Wes Moore is inheriting a serious crisis the Hogan administration failed to address. We are neglecting children and youth who have high-intensity behavioral health needs because of insufficient therapeutic residential care options.
Many in foster care are relegated to boarding for weeks or months in emergency rooms or to living in short-term psychiatric hospital wards with no end in sight because of the shortage. Others are being “placed” in hotels with gift cards for fast food and 24-hour supervision by contractors. This is an act of pure desperation for the local departments of social services and their case workers, who are charged with providing for the well-being of these children and youth, and held accountable by the juvenile court and state and federal agencies.
We can only speculate how long it will be until “hoteling” a youth leads to a critical incident, one that could have been prevented if adequate mental health services were available.
Two decades ago, group care for children fell into disfavor in public child welfare, a welcome change in many respects because in most circumstances children fare best in families. Numerous group programs closed, resulting in a loss of roughly 350 beds. Around the same time, other child-serving state agencies narrowed their missions and reduced access to out of home placement.
But eliminating therapeutic residential care and limiting access didn’t eliminate the need for it. In fact, COVID and other stressors, appear to have increased the number of youth in need of mental health therapies today, some at the highest residential levels, according to the Governor’s Office of Crime Prevention, Youth and Victim Services.
Over time the ill-equipped state’s foster care program has become the default provider of therapeutic care for youth with serious emotional and/or developmental disabilities. Sadly, they have little prospect of healing while being literally boarding in emergency rooms, ‘living’ on psychiatric wards and in hotels for lack of alternatives.
Maryland is a wealthy state with enormous gifts, talents and resources. We have no excuse for the neglectful care of these young people, who have many strengths, but also complex needs that make finding a placement provider willing and able to accept the child an increasingly insurmountable challenge. Some of the children engage compulsively in self-harming behaviors, such as swallowing foreign objects and/or cutting; become threatening or harmful toward caregivers and others; endanger family pets; or impulsively engage in serious property damage. Some have a history of sexually victimizing others, including younger children.
Residential providers in Maryland have the right to reject referrals for placement and to eject youth with only 72-hours notice, leaving local departments of social services scrambling to find alternatives in a system that increasingly has few to offer. However, these young people, like anyone else, deserve the best care we can offer. But what they’ve gotten for the last decade is hand-wringing instead of solutions, finger-pointing at local departments, and a lack of will to remedy the neglect of children the state is responsible for.
The state must act in both the short and long term to solve this crisis. Among the steps necessary are to:
- Open a 25-bed “no eject, no reject” psychiatric crisis respite program accessible to children regardless of child welfare status; such crisis respite was a strategy pursued in California by way of legislation.
- Complete a capacity study similar to that completed in Oregon to better understand the needs of the children in our child welfare system’s care.
- Fast-track “rate-setting reform” to enable providers of care for children to implement programming that meets more needs.
- Restore residential treatment center capacity.
- Establish psychiatric inpatient diversion programs that include access to mobile crisis response and crisis beds.
- Strengthen primary prevention community based services.
- Convene a work group to study national models for providing care for children and youth with high intensity behavioral health needs and/or developmental disabilities, and commit to following the recommendations.
Maryland is a great state with endless talent and boundless intellectual resources. The time is long overdue to put our gifts and resources together and stop the irreparable damage of emergency room boarding, psychiatric hospital housing, and “hoteling” of children. When we are doing something with someone else’s child we would not do with our own, we know it is wrong. Such collective neglect of children is unconscionable.