Foster care children are stuck in hospitals across the state: Do we have a solution?
Traci LaLiberte is the executive director for the Center for Advanced Studies in Child Welfare at the University of Minnesota and is working to both identify the root cause of this problem while trying to find an urgently needed solution
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A Star Tribune article told the story of a 10-year-old boy with severe autism and aggression who has been living for seven months in an emergency room in Waconia.
MPR News host Cathy Wurzer talked with Traci LaLiberte, executive director for the Center for Advanced Studies in Child Welfare at the University of Minnesota, for a more in-depth look at this growing problem in Minnesota.
Use the audio player above to listen to the full conversation. Subscribe to the Minnesota Now podcast on Apple Podcasts, Google Podcasts, Spotify or wherever you get your podcasts.
We attempt to make transcripts for Minnesota Now available the next business day after a broadcast. They will appear here when ready.
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Audio transcript
CATHY WURZER: This next conversation may well get your attention. There is a 10-year-old boy who is severely autistic and often aggressive who's been living in the Ridgeview Medical Center's emergency room in Waconia for the past seven months. His plight was outlined in a recent story in the Star Tribune.
The boy, who is in the child welfare system, is stuck at Ridgeview Medical Center because there's nowhere for him to go. The story shines a light on what reporter Jeremy Olson wrote is a growing problem in Minnesota for large and even small hospitals-- the boarding of children with uncontrolled behavioral and developmental problems.
We wanted to know why this is happening, so we've called LaLiberte. Dr. LaLiberte is an internationally recognized scholar in the fields of child welfare and disabilities. She's the Executive Director for the Center for Advanced Studies in Child Welfare at the University of Minnesota. Doctor, welcome.
TRACY LALIBERTE: Thanks for having me.
CATHY WURZER: I am positive there are a lot of people who are shocked to hear this boy's been living in a hospital ER for months. M Health Fairview Masonic Children's Hospital evidently was so overrun with special needs kids last spring, it converted an ambulance bay into a shelter for them. This is happening across the country. Why are these kids without a permanent place to stay?
TRACY LALIBERTE: Well, it's a complex issue, really, that stems from the intersection of multiple services. So you have kids who are being served by a developmental disability service system, and you add in a child welfare or child protection service system, and you often also have the mental health service system.
And those systems don't always intersect well. And when a child enters from one of those systems, the other systems don't necessarily have the capacity or the pathways to step up and provide the service, even though the service might actually be better positioned in a different system. So an example of that-- if the child enters through child protection but they've got multiple disabilities or severe behavior issues, those might be better served through a mental health service provider or a disability service provider.
Child welfare uses its own track system, and it's really hard to sometimes access services across service systems-- not impossible. But that's an area that really needs some additional attention is the intersection-- because kids and families don't live in one part of their life. They live across their life.
CATHY WURZER: Why are these kids ending up being dumped at ERs?
TRACY LALIBERTE: Well, often, what happens is something has escalated, whether it's within the kid's own family, or if they're in a foster home, or, perhaps, a group home. And things escalate to the point that for issues of safety, they might call in the police or they might just immediately go to the emergency room.
If the emergency room does not have a place to discharge that child with a safe plan, then they are not allowed to discharge that child. So if a service provider, a residential treatment center, for instance, is not available, literally, there are none, then the emergency room cannot discharge that child and they must hold the child, which is what I believe is the situation in Waconia.
CATHY WURZER: There are more child psychiatric beds coming online soon, but I'm guessing there needs to be more specialized care for special needs kids. And that's scarce?
TRACY LALIBERTE: That is scarce. We are in a situation where residential providers-- so these are not always acute situations. Some kids need a longer term plan with heightened level of care. And that really directs us to a residential.
And at this point, residentials are actually on the decline, the existence. We've been closing residential providers while the demand has increased and we have workforce issues. So those three things happening together is kind of a perfect storm, so to speak, in terms of really entrenching us in this problem.
CATHY WURZER: I'm wondering-- I bet there are people listening thinking, wait a minute-- where are the parents in this equation? But we're talking about families who are in crisis?
TRACY LALIBERTE: Families are in crisis. Often, they've exhausted all the resources available to them. They may have been referred to child protection for issues of abuse or neglect and they need help. Or they may have sought out that help and there was no help available. They literally knocked on every door.
They've spent years trying to get help, and they're often directed to child welfare or child protection then to receive help for placement. Well, those placements, as we've just talked about, aren't always readily available. And parents are put in a horrific position where they can be, then, alleged or substantiated to be neglectful of their child if they, quote unquote, "abandon them." So Sue Abderholden of Nami, Minnesota is working on legislation to prevent that so that parents are not penalized for seeking help for real high need kids.
CATHY WURZER: Say, before you go, is there a different model of treatment or placement that should be looked at? What are other countries doing?
TRACY LALIBERTE: Well, other countries do very similar things to what we do in terms of a combination of residential providers, group home living, and living in the community, often with substitute care providers-- so foster care providers, for instance.
The level of support and the level of training, both of which are an issue for us in Minnesota and across the country, I believe, are handled differently in other countries. Other countries are able to provide that support in a different way and make sure their workforce is adequately prepared, which ours, unfortunately, has not been historically.
CATHY WURZER: Dr. LaLiberte. I appreciate your time. Thank you so very much.
TRACY LALIBERTE: Thank you.
CATHY WURZER: We've been talking to Tracy LaLiberte. She's with the University of Minnesota's Center for Advanced Studies in Child Welfare. And coming up after the break, I'm going to talk with an advocate for children in the foster care system. That's right after the news.
The boy, who is in the child welfare system, is stuck at Ridgeview Medical Center because there's nowhere for him to go. The story shines a light on what reporter Jeremy Olson wrote is a growing problem in Minnesota for large and even small hospitals-- the boarding of children with uncontrolled behavioral and developmental problems.
We wanted to know why this is happening, so we've called LaLiberte. Dr. LaLiberte is an internationally recognized scholar in the fields of child welfare and disabilities. She's the Executive Director for the Center for Advanced Studies in Child Welfare at the University of Minnesota. Doctor, welcome.
TRACY LALIBERTE: Thanks for having me.
CATHY WURZER: I am positive there are a lot of people who are shocked to hear this boy's been living in a hospital ER for months. M Health Fairview Masonic Children's Hospital evidently was so overrun with special needs kids last spring, it converted an ambulance bay into a shelter for them. This is happening across the country. Why are these kids without a permanent place to stay?
TRACY LALIBERTE: Well, it's a complex issue, really, that stems from the intersection of multiple services. So you have kids who are being served by a developmental disability service system, and you add in a child welfare or child protection service system, and you often also have the mental health service system.
And those systems don't always intersect well. And when a child enters from one of those systems, the other systems don't necessarily have the capacity or the pathways to step up and provide the service, even though the service might actually be better positioned in a different system. So an example of that-- if the child enters through child protection but they've got multiple disabilities or severe behavior issues, those might be better served through a mental health service provider or a disability service provider.
Child welfare uses its own track system, and it's really hard to sometimes access services across service systems-- not impossible. But that's an area that really needs some additional attention is the intersection-- because kids and families don't live in one part of their life. They live across their life.
CATHY WURZER: Why are these kids ending up being dumped at ERs?
TRACY LALIBERTE: Well, often, what happens is something has escalated, whether it's within the kid's own family, or if they're in a foster home, or, perhaps, a group home. And things escalate to the point that for issues of safety, they might call in the police or they might just immediately go to the emergency room.
If the emergency room does not have a place to discharge that child with a safe plan, then they are not allowed to discharge that child. So if a service provider, a residential treatment center, for instance, is not available, literally, there are none, then the emergency room cannot discharge that child and they must hold the child, which is what I believe is the situation in Waconia.
CATHY WURZER: There are more child psychiatric beds coming online soon, but I'm guessing there needs to be more specialized care for special needs kids. And that's scarce?
TRACY LALIBERTE: That is scarce. We are in a situation where residential providers-- so these are not always acute situations. Some kids need a longer term plan with heightened level of care. And that really directs us to a residential.
And at this point, residentials are actually on the decline, the existence. We've been closing residential providers while the demand has increased and we have workforce issues. So those three things happening together is kind of a perfect storm, so to speak, in terms of really entrenching us in this problem.
CATHY WURZER: I'm wondering-- I bet there are people listening thinking, wait a minute-- where are the parents in this equation? But we're talking about families who are in crisis?
TRACY LALIBERTE: Families are in crisis. Often, they've exhausted all the resources available to them. They may have been referred to child protection for issues of abuse or neglect and they need help. Or they may have sought out that help and there was no help available. They literally knocked on every door.
They've spent years trying to get help, and they're often directed to child welfare or child protection then to receive help for placement. Well, those placements, as we've just talked about, aren't always readily available. And parents are put in a horrific position where they can be, then, alleged or substantiated to be neglectful of their child if they, quote unquote, "abandon them." So Sue Abderholden of Nami, Minnesota is working on legislation to prevent that so that parents are not penalized for seeking help for real high need kids.
CATHY WURZER: Say, before you go, is there a different model of treatment or placement that should be looked at? What are other countries doing?
TRACY LALIBERTE: Well, other countries do very similar things to what we do in terms of a combination of residential providers, group home living, and living in the community, often with substitute care providers-- so foster care providers, for instance.
The level of support and the level of training, both of which are an issue for us in Minnesota and across the country, I believe, are handled differently in other countries. Other countries are able to provide that support in a different way and make sure their workforce is adequately prepared, which ours, unfortunately, has not been historically.
CATHY WURZER: Dr. LaLiberte. I appreciate your time. Thank you so very much.
TRACY LALIBERTE: Thank you.
CATHY WURZER: We've been talking to Tracy LaLiberte. She's with the University of Minnesota's Center for Advanced Studies in Child Welfare. And coming up after the break, I'm going to talk with an advocate for children in the foster care system. That's right after the news.
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