Czar of Programing the Foster Care Alumni of America Illinois Chapter has that data as well.

Comment by James McIntyre Tuesday, Jun 5, 18 @ 1:44 pm
This is a symptom of the lack of investment in services and the very low rates for the non-profit child welfare providers in serving Illinois youth and families. The system is designed to starve providers making it very difficult to invest in expanding services. I run one of those agencies and though we continue to expand and improve clinical interventions to meet the needs of children and families our lack of resources dramatically slows our ability to build needed capacity.

Comment by Gary Huelsmann Tuesday, Jun 5, 18 @ 2:01 pm
*not (see intro to second excerpt)

Comment by Anonymous Tuesday, Jun 5, 18 @ 3:29 pm
Perhaps Rauner can explain how cutting taxes and establishing right to work zones would fix this problem

Comment by Truthteller Tuesday, Jun 5, 18 @ 3:54 pm
=== The issue is not with DCFS, the issue is that it is difficult to find placement for these children. ===

Listen to Andrea Durbin, listen to James McIntyre.

The shortage of group home beds? Shortage of foster care? Shortage of specialized foster care? Shortage of supportive services that prevent hospitalization in the first place?

These are all choices that DCFS directors make and enable, and that governors own.

I wonder if Medicaid is paying for those unnecessary hospital days, Greg Harris?

Comment by Yellow Dog Democrat Tuesday, Jun 5, 18 @ 4:19 pm
@Yellow Dog Democrat when a young person is decalared Beyond Medical Need Medicaid no longer pays the bill neither does DCFS. The Department however gets a free babysitter.

Comment by James McIntyre Tuesday, Jun 5, 18 @ 4:23 pm
Yellow Dog Democrat, no, Medicaid can’t pay for days past medical necessity. DCFS (the state) has to pay for it, historically at half the regular (medically necessary) per diem rate, though I think sometimes the hospital does get left holding the bag so to speak.

Comment by Perrid Tuesday, Jun 5, 18 @ 9:00 pm
There’s a couple in South Bend, IN, who have opened a “gentle” orphanage, basically a hopefully-temporary foster home but a very gentle step between institutionalization and living in a family home. The married couple live in the orphanage, which hosts around 12 kids at a time — not 100. They’re able to provide pretty comprehensive services for kids who need it, while having them in a home-ish environment. It’s not perfect, but it’s better.

Comment by Suburban Mom Tuesday, Jun 5, 18 @ 11:37 pm
Another point to note—- a good percentage of these many of these kids could avoid the DCFS system altogether.
After a child is determined to be BMN (beyond medical necessity) instead of offering families who are still involved with the child an ICG grant (administered by HFS) they are shuttled to DCFS to relinquish custody of their child and become ‘ youth in care’ (formerly wards of the state).
Forcing parents to give up custody of their children to the state without providing options is simply inhumane .

Comment by StateRep12 Wednesday, Jun 6, 18 @ 7:22 am
StateRep12, I’ll point you to the rule for the new ICG program - new as in the rule HFS adopted after taking the program over from DHS - that has a section (the Specialized Family Support program) that is literally put in place to help with psych lockout kids. ftp://www.ilga.gov/JCAR/AdminCode/089/08900139sections.html

There has to be an application process, it would literally be illegal to allow kids into the program without reviewing their application info, just because they were being locked out. This program has a crisis response component and an assessment component that tries to find the best solution for the family, which could be an ICG.
Youth in care aren’t eligible for the program, since the state is the guardian and should be paying for services, though Feignholtz just passed a bill that changes the eligibility rules a bit so that if a kid is taken into temporary custody while an ICG app is being processed it doesn’t disqualify them.

Comment by Anonymous Wednesday, Jun 6, 18 @ 8:03 am
Just another example of how IL spends money inappropriately. THIS should be as big a story as the CPS sexual assaults of students debacle. Give your research to the Trib and let them run with it.

Comment by Jerry Wednesday, Jun 6, 18 @ 8:57 am