The Increase in Hotel Placements
(Originally published March 2022)
A useful guideline for evaluating the commitments of political leaders and directors of public agencies is to pay attention to what they do rather than what they promise to do. Policymakers and top managers quickly learn to acknowledge challenges and fault in careful language (e.g., “we can do better”) and take a proactive stance (“we have a plan”) in their public statements. For most concerned citizens, this is enough to allay fears and mute criticism. Reasonable people understand that government agencies face tough challenges and sometimes perform poorly but expect competent leaders and managers to recognize unacceptable performance and act accordingly. Most concerned citizens, usually a small fraction of the electorate, understand that coping effectively with tough problems will take time. Initially, they are willing to give political leaders and managers the benefit of the doubt, but not indefinitely.
In light of the guideline, “pay attention to what leaders do rather than what they promise to do,” consider the following trends in
“Placement Exceptions,” days of care in mostly hotel placements, and office placements of foster youth in Washington State:
Note: The number of children placed rises from 195 in 2017 to 281 in 2022
The Division of Youth and Family Services (DCYF) took over administrative responsibility for child welfare in Washington on July 1, 2018. The 85% increase in placement exceptions from 2021 to 2022 is misleading because DCYF included 577 night-to- night placement moves of children from foster home to foster home in this data, something the agency had not done in prior years. In daily placement moves, a foster child may be dropped off at a foster home after dinner and picked up before breakfast. Children are sometimes supervised in a child welfare office or other setting before being moved to another home for an overnight stay. Foster parents may be paid $300 or more for overnight stays in which a foster child does not receive so much as a meal.
Region 5 (Pierce County) has made frequent use of 24-hour placements in recent years while utilizing few hotel placements. Night-to-night placements have been widely used for many years, often for young school-age children. They reflect unacceptable placement practices resulting from a lack of foster homes or residential care beds. They are deeply distressing to many DCYF staff.
After subtracting night- to- night placements from 2022 placement exception data, there has been more than a 370% increase in hotel stays/office placements since 2018, despite repeated promises to eliminate hotel/office placements and a federal court order requiring the state to stop this practice. DCYF made good on one part of this promise in 2022 by virtually eliminating office placements, but at the cost of greatly increasing hotel placements.
Hotel stays are costly. According to some news reports, the average cost is $2000 per night, which pays for two caseworkers (minimum) and often a security guard, in addition to hotel rooms for the youth and caseworkers. Hotel placements are dangerous to child welfare staff. The Children’s Ombuds Office recently reported there were 38 assaults by youth on child welfare staff in a 16-month period, one of which sent a caseworker to a Puyallup hospital emergency room with a broken nose and concussion. Most of these assaults occurred in hotels, but a few occurred in cars while caseworkers were transporting youth to out-of-county facilities or driving them around throughout the night to avoid reporting another placement exception. Some DCYF staff have insisted on local television news that assaults on staff by youth have been grossly underreported.
It is only a matter of time until something worse occurs, with devastating consequences for DCYF staff recruitment and retention, along with a huge tort judgment or settlement. Even now, why would promising young MSW’s go to work for an agency which will require them to supervise hotel placements of violent youth?
A substantial percentage of placement exceptions occur in two regions: Region 4 (King County) and Region 6 (southwest Washington and Olympia to Pt. Angeles and Forks). In 2022, 4281 out of 4692 placement exceptions (mostly hotel placements) occurred in Regions 4 and 6, while all of Eastern Washington (Regions 1&2) had a total of 15 placement exceptions. King County youth placed in hotels are disproportionately Black or Multiracial (36-37%), yet there has been a deafening silence from most child advocates for years regarding this inhumane treatment of emotionally troubled youth.
There is a long history of the use of placement exceptions in Washington state’s child welfare system. Overnight office placements were common in regions 3 and 4 during the early 2000’s, and then were virtually eliminated during the initial years of the Braam settlement agreement, only to re-appear after the state legislature cut Behavioral Rehabilitation Services (BRS), i.e., residential care services, by $50 million dollars during the Great Recession. These cuts were not immediately or fully restored following the recession as policymakers seized the opportunity to make permanent reductions in residential care programs whose steadily rising costs were questioned (and resented) by budget writers in both the executive and legislative branches.
For several years before the creation of a stand-alone child welfare department (DCYF), Washington had become the ‘canary in the coal mine’ for the consequences of drastic cuts in residential care. For this reason, I did not immediately blame child welfare leaders for the increase in hotel placements from 2018-20. DCYF leadership inherited a public policy debacle created by large budget cuts which would take time to undo. However, after 5 years in which placement exceptions increased by 370 percent, and after repeated assurances that the agency has a plan to eliminate them, I question the resolve of policymakers and DCYF leaders to do so. What can account for a reluctance to do what is necessary to stop hotel placements and night-to-night placement moves? It cannot be funding, given the cost of these placements and the prospect of a large number of tort actions for years to come.
Neither is the answer managerial incompetence or inability of child welfare offices to achieve challenging goals. DCYF almost eliminated out-of-state residential care placements a few years ago after a disability rights organization took legal action on behalf of a youth placed in a facility in the Midwest. This was no easy task and was a notable early achievement of the state’s new stand-alone child welfare department. Bringing almost one hundred behaviorally challenging or severely disabled youth back to residential placements in this state required strong political support in the Governor’s Office and legislature.
However, this priority tapped out the residential care capacities of private agencies whose business model was deliberately undermined for years in order to greatly reduce the use of residential care programs, but without a viable alternative. According to the 2022 Children’s Ombuds Report, 14 residential care facilities closed in the past two years (2021-22), in large part because BRS rates were not sufficient to pay their costs. Once state government has deliberately driven private providers out of business, why would these agencies choose to reinstate programs based on promises to raise rates?
In 2022, DCYF virtually eliminated office placements after embarrassing TV news stories of children sleeping in offices without bedding, spending nights in cars, or being driven around for hours rather than being placed in a foster home or hotel. When there is strong public pressure and political support for stopping unacceptable practices, DCYF leaders find a way. The significant increase in hotel placements since 2018 indicates a public tolerance for this practice, including a muted response from influential advocates who consider the likely alternative, i.e., a reinvestment in residential care, much worse.
The implementation of Family First legislation has accelerated the demise of residential care, which has decreased 25% nationally during the past five years. It has been the goal of the federal Children’s Bureau and influential foundations to reduce the use of residential care (which has a bad reputation among advocates and most scholars) and they have succeeded; but without developing -- or sometimes even proposing - viable alternatives. The widespread use of hotel placements, office placements and other inhumane alternatives (such as having youth sleep in jails or prisons) around the country is the direct result of policies whose goal is the elimination of residential care. Washington has been on the leading edge of this change in child welfare policy and practice, and its child welfare leaders have not been willing to reverse course, regardless of the consequences.
The large increase in placement exceptions is the most visible result of the reduction in residential care, but there are others. During recent years, there have been stories in the Seattle Times regarding the refusal of child welfare offices to respond when parents refuse to pick up their emotionally disturbed adolescent from a hospital psychiatric unit or emergency room. These are desperate parents who can no longer count on any assistance from DCYF or any other state agency when they refuse to allow their child to return home. In addition, DCYF has decided it does not have legal responsibility for youth who are not already legally dependent when these youth exit detention facilities and parents refuse to allow them to return home. In effect, public policy in Washington has become that “these youth are not our responsibility and if they end up homeless, so be it.” This is an unconscionable practice which has become routine during recent years in this state.
What Can Be Done?
In 2022, the state of Washington settled a class action lawsuit on behalf of foster youth through a promise to create a professional foster parent program. DCYF leaders were unwilling to even discuss this option for years, possibly because of strong opposition from key legislators, one of whom once assured me that foster parents are not motivated by economic considerations! However, the settlement agreement does not describe professional foster care, and there are few models around the country that have been tested. DCYF has outstanding staff developing its professional foster care model, but it will require political leadership as much as innovative ideas to overcome opposition to the following essentials:
Professional foster parents must receive a salary and/or reimbursement for care of behaviorally troubled or physically disabled youth that allows at least one parent to devote their full time to foster care. Concretely, this means that professional foster parents must receive a six-figure income, along with benefits; as well as a wide range of needed support services, for care of no more than two youth at one time. Viable professional foster care will not cost less than residential care; it is not a cost cutting strategy.
In some states, “professional foster parent” has been a designation used to justify monthly exceptional cost payments of around $1000, in addition to the usual foster care rate. If DCYF does something similar to overcome the objections of legislators who dislike the idea of paying foster parents for the care of behaviorally challenging youth then the promise in the settlement agreement to develop professional foster care will be empty rhetoric.
Professional foster parents must be qualified by virtue of education and experience to provide foster care for behaviorally challenging or severely disabled youth and meet yearly training requirements.
Professional foster parents must be given incentives for outstanding performance rather than required to accept “step down” rates as youth make therapeutic progress in school and in peer relationships.
Professional foster parents must be treated with the same regard as other professionals by DCYF staff and by courts.
If these requirements are met, Washington has the opportunity to create a therapeutic foster care system for youth with serious mental health conditions, and to become a national leader in in foster care reform.
Nevertheless, professional foster care by itself will not eliminate the need for residential care for a small percentage of foster youth.
Currently, 250-300 foster youth in Washington annually require placement exceptions, mostly hotel placements, and about a third of this number utilize most of the days in care. Many of the 80-100 youth who live in hotels for 10 days or more are violent and dangerous and need to be in institutional settings for brief periods of time, though not indefinitely. Some of these youth cannot be safely cared for by professional foster parents, no matter how skilled and committed, or by most residential facilities.
The number of mental health Children’s Long Term Inpatient Program (CLIP) beds needed to stabilize these youth before placing them in a family or residential program needs to be significantly increased. Currently, Washington funds less than 100 CLIP beds for a child population of 1.7 million. There is no reason for a state as wealthy as Washington to be in this predicament. Washington State should also fund an Infant and Childhood Mental Health Program for the screening of the service needs of all children who enter foster care.
There is also a small percentage of foster youth who for various reasons need facility-based care rather than foster care. The policy goal of first reducing and then eliminating residential care is understandable, but it is not realistic. A recently published book, Revitalizing Residential Care for and Youth: Cross National Trends and Challenges, ed. by Whittaker, et al, provides information regarding residential care in 16 developed countries in Western Europe and also Australia, Israel and Argentina and the U.S. There is not one of these countries in which less than 7% of the foster care population is in residential care. In ten countries, more than 30% of foster children and youth are in residential care. Most of these countries have better family support systems than the U.S., and child populations with higher rankings on standard child well-being indicators.
Whittaker, et al, describe a wide range of residential care models around the world that vary greatly in program design, quality of care and outcomes. Providing safe and therapeutic residential care is a challenge everywhere, but a few other countries, e.g., Germany and Finland, have been far more successful than the U.S. in maintaining exemplary programs. The authors assert:
“Our analysis indicates that countries with low educational requirements for staff are those … who have sought a drastic reduction of its use, (particularly the U.S. and Australia). In contrast, countries with a high qualification requirement, such as those with a social education model … or social pedagogy specialties have higher utilization rates of residential care.”
They hypothesize that countries with low educational requirements for residential care staff have poorer quality programs and worse outcomes, which leads to disinvestment as well as calls to eliminate residential care altogether.
To date, the policy guideline, “first reduce, then eliminate residential care,” has had disastrous consequences in multiple states with no end in sight. A more realistic and better-informed policy would be to stabilize residential care at 7-10% of the foster care population, while investing in program improvements that replicate model programs in the U.S. and Western Europe. These programs should work in tandem with a cadre of professional foster parents large enough to care for 5-10% of foster youth. ©
Dowd, P., Washington State Office of The Family and Children’s Ombuds Annual Report (2022), Tukwila, Washington.
Whittaker, J., Holmes, L., Del Valle, J. & James, S., Revitalizing Residential Care for Children and Youth: Cross-National Trends And Challenges (2023), Oxford University Press, New York City.