How local foster care advocates are changing hospital stay protocol

CATHY WURZER: We've been talking about a story that first ran in the Star Tribune about a 10-year-old boy who has spent seven months in the emergency room at Ridgeview hospital in Waconia. He has special needs and can be violent. So officials say placing him in a permanent home is challenging.

Now, emergency rooms are required to care for everyone, so these kids are being dumped in emergency rooms in large and small hospitals in Minnesota and across the country. We're turning now to an advocate for children in the foster care system who says this is increasingly common. Hoang Murphy is the Founder and Executive Director of Foster Advocates, an advocacy organization working to improve foster care in Minnesota. Welcome to the program. Hoang Murphy, are you with us?

HOANG MURPHY: I certainly hope so.

CATHY WURZER: Yeah. So do I. Thank you so much. I appreciate your patience with us. Thank you so much.

There's a lot to talk about here, obviously. I know you work closely with youth in foster care. Have you ever worked with someone in a similar situation to this young man we've been talking about?

HOANG MURPHY: Kind of. I don't think there's any easy way to speak about this issue, but I've spoken with a lot of folks, including [INAUDIBLE] items and other folks in this space who have direct experience working on cases just like this. But I do have a personal experience in which my brother, when we were in care, is someone that had to be in a placement setting like this. And there weren't available homes for him to be in-- so both from the side of a kid who was watching this happen to a sibling, and from a systems level.

CATHY WURZER: The system for kids with severe behavioral issues sounds broken. The U of M professor we talked to indicated that there are multiple systems designed to help kids, but it sounds like everyone is doing their own thing and coordination is lacking. What's your read on that?

HOANG MURPHY: My read is that this is not a new issue. I'm glad that it's being covered now and that this young person is getting the attention that the story needs. But this is something that has been ongoing, and, like with so many things related to the pandemic, it's deepened because of COVID.

But these are existing systems failures. There's just a general mental health crisis and lacking support for young people in care. And there's just not enough targeted services, especially for those in foster care.

CATHY WURZER: When kids with high needs are in the foster system, are there safety nets for them? Are they treated the same as other kids?

HOANG MURPHY: No, certainly not. I think that's one of the challenges that we've run into is that when a family is maybe not doing right by a young person or a kid, if that's what the county and the state is there for, then they step in. But when the county and state are not doing right by someone who's in foster care, where are these kids supposed to go? And we're seeing the direct result of that-- the accountability doesn't really stop with anybody.

CATHY WURZER: There aren't the state-run institutions of the past, and residential treatment centers in Minnesota have really long waiting lists. There are worker shortages. So I don't know-- where's the help for these kids? Do you need more foster parents, more foster homes?

HOANG MURPHY: Yeah. I think there's a lot of ways that this can be addressed. But the most significant one is that we can't just address it for just a single case. When this comes up, it's because of systems failures and funding challenges that existed months and years before this point.

We experience urgency in these concept moments when cases like this come up. But the real way to address this is that, yeah, you're right, there is a high need for there to be placement settings that can support fosters. We don't know at any given time how many foster homes are even available.

Across the state, we don't know which ones are capable or ready and willing to take on a young person who is coming with significant needs. And so often, the default, then, is that there is a dumping ground where if you can't find a home for a young person or you haven't put in the proper efforts to support family members who would like to care for this young person, then the only options are a hospital, which has to take them, or a juvenile detention center.

CATHY WURZER: You mentioned funding challenges. You've mentioned this a couple of times now. Folks living with disabilities receive state and county money that's used for their living expenses, say, if they're in a group home. Is there a similar situation if a child is in the foster care system?

HOANG MURPHY: Yeah. So there's a benefit that young people get that are in foster care, that if you have a disability, you're supposed to get social security dollars towards this, including disability Payments and as a state, frankly, with 87 counties, we take this money and we do not use it for the direct benefit of the child. It's actually spread across the county in some cases. In other cases, it's just for that department.

But where it comes into present challenge for this individual young person is that this fund could be used for the direct benefit of their care under the direction of someone who is supposed to be looking out for their best interests. But that's one challenge around funding for this young person in particular, but then there's also the larger funding challenge of that we, frankly, just don't want to pay for the care of someone else's kid.

And so we provide the bare minimum. And that's what we're looking at is that we have not supported systems and structures that allow for folks to have care facilities that are set up well to support children. We know that we don't want young people in residential treatment whenever we can avoid it, and we don't want them in congregate care settings whenever we can avoid it. But there are not a lot of dollars to support folks who have the specialized skill and have a home that is equipped to support this or to support family members who would otherwise step up to do this, but can't afford to care for a young person with this many needs.

CATHY WURZER: In order to change this, does this need to go through the state legislature and get several laws tweaked and changed?

HOANG MURPHY: I think it's a little bit of both. Counties in Minnesota are the ones that have direct responsibility here. So counties could choose to increase funding for this area if they so wished. All of them could choose to stop taking this money from young people.

It's not just young people with disabilities, it's also young people who've had a parent die and that's the reason why they enter foster care. The counties don't have to take that money, but they currently do. So the counties could just stop that practice, and then they could also then increase their funding for foster care.

But really, I think this is a systems-wide issue for the state. And we have a surplus of $9 billion. We can't afford to continue to do nothing for the children that are directly under our care.

This might make sense if we were a low income family that was really struggling and needed to just place a young person in hospital, because we had no other choice-- but we're a state with $9 billion. We can certainly afford to support centers, and homes, and families to better care for the young people that we separated and said that we were going to care for them better than if we had left them. I don't think a young person being stuck in a hospital for this amount of time not going to school is being cared for better.

CATHY WURZER: As you know, we're talking about kids and there's privacy concerns-- and a lot of privacy is involved in the foster system. Because the Star Tribune story has caused a lot of outrage, people just didn't know this was happening-- do you think it makes issues like this less visible because of the privacy concerns?

HOANG MURPHY: Yeah. That's a really important question, Cathy. Because as someone who advocates in the system, one of those challenges that I've seen is that whenever we want data that might require the counties or the state to move in a positive direction, in a direction that usually costs extra money or effort on their part, then they don't have the data, or it's private.

But whenever, at least in my experience as someone who was in foster care, everyone knew that I was in foster care. Everyone at that hospital knows that this young person is in foster care, knows their name. Everyone in school knows this.

And so I do think that there needs to be some reform around that issue. But we can't let the lack of data to the public stop us from doing the things that we have to do at the county and state level and systems level. These are one of the areas that you can't just hide us in a hospital or foster home, and pretend that we don't exist, and then say that we can't share data about this person. That's not acceptable to me either.

CATHY WURZER: Wow. This is such a complicated issue. I think we should do more on this, and I do appreciate your voice on this. Thank you so very much for taking the time to talk with us.

HOANG MURPHY: Absolutely.

CATHY WURZER: Hoang Murphy's been with us, the Founder and Executive Director of Foster Advocates. That's an advocacy organization working to improve foster care in Minnesota.