Treatment Services

Frequently Asked Questions


The Oregon Child Welfare system has a capacity issue. And while capacity is a struggle across the entire the foster care system, it has most acutely impacted the state's ability to provide treatment to the children within the system who have experienced the most severe traumas and have the most intensive behavioral of psychiatric health treatment needs.

 

There is no one primary factor that led to this issue. It is a complex system-wide problem that will require a system-wide solution.

 

The decline in system capacity began around 2013 and 2014. During this time regulations on programs began to increase and the children’s behavioral health landscape changed significantly. At the same time foster care was experiencing a steep decline in non-relative foster caregivers.

 

The impact at a crisis level was identified in 2016 when we saw a decline in foster care availability, Behavioral Residential Services (BRS) programs and Psychiatric Residential Treatment Services (PRTS) programs. The highest number of children placed out of state was 88 in March 2019.

 

Between 2015 and 2018, Oregon PRTS capacity decreased by at least 67 beds. This was approximately a 50 percent loss of the PRTS capacity in Oregon which had not been replaced:

·        The closure of Youth Villages PRTS in 2016 resulted in the loss of 35 beds.

·        The closure of Looking Glass PRTS resulted in the loss of 12 beds in 2016.

·        Through restructuring, Trillium Family Services reduced capacity by 20 beds.

 

Additional capacity loss:

 

  • Oregon entered its current foster care crisis with an estimated loss of about 400 foster care homes in 2016 and 2017.

  • In 2014 the intellectual/developmental disabilities system discontinued its use of proctor care which reduced placement capacity by 60. Proctor care is in-home foster care which includes behavioral support services provided in the home and community.

  • In 2015 and 2016 there was a BRS decline of approximately 100 placements within both therapeutic foster care and residential settings.

  • If not for the system capacity loss detailed above, most of the children who were placed out of state would have been served within Oregon.

 

Why does the state have limited placement options?

As mentioned above, there was a significant reduction in capacity for both PRTS and BRS within Oregon as well as a reduction in foster non-relative foster caregivers. And while DHS has been rebuilding BRS capacity, it has not yet been able to meet the level of placement options needed.

 

That said, there is no one primary factor that led to this issue. It is a complex system-wide problem that will require a system-wide solution. Some factors beyond the capacity reductions already mentioned include:

·        Reimbursement rates, which have improved since 2016 and continue to be discussed.

·        New and stricter regulations reduced the desire of new providers to replace missing capacity. 

·        Providers, which are small not-for-profit entities, had difficulty adjusting to the changes in the children’s behavioral health system.

·        Behavioral health outpatient programs such as intensive community-based behavioral health treatment was not developed consistently across the state or with a service intensity required to maintain youth in non-residential care settings.

 

What is the current total capacity gap?

 We are talking about the ideal foster care system capacity need, which would include enough placement options in each placement type so that there is a buffer that allows for transitions between types of care.

 

The additional capacity needed, with a buffer, is 1,860 placement options. This includes

·        65 BRS placement options

·        72 PRTS placement options

 

These increases would serve the needs of most kids. The exception is the small number of kids with highly complex needs that are limited or not available within Oregon's system.

 

Some examples include:

·        Sexual harming treatment programs with other specialized needs

·        Programs for commercially sexually exploited children (CSEC) with other specialized needs

·        Programs to manage highly aggressive and violent behaviors

  

What is currently underway to address capacity needs?

As part of the Child Welfare Reform, DHS and OHA are working together and collaborating with Coordinated Care Organizations to expand system capacity and make sure that the kids served by our organizations get the care they need.


Recently passed by the legislature in 2019, SB 1 is expected to help with some of the system issues around kids with specialized needs. In addition, appropriations proposed in SB 221 were included in the OHA and DHS budgets for January 2020. These budget appropriations will result in the development of Intensive community based behavioral health services, additional proctor foster care and services for youth eligible for developmental disabilities services.

Proctor care is in-home foster care which includes behavioral support services provided in the home and community.

Child Welfare has been actively working with partners and has created an additional 95 new BRS placement options since 2018. This work will continue to expand according to the outcomes of the "Capacity Needs for Children" report attached. The goal is to create 12 BRS placement options by January 2020. This level of care has a specific focus on serving youth who may have otherwise been recommended for treatment out-of-state.

 

Child Welfare is committed to increasing foster home capacity by 150 new foster homes by Dec. 31, 2019. This effort is being supported by the Governor’s Executive Order. 

 

The Governor also directed DHS and the Oregon Health Authority (OHA) to create 15 PRTS placement options dedicated to Child Welfare.

 

What else is important to know?

 

·        Though Psychiatric Residential Treatment Services (PRTS) are not administered by DHS, some children and youth in DHS custody rely on those programs.  We are working collaboratively with OHA to fill this capacity gap.

 

·        Building more BRS and PRTS capacity will not solve the whole out-of-state placement need. There are some very specific and very specialized needs that Oregon has limited or no treatment capacity. Oregon will need to build options within the system to treat these needs. Some examples include:

·        Sexual harming treatment programs with other specialized needs

·        Programs for commercially sexually exploited children (CSEC) with other specialized needs

·        Programs to manage highly aggressive and violent behaviors

 

·        Capacity building at the PRTS and BRS levels presents a few challenges including:

·        Strict regulatory standards. 

·        Lack of buildings across Oregon that are adequate to operate these programs

·        Workforce competition. Many programs struggle to hire the staff needed to operate and staff turnover rates are quite high in these programs.​​​​