Special child placements cost counties big bucks

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EDITOR’S NOTE: This is the second in a series of stories regarding out-of-home placement of children and the community’s hope to reverse the trends.

WORTHINGTON — When it becomes necessary for a child to be removed from the home for safety and stability, the county’s family service agency is tasked with making the placement. Depending on the circumstances, that may mean enrolling a child in foster care, in a mental health treatment program or in a correctional facility.

The path taken is based primarily on the needs of the child. Ideally, he or she would stay in the same county as the family. However, in cases where specialized treatment is required, the child may end up in a facility four or more hours away from home.

In Rock County, Family Services Director Randy Ehlers said there had been a situation a few years ago in which an adolescent teenager with “sexual perpetration issues” had to be sent to facilities more than four hours away from Luverne. Over the course of two and half to three years, that placement cost Rock County approximately $170,000 — money that came from the taxes the county collects from its residents.

“He was in treatment facilities that ranged from $156 to $223 per day,” said Ehlers of the case. “We’re required to find a facility that provides for the best interest of the child — the unique treatment needs of the child.”

Up until the last legislative session, Minnesota counties were given payment incentives to keep a child in Minnesota for treatment. That meant Rock County, which borders both South Dakota and Iowa, looked at treatment options several hours away from home rather than turn to programs available in Sioux Falls, S.D., just a half-hour drive down Interstate 90.

Ehlers said the same incentives are now received to place a child in treatment in Sioux Falls when necessary.

He spoke of two other high-cost cases Rock County has dealt with in recent years, including a case involving a child younger than age 5 with unique medical issues.

“Over the course of almost two years, we spent close to $85,000 in county dollars,” Ehlers said.

Eventually, the child was moved to a permanent setting and therefore removed from the county’s responsibility. Had that not happened, Ehlers said the child would have stayed on the county’s bill until she turned 18.

One of the most expensive placements for Rock County was a young child with mental health and behavioral needs requiring 24-hour residential care. That child was in treatment for nearly two years, at $210 per day, for a total of approximately $128,000.

“These three are kind of unique situations, but they are good examples of the responsibility counties have,” Ehlers said. “The county is really the safety net for children. There is no way for a family to afford those types of treatment costs.”

While the county does what it can to get reimbursed — from billing insurance companies to collecting fees from the parents — Ehlers said the money collected comes “nowhere close” to the amount the county is billed.

In 2009, Rock County budgeted $450,000 for out-of-home placements. With a decline in numbers this year — there are 10 youths in placement between the ages of 8 and 17 — Ehlers said the county will actually spend closer to $400,000. That is the amount they have budgeted in 2010.

“Although we set a budget for those services, we don’t really have any control over that budget,” Ehlers said.

Each year, it is a guessing game for county administration and commissioners to set a budget that isn’t too far off from the dollar amount actually needed. If the county comes up short on funds for out-of-home placements, the money comes from reserves or savings found elsewhere in the budget.

In Nobles County, the budget for out-of-home placements has been set at $800,000 in 2010 — an increase of more than $63,000 over 2009. The additional money was budgeted because the Family Service Agency had already exceeded its 2009 budget by more than $40,000 as of early October.

While Nobles County’s budget for out-of-home placements is rising because the number of children removed from their families has increased, family and children’s social service supervisor Deb Clem said there have also been some unique circumstances that required higher than typical costs.

“We had an adolescent child that, over the past two years, has been in and out of corrections for various things,” said Clem.

In those two years, the child never had a “solid” placement and reoffended soon after being discharged from a correctional facility. His case alone has cost the county more than $90,000 in the past two years, Clem said.

“Those costs come in sending him to secure detention and longer-term correctional facilities,” she added.

Another case in Nobles County involved a pre-adolescent child who was diagnosed with “very serious” mental health issues, making it dangerous for both the child and the family.

Placed for a year in a facility more than three hours away from Worthington, the child cost the county a little more than $73,000, Clem said.

The county’s social workers are required to make monthly visits with all children while they are in placement, regardless of how far away they are from the home county. During those trips, Clem said family members are sometimes transported at the same time for a visit.

In both the correctional and mental health cases Clem described, the children were eventually returned to their families and seem to, at this point, be successfully reintegrated.

A third case in Nobles County that brought higher costs to the county was a foster care case that required an adolescent-age child to be in a therapeutic foster home for nearly a year. The county’s bill for the service amounted to $26,000, said Clem.

Therapeutic foster homes are those in which the foster parents have received more intense training to better meet the needs of the child’s behavioral, physical or developmental issues.

Tags: child services, family service, news, worthington, placement, home, kids, agency