Texas’ big outsourcing of foster care tested by system’s woes
AUSTIN — Though the foster care system in Texas has been rocked by a growing shortage of beds and increasingly pointed critiques by a federal judge, leading providers are urging the GOP-led Legislature to double down on a regional privatization approach.
The private providers are advocating brisk rollout of “community based care,” in which one non-state entity is ceded virtual control of a geographic region, even as citations and official rebukes pile up on the two nonprofits in charge of the push in San Antonio and Fort Worth.
Troubles are mounting in both cities, the only urban demonstrations so far of the community based care model that is likely to be imposed on Dallas late next year – assuming there are willing bidders.
The upheaval in San Antonio this week has capped a year of mounting apprehension for advocates of the new approach for purchasing foster-care beds. Community based care involves delegating authority to an area’s lead vendor and, eventually, eliminating the jobs of Child Protective Services workers and shifting case management to private-agency workers.
Katie Olse, a former deputy state commissioner for CPS’s parent agency and now the foster care providers’ leading lobbyist in Austin, recently told senators of a “capacity catastrophe” in Texas.
Dr. Wayne Carson, chief executive of Fort Worth’s ACH Child and Family Services, used the same words. Both described a four-pronged blast of COVID-19, meager state rations, competition from more lucrative federal contracts for temporary immigrant housing and tough new enforcement inspired by a long-running lawsuit against the state.
Sen. Lois Kolkhorst, the Senate’s top child-welfare policy writer, though, insisted she and top state leaders won’t tolerate further delays in taking community based care statewide.
“I want to jump in that lake and swim,” said Kolkhorst, a Brenham Republican who this week secured Senate approval of a bill shifting oversight of the program to a new independent office.
Amid high hopes, ‘Tapestry’ unravels
The 120-year-old San Antonio nonprofit The Children’s Shelter was supposed to anchor the relay – to use another sports metaphor invoked by Kolkhorst – for carrying community based care successfully into Texas’ big metro areas.
San Antonio, a town where horrific child-abuse cases have long been a staple of local TV newscasts, and Bexar County generate about 40% more child removals than the entire seven-county region surrounding Fort Worth that pioneered the new purchasing arrangement for foster care beds and services.
To help offset low state reimbursements for the added responsibilities of community based care, which providers have complained about for years, The Children’s Shelter raised $7.1 million from three San Antonio-based foundations and local philanthropists.
It formed an affiliate called Family Tapestry, and was awarded the initial contract for Bexar County, amid expectations it then would be a leading contender in a few years to roll out community based care in 27 nearby counties as well.
But the state’s first handoff of foster kids to Family Tapestry in February 2019 was fatally flawed by the Department of Family and Protective Services’ refusal to agree – as it had in the Fort Worth area five years earlier – to not bring children from other regions to San Antonio’s providers, according to Carson and other veteran providers.
That made the capacity shortage, which intensified as the coronavirus pandemic last year increased costs and dampened recruitment of new foster homes, even more crippling for Family Tapestry. Some managerial miscues didn’t help.
‘Inundated’ in the Alamo City
Soon, what was hoped would be the model for community based care in an urban setting got besmirched. A financial-reporting corrective action plan last spring was followed by high staff turnover and a sudden inability to take high-needs teenagers to safe facilities prepared to handle disruptions and acting out. None would accept such kids.
Annette Rodriguez, chief executive of The Children’s Shelter, said the “pinch point” of community based care’s contractual provision that the lead contractor can neither reject nor eject the kids from its region began creating a crisis last summer.
The end result was her and her board’s decision this weekto close a 66-bed emergency shelter known as The Cottage. Family Tapestry furloughed 68 employees, starting next Wednesday.
Just 24 hours before Rodriguez announced The Cottage would close, the department notified her that CPS would not place any more foster children there. The state cited Family Tapestry’s refusal to take into care nine youth. Other San Antonio area child welfare providers scrambled to find new homes for 40 youth at the shelter.
Since last summer, state child-abuse investigators have issued “reason to believe” findings on 14 separate allegations of physical abuse, medical neglect and neglectful supervision at facilities and foster homes run by The Children’s Shelter, according to records obtained by The Dallas Morning News.
Since fall, licensing officials at a separate state agency have placed on probation both an emergency shelter that bore fast-food chain Whataburger’s name, located in San Antonio’s medical district, and Family Tapestry’s child placing agency, or recruiter of foster parents. The Whataburger Center for Children and Youth, described in a state letter as “very chaotic,” has since closed.
Before Whataburger Center closed in early January, youth assigned there frequently ran away, the records show. Also, youngsters with a history of self harm obtained sharp objects or electrical cords. Medications were handled sloppily, in some cases endangering children with complex medical conditions.
Fights broke out, youth engaged in sex in the bathroom and on the grounds, and restrooms were moldy and dirty, according to dozens of “deficiencies” the shelter racked up in just a few months last year, The News found.
“We were overwhelmed and inundated with more youth than what we originally planned [for] and expected,” Rodriguez told reporters on a Zoom call Wednesday.
Asked about the citations and economic sanctions, such as the placement hold at the shelter and the state’s threat to impose “liquidated damages” of $10,000 per incident on Family Tapestry, organization spokeswoman Anais Biera Miracle noted that 13 of the 14 “reason to believe” findings involved teenagers.
“We believe this is a result of special circumstances such as the changing profile of the foster care population, specifically teens with complex histories and needs and the significant decrease in appropriate placement options,” she wrote in an email.
On April 6, the state awarded the community based care contract for the 27 counties surrounding Bexar County to Bulverde-based SJRC Texas, formerly known as St. Jude’s Ranch for Children.
On April 20, U.S. District Judge Janis Graham Jack said she’s incensed that Family Tapestry and Fort Worth-based Our Community Our Kids were placing foster children in unlicensed facilities. Our Community Our Kids, or OCOK, is the division of Carson’s ACH – the former All Church Home – that was created to launch “foster care redesign.” In 2017, key GOP lawmakers rechristened the new purchasing model as community based care.
The placements in unlicensed facilities happened very recently, and even if the stays were relatively short, the practice conflicts with the state’s longstanding claims it’s upgrading foster care with community based care, said Jack, who was appointed by former President Bill Clinton.
She referred to Family Tapestry’s intake center, next to Whataburger Center, and a three-bedroom home OCOK operates in Tarrant County.
Jack said she’s also upset that her monitors in a decade-old foster care lawsuit only learned of the use of unlicensed facilities from a whistleblower, not from the three defendants in the suit, Gov. Greg Abbott, the Department of Family and Protective Services, and the Health and Human Services Commission.
At the April 20 hearing, Abbott policy aide Elizabeth Farley said the governor’s office learned in October of the use of the unlicensed facilities as temporary housing.
Jean Shaw, who heads Residential Child Care Regulation at the commission, acknowledged her unit did not inform Jack’s monitors Deborah Fowler and Kevin Ryan until last month.
“Well, you all are under contempt right now for failing to properly follow the remedial orders that have been in place now since July of 2019,” Jack told lawyer Kimberly Gdula of the attorney general’s office.
“And if you choose to put these children in foster care redesign, you’re still in charge of them,” Jack continued. “And I don’t know if I can make it any clearer that you are responsible for whatever happens to those children in foster care redesign. In fact, when last we met, there’s been a death in foster care redesign in incredibly bad circumstances.”
Fort Worth boy’s death
Jack was referring to the April 2020 death from head injuries of a 3-year-old Fort Worth boy, Amari Boone. According to the Fort Worth Star-Telegram, CPS and court documents said his birth parents struggled with homelessness, and state caseworkers had concerns about allegations of domestic violence and a positive test Amari’s mother had for marijuana while pregnant with his little brother.
Amari and his brother were placed with a succession of caregivers while being supervised by CPS – including with two men who were friends of the family. Last month, the men were charged by a grand jury with various counts of injury to a child by omission. Earlier this month, the biological parents sued ACH and its employees, accusing them of ignoring repeated warnings that Amari was being physically abused. The suit says ACH should’ve sent someone to check on the boys but failed to do so.
Carson declined to comment.
The case marked the first abuse-related death of a child under state supervision in a community based care region, though it occurred in a “kinship” placement that the family arranged with CPS, Carson noted.
Under the 2017 law that renamed foster care redesign, the lead contractor also oversees relative or “kinship” placements. However, ACH didn’t take over case management duties until March 2020. According to the Star-Telegram, the two male friends of the family were granted temporary custody of Amari and his brother in late January 2020.
State’s crackdown can ‘seem silly’
ACH has absorbed other blows to its once-vaunted reputation, though it’s contesting them vigorously, a review by The News of state enforcement letters and citations over the past 15 months found.
Twice late last year, and twice more this year, the department’s Residential Child Care Investigations unit issued “reason to believe” findings on allegations of physical abuse involving four children in OCOK’s care.
“Yes, this is an unusual number of RTBs compared to our past history,” Carson said in written responses to The News. “Our impression is that Reason to Believe findings have been issued much more readily and sometimes, unjustifiably against staff in the last 6-7 months.”
“They’re scared to take kids right now because it just feels like nothing anybody does is good enough,” Wayne Carson said of foster care providers upset by what they consider overzealous state enforcement. Carson, chief executive of ACH Child and Family Services, is shown promoting a new system for purchasing foster care beds and services in Mineral Wells in August 2016.(Nathan Hunsinger / Staff photographer)
In an interview, Carson said the incidents involve runaways at an ACH emergency shelter, which is an unlocked facility. Accusing the staff members involved of lack of supervision, and making that equivalent to physical abuse of a child, is overreach, he said. OCOK has appealed, he said.
Between Jan. 1, 2020, and the end of last month,the commission’s Residential Child Care Regulation division cited ACH’s various subsidiaries with 56 violations of minimum standards. ACH has appealed, knocking the number down to 35.
In Jack’s original rulings in the lawsuit, filed in March 2011 in her court in Corpus Christi, she denounced the state’s “inadequate placement array” that forced assignments of children to homes and treatment centers far from their communities. The 5th U.S. Circuit Court of Appeals, though, overturned that part of her proposed remedies.
She’d expressed great skepticism about community based care. But Jack was forced to live with it.
However, the judge, who’s now on senior status, has a free hand from the 5th Circuit to demand tougher regulation – and she’s doing it. While for many years Texas barely ever revoked a license or came down hard on providers, contracts are being yanked and licenses relinquished at an unprecedented rate. Many providers still caring for CPS’s kids have protested the pendulum has swung too far toward harsh enforcement.
“There’s a whole universe of these [citations] that should be issued,” said ACH’s Carson, who applauds the exit of shoddy providers. “And then there are those of these that to us seem silly. The state’s going completely overboard.”
Late last week,five former state protective services chiefs, in a letter to House Speaker Dade Phelan pleading for a cash infusion to help stabilize a system they said is in crisis. Over the past 18 months or so, it’s lost a net of more than 1,000 beds. The former commissioners sympathized with reputable providers.
“While the lawsuit has helped advance positive and needed reforms, the punitive nature of our oversight system is making organizations more risk-averse, which makes it more difficult to place children with complex behavioral health needs,” wrote former commissioners Hank Whitman Jr., John Specia, Anne Heiligenstein, Jim Hine and Carey Cockerell.
Top senator wants ‘culture change’
Kolkhorst, chairwoman of the Senate Health and Human Services Committee, has hinted some additional money may be found for increased rates. But early in the session she proposed yanking oversight of community based care from the department and giving it to the commission.
At an April 7 hearing, Kolkhorst suggested that because hundreds of CPS workers could lose their jobs, during an eventual transfer of their duties to private entities, the department would have to undergo a “culture change” to enthusiastically embrace community based care. And such zeal is needed, she said.
Protective services commissioner Jaime Masters pleaded for the program to be left where it is.
“I understand your comments about culture,” she told Kolkhorst. “It was no different than how I feel like I’ve changed the [department’s] direction about the lawsuit. … I know that I can change the direction about CBC. But I need you to give me a chance to do that.”
Replied Kolkhorst, “Well, we’re going to work through that.”
The latest version of her foster care bill, approved unanimously by the Senate this week, would move the program to a “transition” office, administratively supported by the department but headed by a gubernatorial appointee other than Masters. A new House-Senate oversight panel would be created, to mull community based care’s future.
ACH’s Carson remains upbeat that “if given time and support from state leadership,” community based care can “respond well to the current challenges.” It’s “workable in a big metro area,” he insisted.
ACH, after investing $6 million of its own funds in the seven-year-old effort, still has an endowment of $96 million.
Judy Lugo, president of the Texas State Employees Union, in which health and social program workers are the membership’s mainstay, said lawmakers clearly aren’t solving capacity problems.
The number of children in CPS custody who spent two or more consecutive nights in a state office or hotel increased in March to 237, a record for recent years. The union says CPS workers who are required to pull overnight shifts watching the children are strained and sometimes endangered by the older children bunked at offices.
“Many of these older foster children were just toddlers when state leaders began to fight the successful federal lawsuit in 2011,” Lugo noted. While the state should “take every step possible” to attract and support new, high-quality placements, “in this privatized model, the state’s only leverage is to cancel contracts,” she said.
Compounding Texas’ predicament is competition. In both community based care and the “legacy system,” the department only pays for days a foster child actually spends in a placement. The federal Office of Refugee Resettlement, though, reeling from a surge of unaccompanied minors at the U.S.-Mexico border, allows organizations to propose costs for beds, staffing and training. If ORR accepts a provider’s offer, it covers the costs whether it actually places children with the organization or not.
At the Senate hearing, Masters said her department and the Health and Human Services Commission “now both … are getting lobbied by the feds, asking for our capacity – and they pay way more than we pay. And so we are going to be in trouble.”