Consultant finds gaps in county’s foster care

Foster care consultant Richard Matt walked into Clark County Family Services and immediately was overwhelmed by the same things that have bowled over consultants in the past:

• Too few caseworkers to carry the load.

• A shocking lack of computer capability to put together basic and accurate information.

• A turf tussle between state and county child welfare agencies that doesn't serve the best interests of families in the system.

After Matt noted those problems, blinked his vision back to normal and settled in to do the job he was hired for -- evaluating the framework of care resources and practices for severely emotionally disturbed foster children -- he was overwhelmed again.

This time, it was the confusing organization of services and dearth of assistance available to some of the neediest adolescents in the local child welfare system. About 10 percent to 12 percent of the foster children in Clark County require treatment for mental illness, depression, violent behavior or suicidal tendencies.

"You do have a definite lack of services for high-end kids," said Matt, who heads the Missouri Alliance for Children and Families.

Where Clark County places high-needs children depends on the seriousness of their conditions.

Some children with emotional disturbances can be placed in regular foster care while receiving supportive mental health services. Higher-needs children might need group-care settings, such as those offered by Girls and Boys Town and smaller treatment homes, where they have access to therapeutic services on-site. Children with extreme needs might require residential treatment at a psychiatric facility.

Children in group care or residential treatment can and should be moved into regular foster homes more quickly by Clark County, Matt said. Group care and residential treatment shouldn't be considered permanent placements for children, Matt said. Residential care is costly, and children are more likely to thrive in a family setting than in residential care.

Matt also said that more effort needs to go toward keeping children in their own communities whenever possible to lessen the disruption in their lives.

One of the findings that disturbed Matt most about Clark County services for severely emotionally disturbed children is the lack of oversight for treatment homes, which can take in up to 12 children when licensed as a group-care facility.

Under national accreditation standards, Matt said, no more than two treatment-level children should be in a foster home at the same time. However, in Clark County, foster homes that are licensed as group-care facilities can take in up to 12 children.

Clark County providers of high-end care also work without formal contracts, Matt said, which has created a lack of accountability.

Providers also have the option of refusing to take in children referred to them by family services. That contributes to a growing population of children at Child Haven, the county emergency shelter, while providers qualified to care for severely emotionally disturbed children maintain vacancies.

At the time of his review, Matt also found that homes for high-needs children were uneven in their requirements for staff training and the levels of support provided to children in residence.

"Clark County DFS does not have any mechanism for monitoring the providers or holding them accountable for predetermined standards," Matt said in his report.

"Currently, information is limited to anecdotal bits of information and there is a lack of data about how the providers meet the needs of children."

Nevada's system of providing for foster children with mental health needs struck Matt as unusual, though Clark County is responsible for foster care, it's the state that provides the necessary wrap-around services to severely emotionally disturbed children. Those services include psychiatric assessment and evaluation, therapy, behavior management and parent training.

On the one hand, the state-county divide means that children have multiple layers of support, Matt said. On the other, it creates confusion with regard to case management. A child in a treatment home will have as many as three different people from the county and state managing the case. That leads to duplicated services, inefficiency and dissatisfaction for everyone involved, Matt said.

"I'm certainly not an expert on bifurcated systems," said Matt, of Nevada's division of child welfare services. "But these agencies need to come together and really talk about this."

Matt's report to Clark County Family Services included 19 recommendations for how to improve functions for severely emotionally disturbed foster children.

Some of the recommendations involve financial and regulatory changes that will have to be hashed out by legislators, such as lowering the caseloads for child welfare workers, improving technology and crafting a more unified network of services between the state and the county.

Clark County Director of Family Services Tom Morton said discussion of those items probably will be raised in the 2009 session, just as they were this year.

Lawmakers approved a two-year budget that included a 67 percent increase for Clark County's child welfare integration budget. The increase included $20 million to reduce caseloads to about 22 cases per worker. In the past, some county child welfare workers have handled 40 cases or more.

However, the gains made earlier this year might be dialed back as the state experiences a shortfall in anticipated revenues.

Morton is one of the Clark County officials who has refused a request from the state to identify items that could be cut from the budget.

In a letter sent to Gov. Jim Gibbons on Oct. 19, Morton noted the well-documented shortcomings in Nevada child welfare that have garnered the state negative attention from the federal government. He also asked that child welfare be exempt from budget cuts because the only realistic reduction would have to be personnel.

"The cost of budget cuts to child welfare is increased risk of harm to vulnerable children and the potential permanent loss of a child's family," Morton wrote. "Each permanent loss of a family means both trauma to a child and exponentially expanded costs to the state in the form of foster care and adoption expenses."

Money is also at the root of the problem that Nevada has in attracting more providers to care for severely emotionally disturbed children, Morton said.

Providers of high-end services, such as Pennsylvania-based KidsPeace, have considered expanding to Nevada but are hesitant when told of Nevada's daily rate for treatment agencies.

That rate is $80; Morton said providers such as KidsPeace can get $125 per day in other states.

"The point is that a number of providers with good national reputations balked when they found out what we are paying," Morton said.

Nevada Department of Health and Human Services Director Mike Willden could not be reached for comment.

Earlier last week, however, Willden said that should Clark County officials not identify potential 5 percent budget reductions, he will do it without their input.

A 5 percent cut to the local child welfare budget is more than $3.5 million over the next two years, Morton said.

Willden also could not be reached for comment on Matt's suggestion for increased unity in services for high-needs children.

Morton said he is willing to explore Matt's recommendations for greater county-state cooperation in serving foster children with mental health needs.

He acknowledged that Clark County caseworkers often lack the background to deal with severely emotionally disturbed children.

"Our workers are not trained to adequately deal with mental health issues," Morton said. "And they aren't in a position to case-manage the mental health dynamic."

Contact reporter Lisa Kim Bach at lbach@reviewjournal.com or 383-0287.