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Ohio's Foster Care Crisis Forcing Hundreds of Kids to Sleep in Offices

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Monday, August 21, 2023   

By Cathy Candisky for the Public Children Services Association of Ohio.
Broadcast version by Nadia Ramlagan reporting for the Public Children Services Association of Ohio-Ohio News Connection Collaboration.

Twice in the last year, Zoey, a 16-year-old in foster care, had to spend the night in the Franklin County Children Services office.

She had nowhere else to go.

"It was bad," recalled the soft-spoken Zoey, a stuffed bunny clutched under her arm. "It wasn't scary. It was just uncomfortable."

Zoey, who asked to be identified by only her first name, ate canned ravioli and camped out on a sofa in a windowless visitation room she shared with another girl.

"We didn't watch TV. We just sat here staring at each other," Zoey said. "How do you sleep on this hard couch and a pillow that was flat?

"We stayed in here and we did nothing."

Across Ohio, a shortage of foster families, group homes, residential treatment facilities and other placements has overwhelmed child welfare agencies. Frequently, it means youth in their custody are housed in offices, hospital emergency rooms and other ill-suited places for days, weeks and sometimes longer.

In the year ending June 2022, 503 children in foster care spent at least one night in county government offices across Ohio, according to a state report. Dozens more youth stayed in hospitals even though they weren't sick and there was no medical reason for them being there.

Child welfare officials say it's the last option for already traumatized kids with severe behavioral health issues and developmental disabilities. There simply are not enough places offering the treatment they need.

"Residential facilities have been serving children with less significant needs and the children that we are left placing are those that have very deep-end type of issues and significant traumas that have been repeatedly occurring throughout their lives," said Donna Seed, director of social services at Lucas County Children Services.

"They [have] issues that can range from delinquency to gang issues to significant developmental delays to ranges on the autism spectrum, or even medical issues."

Kellijo Jeffries, director of Portage County Job and Family Services, recently was unable to find placement for an 11-year-old girl with developmental disabilities who sometimes was aggressive as well as two youth who had attempted suicide.

Foster families, group homes and treatment facilities commonly share when they deny placement that the youth's needs are too great, or they don't have appropriate services or enough staff to meet the child's need, Jeffries said. "Until we have capacity and the right facilities and options for these kids, we're going to continue to spin."

In the case of the youth with developmental disabilities, her placement provider took the child to the hospital when she wouldn't go to sleep, started banging her head and refused her medication. The placement provider then notified the agency that it could not take her back because of insufficient staff and her aggressive behavior.

The two youth who had recently attempted suicide were discharged from a Northeast Ohio hospital, but because the agency could not secure immediate placement, despite collaborative efforts with county and state agencies, both children remained in the hospital for days after discharge.

The system not only is failing these youth, it's compounding their problems, said Angela Sausser, executive director of the Public Children Services Association of Ohio.

"This kid is being told essentially that you're not wanted. No one wants you. You can't be with your family. They may not want you because of your behaviors, or can't take care of you because of your behaviors, and now nobody else wants you and you're stuck in this cold government agency eating takeout and showering at the YMCA. Children experience trauma from being removed from their own homes. By not having a placement option readily available, we are just adding to the child's trauma."

Nearly 15,000 youth are in state custody and about a fourth of them have complex issues including mental illness, developmental disabilities, and kids from the juvenile justice system, some involved in felony-level crimes.

Approximately 1 in 4 of youth in state custody are there for these other reasons, with no history of abuse and neglect. Sausser said it's time to ask why children services has become the "system of last resort" when other systems cannot meet the needs of these youth.

Foster children's health care is covered by Medicaid while they are in custody. Medicaid is required to meet their physical, developmental, and mental health needs, but while screening and diagnosis for behavioral health conditions is common among foster youth, appropriate and available treatment for those with aggressive behaviors resulting from mental illness, developmental disabilities or trauma is in short supply.

Caseworkers say the number of youth needing intensive, long-term treatment has grown, making it harder to find a foster family or group home to take them. The longer kids wait for placement, the longer they wait for treatment, and for many youth their conditions worsen.

"It is truly additional trauma. It can worsen acute symptoms," Dr. Katherine Junger, associate medical director of mental and behavioral health for Cincinnati Children's Hospital Medical Center, said of kids stuck at the hospital.

"It leaves them feeling helpless and hopeless and, quite frankly, rejected and removed from society."

The nation's largest pediatric psychiatric unit with 100 inpatient beds, Cincinnati Children's had 22 youth in its emergency room waiting for placement in April. Another 22 children remained in inpatient beds because appropriate home- or community-based treatment was unavailable.

The inpatient unit is designed for short-term crisis stabilization where youth stay five to seven days before they are discharged and moved to long-term care.

When forced to stay longer, Junger said, "they can actually get sicker while they're in the hospital because they're at this level of care that is inappropriate for their needs but it's where they can be safe until we can find a better place for them to be."

Next: "Someone is going to end up very hurt and [my child] is going to be scarred for life by something she can't come back from."

Cathy Candisky wrote this article for the Public Children Services Association of Ohio.

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