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54 pages about 49 kids: The children who refused placement in Hillsborough County

Back in August, an ad hoc committee of the juvenile justice board in Hillsborough issued a lengthy report on the state of placement instability in their circuit. The report diagnosed the phenomenon of children refusing placement as a major source of that instability.

The committee concluded that “children under the care and custody of Florida’s child welfare system should not have the ability to refuse temporary placements that have been determined to be in their best interest by the parties charged with their care.” The committee recommended a new law to expand the “children in need of services” statute to permit foster children to be placed into staff secure facilities (i.e., 24-hour supervision) if they refused placement, were chronic runners, didn’t go to school, or didn’t comply with the treatment recommended. They could then be placed in a physically secure (i.e., lock-down) facility if they didn’t comply with the staff secure program.

The proposal initially struck me as well intended but misinformed. Foster kids can already be placed in staff secure facilities by DCF without a court order. Any group home can be converted to staff secure by upping the staffing ratio and making sure someone is awake at all times in the home. You don’t need a new legal regime for that — you need money.

Second, foster kids can be placed in physically secure programs through a DJJ commitment, a SIPP placement, a Marchman Act placement, or a Baker Act. All of those placements are extremely expensive and have a limited number of beds. The gatekeepers for those programs have to do constant triage to limit use of the programs to the neediest children. If you want to increase access to secure settings with intensive treatment, it will take money to expand the placement array. Once you have a sufficient array, you can start working with the less extreme cases described by the committee.

The report correctly notes that Florida’s foster care placement system is reactionary. It recommends data collection and analysis to create predictive models for which children will have future placement challenges, because “indisputable data on risk factors is not available and would be beneficial to decision making.” If you know me or have read anything on this blog, you know that I couldn’t pass that challenge up.

It turns out that Hillsborough has been logging when children refuse placement in FSFN since 2017. (This should be required for all CBCs.) There were 49 kids in the most recent version of the public database that had ever refused placement. Me and my team of intrepid students reviewed the complete history of all 49 kids, then the history of their most common placements, and then the whole placement array in Hillsborough. What we learned filled over 150 pages. I have broken it into a main report and an addendum that gives a narrative of the placement history of all 49 children. (The addendum will come out soon — it’s over 100 pages.) This post is a summary.

What we found was consistent with existing research on placement instability in foster care. The refusal children were disproportionately non-white teens with significant time in group home settings; but there were children as young as seven who refused. For the most part they were well-known to the system: the median number of placements prior to refusal was 21 (31 in total), and nearly 70% of their placements prior to refusal (75% in total) ended because the provider requested the child be removed. Being ejected by providers after placement was the most pronounced feature of children who refused placement. Most of the children refused only one or two times; and many spent more time at the agency’s office because no appropriate placement could be found than they did because they refused.

What surprised us was that children were slightly more stable after refusing placement than they were before, at least temporarily. The refusal episodes seemed to elicit an agency response that children’s previous placement instability did not. Usually the added stability was from the agency obtaining therapeutic placements, but sometimes stability came from negative causes, as some kids ran away for extended periods of time or were arrested. In some cases, it appeared that the children refused with a specific placement in mind they wanted to be in.

Speaking of arrest, the committee was mostly composed of DJJ professionals, so it makes sense that they were focused heavily on that population. However, it turned out that the children who refused placements were not any more seriously involved in the delinquency system than other unstable kids in foster care. They did, however, appear to have higher levels of mental health needs.

And that’s where Hillsborough is particularly failing. Our review of the system as a whole found a placement array that routinely played hot potato with high-needs children, bouncing them around in circles often back to placement they were just kicked out of. When I first read the committee’s report, my thought was “you’re describing an STGC — just open one.” Hillsborough has no Specialized Therapeutic Group Care programs, and instead sends children across the state to therapeutic programs. Locally it relies on group homes that rarely keep children more than a month on average and enhanced rate foster homes that keep kids a median of 4 days per placement. The problem isn’t the law; the problem is the array.

Our review disagrees with the committee’s report in another way: instability was in fact highly predictable and often began long before a child refused placement. Existing research shows that a child with 4+ placements has a 70% chance of additional instability, and a child with 6+ daily maladaptive behaviors has a 25% increase in risk of disruption per additional behavior. By reviewing the placement histories we found 131 highly unstable children in Hillsborough since 2017, many of whom had more than 50 placements. Only 38 of them had ever refused a placement, though. Refusal and non-compliance are not appropriate triggers for intervention — instability is.

Where we agree with the committee is this: Hillsborough needs to regain control over its array and create a clear escalation process for children who are serially ejected from placements. This will take a significant effort to change the culture. The burden should not be on the children to accept a 22nd placement failure or risk civil commitment for disobedience. The burden should be on the providers to work with children to never get to that level of instability.

Our full report is linked here. The addendum containing the narratives for all 49 children will be released soon. I hope this is helpful to people on the ground in Hillsborough.

Here are the documents via our dropbox:

A special thanks to the good folks at Print Farm for putting together the report and the graphics.

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