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DHS continues to experience alarming decline in therapeutic foster homes

The Oklahoma Department of Human Services continues to experience an alarming decline in the number of therapeutic foster homes available for children with significant behavioral, emotional and physical challenges, according to a new report released this week by a three-person oversight panel.

Since 2013, there has been a stunning 82% drop in the number of therapeutic foster homes available for children who need those services, the report said. The decline has occurred despite repeated warnings that the state has a critical need for more such homes, the overseers said.

Criticism of the state's efforts to recruit more therapeutic foster homes was contained the the 13th edition of a twice yearly progress report issued by three out-of-state overseers. The panel was hired to monitor the state's compliance with an agreement to settle a 2008 federal class action lawsuit over the maltreatment of children in state care.

While the report was critical of therapeutic foster home recruitment efforts, it praised the state's other efforts to improve its child welfare system, finding DHS had made "good faith efforts to achieve substantial and sustained progress" in 28 of 30 areas that were measured.

Most notably, DHS has experienced success in reducing the incidents of children being abused in state care, the report said, citing a 37% decline in the number of children abused in foster care settings during the most recent reporting period.

The report also lauded DHS for recruiting 810 new traditional foster homes, reducing worker caseloads, reducing the use of children's shelters and reducing the number of times children are bounced around between foster homes once they come into state care.

Finding therapeutic foster homes, however, continues to be a problem.

"Many children who need therapeutic care continue to be denied TFC (therapeutic foster care) placements, either because of a lack of available TFC homes or a determination by the Oklahoma Health Care Authority (OHCA) that they are ineligible for this level of care based on the criteria established by the state of Oklahoma," the report said.

The report spent several pages highlighting struggles DHS has experienced trying to get authorization from the Oklahoma Health Care Authority to place specific children in therapeutic foster care, citing instances in which the authority rejected children as having too low of an IQ, needing a higher level of care or not meeting medical necessity criteria.

DHS appeared to generate some of its own problems when it sought to create a new category of foster homes, called intensive therapeutic foster care homes, to care for children with greater behavioral health needs than children currently authorized for therapeutic foster care placement, the monitors reported.

The agency moved eight children out of therapeutic foster homes in order to convert those homes to the higher level of therapeutic care, the report said.

"The records for two of these children (living in separate TFC homes) were particularly concerning, as they had experienced severe placement instability prior to being placed in the TFC homes from which they were displaced," the report said, noting the children had expressed comfort with the care and stability provided by the homes prior to being removed.

DHS also contributed to the trauma of about 50 children who had be approved for therapeutic foster care by engaging in a practice of placing them in short-term placements for a few days while working to identify more suitable placements, the report found.

"There is no adequate rationale for a practice that aided placement instability for children in need of therapeutic care," the report said. "However, again, the lack of TFC homes in Oklahoma is a significant cause of children in DHS custody experiencing placement instability and/or also being placed in settings that are not prepared to meet their individual needs."

Gov. Kevin Stitt appointed Justin Brown to serve as executive director of DHS on June 17 and his leadership team quickly moved to end the practice, the report said.

Brown, who replaced Ed Lake as executive director, noted he was only on the job for a few days of the time period covered by the progress report.

Brown said he and his staff have been working diligently to solve the agency's therapeutic foster care problem.

Collaboration and partnerships will be the key, he said.

"In order to serve those kids with therapeutic needs in a foster setting, we have to have the help of all of our sister agencies, the Department of Mental Health and Substance Abuse Services, the Health Care Authority, and really serve together," he said. "Ultimately, the therapeutic foster care issue really is around rallying the proper supports around kids in need."

Deb Shropshire, DHS' director of child welfare, noted the decline in therapeutic foster homes occurred over several years. To turn things around, DHS will need help not only from other state agencies and private placement agencies, but also from ordinary Oklahoma citizens willing to become foster parents and therapeutic foster parents, or assist such individuals, she said.

"I think we feel pretty confident in the strategies and ... the partnership efforts that have happened over the last six months," Shopshire said. "We really hope to see a reversal in that trend."

Shropshire described the struggle between DHS and OHCA over which children should qualify for therapeutic care as being more of a communications issue than a funding issue.

Meetings have taken place, and "what we came to understand pretty quickly was that the Health Care Authority maybe didn't fully understand what our kids were needing," she said. "We've seen a lot of improvement this fall."

Brown said the agency is trying to shift from talking about metrics and numbers to talking about the needs of individual children.

"We're now focusing directly on child by child decisions," Brown said. "We are here focusing on each individual child, understanding what the needs are for that child rather than how do we serve a hundred or a thousand children at a time."

Randy Ellis

For the past 30 years, staff writer Randy Ellis has exposed public corruption and government mismanagement in news articles. Ellis has investigated problems in Oklahoma's higher education institutions and wrote stories that ultimately led to two... Read more ›

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