“Emergency Shelter Care” ended in December of 2012. That was when our organization was required by Louisiana’s Department of Health and Hospitals (now Louisiana’s Department of Health or “LDH”) to close our ESC program.
Emergency Shelter Care was licensed by the Department of Social Services (now Louisiana’s Department of Children and Family Services or “DCFS”). The service was required so often that in 1989 we constructed the Lewis Building on our Ruston campus. It housed 24 boys and girls. In it we provided emergency shelter care and the accompanying diagnostic services to hundreds of Louisiana’s children.
In 2011, LDH launched the Louisiana Behavioral Health Partnership (now “Healthy Louisiana”) using Federal money that had strings attached. One string required all three of our children’s homes to become licensed by LDH or limit care to no more than 16 children – total! (We care for 126 at a time and provided services to 289 children last year.) The other string ended Emergency Shelter Care.
LDH created two new services designed to partially replace Emergency Shelter Care. These two services are Short Term Respite Care and Crisis Stabilization.
Neither is sufficient to meet the real needs of Louisiana’s children.
Short Term Respite Care is designed to help meet the needs of the caregiver and the child. The respite provider cares for the youth or child in the child’s home or a community setting (like taking a child to a playground or to get a hamburger). It gives the caregiver/guardian a break. Children or youth in CSoC can receive up to 300 hours of respite each year. This service helps reduce stressful situations. Respite may be planned or provided on an emergency basis.
Short Term Respite’s short falls? Limited participation and it is a limited service. It is only available to the children who are enrolled in CSoC, Louisiana’s Medicaid-funded Coordinated System of Care. At any given time, CSoC is limited to 2,400 children. Louisiana has a 1,083,475 children. Among the 2,400 CSoC children, many will never need Short Term Respite Care. There are more children among the million who are not in CSoC who could benefit from Short Term Respite Care.
The second service LDH created is Crisis Stabilization. It is more structured than Short Term Respite Care. It provides short-term, intensive support for children 0-20 years old and their families. The intent is to provide an out-of-home crisis stabilization option for the family in order to avoid psychiatric inpatient and institutional treatment of the youth by responding to potential crisis situations. The goal is to support the youth and family in ways that address current acute and/or chronic mental health needs and coordinate a successful return to the family setting at the earliest possible time.
(Here’s an anecdotal aside: When DHH was developing plans to create a Medicaid-funded managed care system, it used Wraparound Milwaukee as its model. DHH even brought the Director of Wraparound Milwaukee to Baton Rouge to explain how it operated. “It eliminated residential care,” was one of the reports. After hearing about Wraparound Milwaukee for several months, I spent a week in Milwaukee County to learn more. Like Louisiana, the population of Milwaukee County is around 4,000,000. Wraparound Milwaukee works because all 4,000,000 people – the providers of care and the recipients of care – live within 40 minutes of each other. They are not spread over 64 counties/parishes in a state that is 80% rural and without public transportation. And that report about residential care being eliminated? It had been mostly eliminated in Milwaukee County. Children were being placed into children’s homes in the surrounding counties.)
While a children’s home is a perfectly logical place for Crisis Stabilization services to be provided, Louisiana’s Department of Health prohibits Louisiana’s children’s homes from providing these services to children. Today, children from north Louisiana who require Emergency Shelter Care are transported to south Louisiana. I believe there are only three group homes in Louisiana that provide limited ESC to children. All are far south along the I-10 corridor.
Louisiana is desperate for these services – but only in a way that fits LDH’s regulations. The regulations are the barrier. Attempts at “work arounds” are just that. For example, after five years of trying to recruit providers, last September LDH released Health Plan Advisory 16-23 which opened Medicaid access to a new pool of potential Crisis Stabilization providers: the few DCFS-licensed Therapeutic Foster Care providers.
But Louisiana is also desperately short of Therapeutic Foster Homes! We were asked to open our Methodist Foster Care homes to Crisis Stabilization. Clearly, LDH and the Healthy Louisiana MCOs do not understand the fragile dynamics of a successful Therapeutic Foster Home. One does not put additional stress on stable foster homes! (LDH Behavioral Health does not understand DCFS Child Welfare. Behavioral health is an important service but it is a subset of all that child welfare provides.)
So, While from an LDH administrative/regulatory perspective, using TFC homes for Crisis Stabilization may seem logical on paper, from a child welfare perspective it is not. One does not risk the stability of a Therapeutic Foster Home by imposing the additional burden of also providing Crisis Stabilization to children whose behaviors require intensive support to prevent hospitalization.
We were asked to risk TFC homes, but chose not to chance the loss of a stable Therapeutic Foster Home to fill a service gap created by state regulations. It is unfair to children in foster care to risk the chaos of crisis stabilization because it may lead to a disruption of the foster home. Foster children have already had too many placements!
When Emergency Shelter Care was available in Louisiana, it was never limited to a subset of 2,400 children. It was never limited to Medicaid-funded children. It was not limited to state-placed children. Medicaid had nothing to do with it because it was a child welfare service. And it was not restricted by the friction of managed care.
Emergency Shelter Care simply met the needs of Louisiana’s children who had no where else to stay. I’ve worked in child welfare for 30 years and I do not recall children spending the night in state office buildings until Emergency Shelter Care was closed.
Louisiana’s best solution? Allow DCFS to license Emergency Shelter Care again and give children’s homes – some of which provided ESC for decades – the freedom to provide the services Louisiana’s children and families really need.
It’s time to meet children’s needs, Louisiana!
President and CEO
Louisiana United Methodist Children and Family Services