Anne Heiligenstein , Commissioner, Department of Family and Protective Services June 30, 2010

1. Residential Treatment Centers Child Care Licensing Regulation and Child Protective Services Placements|Presented to: House Human Services Committee Anne Heiligenstein, Commissioner, Department of Family and Protective Services June 30, 2010

2. Residential Treatment Centers: Historical Perspective

3. DFPS Reform I Senate Bill 6, 79th Legislative Session (2005) • Increased the minimum qualifications for Licensed Child Care Administrators • Required residential operators to self-report more serious incidents • Increased background check requirements for residential child care employees • Required drug testing for residential child care employees • Required residential operators to provide emergency behavior training approved by Residential Child Care Licensing (RCCL)

4. DFPS Reform II Senate Bill 758, 80th legislative session (2007) • Created the Committee on Licensing Standards • Required RCCL team inspections • Increased number of RCCL staff • Created new rate category for foster children immediately after discharge from psychiatric hospitals • 4.3% rate increase for residential care providers

5. Strengthened Residential Treatment CenterMinimum Standards - Effective January 2007 • Staff to child ratios dropped from 1:8 to 1:5 • Raised minimum age of caregiver from 18 to 21 • Raised minimum qualifications for Treatment Director • Increased training requirements for both caregivers and professional staff

6. Residential Treatment Centers:RCCL oversight At every RTC, on average, RCCL conducts the following activities each year: • 16 inspections • 12 investigations

7. Capacity Challenges As recently as 2007, CPS faced significant placement challenges: • Number of foster children grew faster than the number of placements available. • Increases in both regulation and enforcement at residential facilities resulted in RTCs being reluctant or unwilling to admit children with high-risk behaviors. The increased serious incidents and resulting investigations created liability concerns for RTCs. • As a result, children were spending nights in DFPS offices or other locations.

8. Residential Treatment Centers: Current Challenges and Potential Solutions

9. Residential Treatment Centers:Where are they?

10. CPS Use of Residential Treatment Centers • As of June 1, 2010, DFPS had 1,583 children in RTC placement. • This represents 9.5% of children in paid foster care placement. • Out of 66 DFPS contracted RTCs, 33 or one-half are located in the Houston region alone. Many children are placed into these facilities from other regions. • Six out of ten children placed in Houston region RTCs are from other regions across the state.

11. Children in RTCs Because children in the conservatorship of DFPS are victims of abuse and/or neglect, the trauma that they have endured can result in significant treatment needs. These children experience not only the trauma, but great loss by being removed from their homes, schools and friends. Also, the children often have serious underlying medical and developmental needs.

12. Children in RTCs 17 year old female-removed from the home due to sexual abuse. • Reports hearing voices telling her to hurt herself • History of verbal and physical aggression, including homicidal threats • Suffers from depression, suicidal ideation, and self-mutilation • Diagnosed PTSD and Bipolar with an IQ of 89 • At her last placement, she assaulted an RTC staff with the leg ripped from an overturned table. The staff lost her eye. • This youth has had 26 placements since coming into care.

13. Children in RTCs 17 year old Female • Physically aggressive to both children and adults • History as a sex offender against a sister in her adoptive home • History of suicidal thoughts, running away, property destruction, and making false accusations • Bipolar Disorder, ADHD, PTSD, Fetal Alcohol Syndrome, and Oppositional Defiant Disorder with an IQ of 90 • Referred to juvenile authorities at least 5 times for theft, sexual assault and assault • Since 2005 has had over 42 placements including multiple stays in psychiatric hospitals, RTCs, and emergency shelters. She considers the hospital to be a "safe place" and will do whatever is necessary to be hospitalized.

14. Challenges for RTCs Both RTCs and DFPS face the challenge of balancing: • Privacy rights of children with supervision and security needs • Need for older children to learn independent living skills while still keeping them safe • Risk of physically preventing a child from running away or hurting themselves or others versus the risk a child will face on the streets or incarcerated • RTC workforce challenges – turnover, training, ratios

15. New Minimum Standards Rules Changes Minimum standards revisions to be proposed for adoption in July: • New rule clarifying that RTCs must operate at all times as if 100% of their children receive emotional disorder treatment services, whether or not the children are “eligible” or “qualify” for those services • Requiring facilities to document and assess children’s “high-risk behaviors” at the time of admission for each child • Clarifying in rule that employees, contractors, volunteers, etc. are required to report suspected abuse, neglect, or exploitation directly to DFPS, and may not rely on the facility’s administrative staff to make the report

16. System Improvement:Changes for Child Care Licensing Immediate plans for improving RTC enforcement: • RCCL will conduct enforcement team conferences on all RTCs • RCCL will follow-up on any findings of abuse/neglect and any serious deficiencies with an unannounced inspection within 30 days of the initial finding or citation • RCCL has implemented more rigorous protocols for RTC staff and child interviews to be used during all team and follow-up inspections

17. Law Enforcement Notifications • DFPS is required by Texas Family Code §261.105(b) to notify law enforcement of any report it receives that concerns suspected abuse or neglect of a child. • In FY09, Statewide Intake staff conducted 251,115 notifications to law enforcement. In FY10, DFPS projects that the number of law enforcement notifications will rise to over 281,000. • SWI is routing notifications to over 1,000 law enforcement jurisdictions

18. System Improvement:Law Enforcement Notifications • Interim storage solution: Extended the storage time for confirmation of sent and received faxes from 30 days to 45 days. • Permanent storage solution: By July 15 DFPS will implement system changes to electronically retrieve fax confirmation data and store it in the DFPS case management database system • By August 1 Statewide Intake staff will contact all law enforcement jurisdictions currently receiving faxes and encourage them to convert to email notification using a generic mailbox.    • This will reduce the number of changes due to staff departures in law enforcement settings.

19. System Improvement: Foster Care Redesign Current Equation (Child’s Needs) + (Lack of Community Resources) = • Placement Outside of Home Community • Increased Number of Changes in Placement • Separation from Sibling(s) and Family • Lack of Educational Continuity • Fractured Social Support System

20. System Improvement: Foster Care Redesign Redesigning the Equation (Child’s Needs) + (Adequate Community Resources) = • Placement in Home Community • Decreased Number of Changes in Placement • Placement with Sibling(s) in Close Proximity to Family • Educational Continuity • Strong Social Support System

21. System Improvement: Foster Care Redesign Final recommendations will be made by December 31, 2010.  Recommendations will include: • How to obtain, contract, and pay for foster care services in a way that promotes desired outcomes for children. • Policy, programmatic, fiscal, and practice implications of system changes; and • A mechanism for balancing foster care services demand and supply.   

22. System Improvement: Foster Care Redesign Public Private Partnership (PPP) Representative of Key Stakeholder Groups including: • Foster Youth Alumni • Providers • Child and Family advocates • Judiciary • DFPS Advisory Council • DFPS Executive Leadership Role in the Redesign Effort: • Provide guidance to the initiative • Serve as conduit of communication between constituents and peers • Propose recommendations to DFPS Commissioner

23. System Improvement: Fostering Connections Fostering Connections will help move children out of foster care and into permanency with relatives – thereby reducing the trauma of foster care and allowing children/youth to connect with family. 

24. DayStar

25. DayStar Recent Activities • CPS workers conducted safety checks on all CPS children and continue to have an increased presence at the facility • Standard by Standard Inspection • Deployed RCCL resources from other regions to support intensive monitoring effort • Significantly increase unannounced and team inspections, including evenings and weekends

26. Child Protective Services DayStar Safety Plan • CPS Placements have been suspended • Safety checks on all children at Daystar completed • Contracted for a monitor to be onsite at Daystar • Star Health will provide trauma-informed training for Daystar staff.