Archive for Sunday, April 26, 1998

KANSAS FOSTER CARE

April 26, 1998

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According to the polls, voters like Bill Graves more than any governor in recent Kansas history. But there is strong and growing evidence that privatization, the biggest single initiative of his administration, is producing miserable results for a few thousand vulnerable people who can't vote: the children whose lives are so bleak they have become wards of the state.

These are children shunted from one temporary home to another. They are children who can only dare to think about their next bed, let alone the next election.

Critics of the privatized foster care initiative say it has made a historically inadequate system worse than ever. In eastern Kansas, where a seriously troubled contractor, Kaw Valley Center, has a state-franchise lock on foster care services, the criticism has been especially sharp. But others elsewhere in the state, served by other state contractors, cite similar concerns.

The list of critics includes judges, social workers, foster parents, legislators, attorneys and children's advocates. Their complaints are many and varied, but branch from a single root: a quick and massive change in the way the state takes care of foster children.

A year ago, front-line responsibility for these children, unwanted or abused in their own homes, was shifted from state social workers to three private contractors and their employees.

The three contractors agreed to care for state wards in exchange for a fixed annual fee ranging between $13,000 and $15,000 per child. This new per-capita system, built upon the same fixed-price principles that have swept the medical industry under the rubric managed care, was such a novel approach to government care of needy kids that it continues to keep Kansas social services in the national spotlight.

``We've started driving from New York to California without a roadmap,'' said Kansas Social and Rehabilitation Services spokesman John Garlinger. ``No state in the country has ever done this before. We're swinging without a net here in many cases. But do I think children are better off than they were two years ago? I think they are. We have people from all over the country coming here and they walk out saying, `You're really doing some good stuff.'''

Complaints voiced

The experts might not leave so impressed if they heard the whole story, said Douglas County District Court Judge Jean Shepherd.

``Their experts from out of state attended a seminar sponsored by SRS and the only speakers were SRS and contractors,'' said the judge, who has worked with troubled children here for 14 years. ``No one else was invited to speak nor were we invited to attend.''

Here are the sort of comments the experts missed hearing:

``The foster homes are imploding,'' said Shelley Bock, a Lawrence attorney and guardian ad litum for young state wards from Douglas County.

``Anybody who says this system is working is way off base,'' said Gaye Kitsmiller, a Lawrence woman who was a foster parent and trainer of other foster parents for 12 years, but quit because of her bad experiences under the new system.

``The new system is awful,'' said one long-time provider of services to troubled children. ``It's certainly not better.'' She asked not to be identified because the non-profit agency she heads relies, in part, on funding through subcontracts from the state's principal contractors.

``It ain't working here,'' said Kathy Rein, a guardian ad litum in Pratt. ``I don't feel we are serving the kids as well as we can or as well as we did. Every social worker I deal with from SRS is frustrated to death.''

The flames of criticism are sparked and fanned by incidents such as those involving the sexual abuse of two young girls by a staff member at a private contractor's Kansas City group home.

In another incident, the same contract agency, Kaw Valley Center, lost for several weeks a teenage girl placed in its care by the state. The girl was taken late one night by a Kaw Valley employee to the doorstep of a house in Topeka. She should have been delivered to Kaw Valley Center in Kansas City. Police sent to the Topeka house the next day couldn't find her.

``As a driver, I had no training,'' said Zahay Grant when the matter came before Shepherd's court on Jan. 21.

Troubles in the east

By most accounts, Kaw Valley, the largest of the state's three contract service providers, is the most problem-plagued. The non-profit agency was awarded the franchise for two of the state's four foster care contract regions. Its area of operations stretches from Nebraska to Oklahoma and includes Douglas County. The executive committee of its board includes Kansas Senate President Dick Bond and his wife, Sue. Bond is an Overland Park Republican. Kaw Valley's chief executive officer is B. Wayne Sims. Under his agency's supervisory umbrella are 510 individual foster care homes and the agency's directly managed group homes in Kansas City, Fort Scott and Pittsburg. The agency also oversees more than 55 child service subcontractors in its two contract regions.

Inspection reports of Kaw Valley facilities over the past year reveal a pattern of ongoing and unresolved problems. State health officials eventually became frustrated enough that earlier this month they moved to pull the license of Kaw Valley's main group home in Kansas City. The suspension order and the $500 fine, the maximum allowed by law, awaits appeal before a state hearing officer. Meanwhile the facility for 68 children -- cited for overcrowding, untrained or undocumented staff workers and other violations that fill five typed pages -- remains in operation.

``Based on this we'll ask (state health agency inspectors) to go back on a regular basis and reside there, if necessary. It had just risen to the level where there were so many complaints,'' said Russell Northup, an inspection supervisor at Kansas Department of Health and Environment. ``Our law limits it (the fine to $500.) But we think that's too low.''

The action was the strongest KDHE could take short of an emergency closing of the shelter. But if there were some place else to put the Kaw Valley kids, Northup said, immediate closure ``would have been considered.''

As it was, however, ``we think that would have made things worse,'' Northup said. ``Where would they put the kids?''

KDHE's action came 59 days after SRS announced it was renewing Kaw Valley's contracts for a second year.

``We believe the partnership we have formed with these Kansas agencies is providing the services Kansas children and families need,'' said SRS Secretary Rochelle Chronister in a press release announcing the contract renewals. ``During the first year, there were several transition issues that had to be addressed, and some will continue to need attention. But as with any major system change like the one we have undertaken, it does take time to work out unexpected problems.''

``I'm not sure what we knew about that particular facility'' when Kaw Valley's contract was being renegotiated, SRS spokesman Garlinger said in an interview last week. ``But all the facilities tend to operate right at the limit of their licenses. Overcrowding is not an issue that just popped up under privatization. It existed before, too.''

Kaw Valley's response

Marilyn Alstrom, a Kaw Valley Center vice president, said when the agency's various subcontractors run out of bed space for youngsters in their care, Kaw Valley must take the overflow or see the children returned to unsafe homes. That is not an acceptable option, she said.

``It seems as soon as a child goes out the back door three children come in the front door,'' she said.

Kaw Valley critics say they don't doubt the agency's ultimate good intentions, but say it bit off much more than it could chew when it bid to be the lead contractor for virtually all of eastern Kansas.

Alstrom said that isn't so. Kaw Valley was one of the state's premiere child-care agencies when it won the contracts, she said, and continues to perform well under the trying circumstances brought by the sweeping system change.

But a March 27 Kaw Valley memo written by CEO B. Wayne Sims and later obtained by a newspaper reporter indicates the agency is scrambling to cover bases and meeting little success.

``Kaw Valley Center anticipates utilizing our residential facilities beyond licensed capacity for an interim period of time (present-June 30, 1998,'' Sims wrote.

Subsequent memo pages show Kaw Valley had canvassed facilities as distant as Hays and Wichita, looking for places to put children. Most were already full. Some were overcapacity. Sims concluded the memo by stating the overcrowding might continue beyond June 30.

Among the stated goals of the system change is to keep children closer to their real homes and schools in order to ease later reunification with family. In Douglas County, an often-repeated criticism of the new system is that it has failed to do either.

Alstrom acknowledged Kaw Valley, a prime service contractor for foster care and a state subcontractor for adoption services, has agreed to relinquish some of its adoption work to better focus its resources on foster care services.

As for Kaw Valley's critics:

``People who criticize and cry the loudest usually have the least amount of knowledge,'' she said. ``When people would rather go to the media or the Legislature than us, then we can't work the problems out face-to-face and one-on-one.

``I think SRS took a lot of bashing (over foster care) and I think maybe Kaw Valley has stepped into that role. Because privatization is brand new, we have assumed some of that criticism. We don't want to go back and relive the year, but everyone is more determined than ever to make privatization work. We feel today we have a better understanding of what our responsibilities are and the direction in which we need to go.

``We've got our staff in place,'' she said. ``We're training staff right now. We've got a lot of our hard work finished now. The most difficult part is providing services to the children.''

Asked about the incidents of staff abuse of children and the girl the agency lost, Alstrom said:

``That raises red flags. I have not heard any of this. I would say this is very unique and always alarming. I would hope we have safeguards in place to protect kids and clients and also drivers from false allegations.''

Asked who at Kaw Valley would know details of the incidents, which were separately confirmed by Lawrence Journal-World, Alstrom responded:

``These are human resource issues and human resource issues go through myself and...and this was an incident before I took this responsibility in January.''

Social worker shortage

Since privatization, Kaw Valley and other contractors report difficulty finding and keeping qualified social workers. Before the initiative was launched it was expected that large numbers of SRS social workers would flock to the new providers. That didn't happen, at least not to the extent anticipated.

Garlinger said SRS staffing has dropped 40 percent since privatization, but many of those former SRS workers moved to other state agencies such as KDHE, Kansas Department on Aging, and the newly created Juvenile Justice Authority. They simply moved to different state offices along with the programs shifted wholesale from SRS to the other departments.

Now SRS finds itself in the same boat as the contractors, looking for qualified help.

``SRS is recruiting in about 10 different states,'' said Garlinger. ``Experienced social workers are hard to come by right now. They can just about write their own ticket.''

Foster parents critical

The privatization initiative also has created more demand for foster parents. Many experienced foster care parents bailed out rather than work under the new system.

Others have stayed with the new system, but don't like it and are simply biding time.

Camille Dalager of Lawrence, who started foster parenting in 1992 and ultimately adopted two children placed in her care, is one of them. After the two unadopted foster children currently in her care have found permanent homes, she said, she's not sure if she'll continue.

``The year before privatization we kept hearing about what was going to happen,'' Dalager said. ``But SRS couldn't give us the information to prepare for it because they didn't have the information to give. We didn't get anything in writing to tell us how this was going to work. We got verbal information but it always varied meeting to meeting.''

And things went downhill from there after the actual transition, a 90-day period last year that saw the transfer of thousands of children's cases from SRS to the private contractors.

Dalager described what happened with one Kaw Valley child in her care, a child she has since adopted.

``I never knew (the child's Kaw Valley) case worker or case manager,'' Dalager said. ``When I called twice to find out who it was, they didn't know. During that period, if you could get people to answer the phones it was incredible. Not only did they not have enough staff, most of the ones they had were brand new with little experience knowing what they were doing. Even if you found out who the case manager was, chances were they weren't going to stay.''

Among other problems, Dalager said, she has had to take Kaw Valley to small claims court to get reimbursed for foster care expenses.

``I guarantee you if foster parents had had a role in planning this, it wouldn't have happened this way,'' she said. ``Now it's designed for hurting children.''

An SRS spokesman said the agency now regrets it didn't allow more input from foster parents and judges before launching the new system.

Judges also have been critical of the change.

A Wyandotte County judge recently held Kaw Valley and SRS in contempt of court and levied a $1,000 fine for failure to provide needed services to a child as ordered by the court.

The same thing has happened in other court districts.

Kathy Rein, a guardian ad litum in Pratt, where the lead contractor is Methodist Youthville, has been enraged by things she has seen since privatization. Haggling between contractors and subcontractors over who will pay for her young clients' services particularly angers her.

``SRS was court ordered to have counseling provided for these two children (clients of Rein) who were victims of extraordinary abuse. Lutheran Social Services and Youthville were negotiating over who was going to provide these services. It went on for an extraordinary amount of time. Meanwhile the children weren't receiving services. Now they deny it was a matter of who was going to pay. Now they say they were just negotiating over what type of services.''

A local magistrate judge didn't buy it. He held SRS in contempt and later ordered a $5,000 fine be paid. Rein said SRS didn't even show up for the first contempt hearing.

``First nobody from SRS showed up,'' Rein said. ``Then the judge fined them $5,000 and by gosh they showed up. The CEOs and supervisors showed up the third time. They all decided they should take this seriously. It's pathetic. These poor kids were abused and they don't even show up. By gum, if I'd got a contempt citation, I'd be there.''

Before privatization, Rein said, it took two people to make something happen for a child. Now it requires a meeting of eight or nine people, including those from SRS, the contractors and the courts to make something happen.

The same types of problems are reported by Judge Shepherd in Douglas County.

She said she must spend much more time on each case now because she has no confidence in the service system and its individual components.

``My job is not to micromanage their program,'' she said. ``It is my job to see that the kids get safe placement.''

During almost 13 years on the bench before privatization, Shepherd issued only two findings against SRS or service providers for ``failure to make reasonable effort'' in dealing with a child.

In the year since privatization, she has issued between 10 and 15.

``I've stopped counting,'' she said in a recent interview. ``I just did another one yesterday.''

Cost accounting

The good news for taxpayers is that even though the number of foster children has increased in the first year of privatization, the state has spent less caring for them.

The last year before privatization, the state spent $68.5 million on foster care. The first year of privatization cost $63.3 million.

``The No. 1 purpose (of privatization) was not to save money but to improve the service delivery system,'' said SRS' Garlinger. ``It's too early to say if it will save or cost more in the long term.''

Whatever the drawbacks of the new system, most agree there is no going back. The massive switch to private contractors and restructuring of SRS has left no system to go back to.

``It's the way it is and we have to see if we can't fix it and make it work,'' said Rep. Jene Vickrey, a Louisburg Republican who also is a foster parent.

He and his wife are among the many foster parents who say they have seen poor results from privatization. Vickrey was among a group of about a dozen Kansas House members from both parties who came together in the waning days of the session after discovering they were hearing the same types of complaints from their various, scattered constituencies.

They asked for and received a meeting with SRS Secretary Rochelle Chronister and SRS foster care chief Teresa Markowitz so they could relay their concerns.

Vickrey also appeared Wednesday before the Legislative Post-Audit Committee, asking that legislative auditors scrutinize Kaw Valley operations and other related foster care concerns.

The committee turned the request aside, instead instructing SRS and Kaw Valley to prepare their own responses to the issues raised. They are to report back Wednesday.

All or none

Many, such as Rein in Pratt, continue to wonder why the Graves administration undertook such a massive change in foster care services without first doing a smaller, pilot program to test it out.

``This might have worked had it come in small doses,'' Rein said, ``or if they'd had their ducks in a row when they started. But they don't have any of the stuff in line.''

An incremental approach was considered and rejected by both the administration and the Legislature. Soon after taking office, delivering on his 1994 campaign promises, the governor instructed his Cabinet chiefs to look for government services they could privatize. No other agency has outpaced SRS at privatization.

``It's a very fair question,'' Garlinger said when asked why the new system wasn't first tried on a smaller scale before entirely scrapping the old. ``The question of piloting this somewhere was a topic of some extended discussion. We decided not to. It was a parity issue. There's no reason one area (of the state) shouldn't get what the other gets. How do you pick who gets made whole and who doesn't?''

In 1996, Rep. Dennis McKinney, a Greensburg Democrat and privatization advocate, offered an amendment on the floor of the House that would have produced the pilot instead of one-shot, statewide privatization of foster care.

``It was voted down resoundingly,'' McKinney recalled, mostly on a straight party-line vote. Most fellow Democrats supported his amendment. Most of his Republican colleagues did not.

McKinney said most House members followed the lead of Rep. Melvin Neufeld, the Ingalls Republican who is chairman of the SRS Appropriations Subcommittee. Neufeld spoke against the McKinney amendment.

``He said it wouldn't work on a pilot basis,'' McKinney said. ``He said we needed to try it over a larger area.''

SRS officials say the new system is working well given its relative newness, and is getting better all the time.

``This is a crawl, walk, run process,'' said Garlinger.

Rough spots on the road to change should be expected.

``It's not a lot of consolation for the children to be a rough spot in the road,'' said Shepherd, the angry Douglas County judge. ``Nor is it much consolation for their families. I'll concede that in five or 10 or 15 years this system might be working, if they'll put in more money, and a lot more trained personnel, and break up the monopoly in terms of service providers so that we're using a variety of therapists and other professionals.

``But how many kids and families are going to pay the price while we work through this?''

-- Mike Shields' phone message number is 832-7144. His e-mail address is shields@ljworld.com.

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