CHARLESTON — Faced with a 46% increase in the number of children in the state’s custody since 2014 as a result of the opioid epidemic, and now a lawsuit, the West Virginia Department of Health and Human Resources is working to implement new strategies to address the child welfare crisis.

Some of those strategies include a move to a managed care organization contracted to organize health care for foster youth, implementation of new federal policy aimed at preventing children from being taken from their families in the first place and attempting to curb the amount of turnover/openings within Child Protective Services.

The strategies were among those listed by DHHR Secretary Bill Crouch in a statement to The Herald-Dispatch following this past week’s filing of a federal class-action lawsuit against the state and his DHHR. The lawsuit names 12 children as plaintiffs and alleges the state has violated the constitutional rights of all the some 6,800 children in state custody by failing to provide the necessary services to protect them from further neglect.

In his statement, Crouch said the lawsuit will cost the state millions to defend, but they will defend it. He said one of the organizations behind the suit, A Better Childhood — a child welfare advocacy and legal organization — never reached out to DHHR to ask about the efforts the state was making to address the issue they admit they have.

In a statement from a spokesperson from A Better Childhood, the organization said since 2016 its co-counsel, West Virginia Disability Rights, had met with Crouch more than 10 times but didn’t include the team as stakeholders during recent discussion on recent reform.

“Plaintiffs’ counsel from West Virginia have an ongoing relationship with defendants and are aware what they have done — and have not done,” said Marcia Lowry, executive director of A Better Childhood, in a release.

The statement went on to say the team concluded the lawsuit was necessary to force reform, but Lowry said Tuesday her organization would be willing to sit down to discuss what can be done to avoid the litigation.

Other child welfare advocates in West Virginia have expressed concerns with the state’s efforts, as well. During the past legislative session, many advocates and foster parents expressed concern about the switch to a managed care organization, fearing it would actually make it harder to get the services they need for their children, citing bad outcomes in other states.

But the state is still moving forward, with many new initiatives gearing up at once.

The frontline

Even in moderate circumstances, working as a social worker for Child Protective Services is a tough job. But when that system is overwhelmed, the job becomes even harder and it becomes harder to find people to do the job.

At the end of August, there were 6,796 children in the state’s custody. More than 83% of the open child abuse/neglect cases involve drugs, according to DHHR, with a 22% increase in accepted abuse/neglect referrals and open CPS cases over three years. Since 2005, adoptions in West Virginia have increased 113%. The number of children in state custody that run away is also increasing.

At the same time, CPS operates on average with a 23% vacancy rate, said Kent Nowviskie, assistant to the deputy secretary for DHHR, during the September interim meeting of the Joint Health Committee. At the end of August, according to a spokesperson with DHHR, CPS had 96 vacant positions out of a total 489 positions statewide, or a 20% vacancy rate.

“It could be worse,” Nowviskie said. “I’ve seen it up to 28%. It’s a scary situation.”

To help retain CPS workers, DHHR is implementing new initiatives to recruit and retain qualified child welfare workers.

There is now a 5% bonus for two- and five-year retention for CPS workers, and in July of this year and last, CPS workers received an over $2,000 raise each year as part of the state employee salary increases.

There is also a $1,500 one-time recruitment bonus for CPS workers in “crisis counties,” which are counties that have vacancy rates and caseloads that are “spiraling out of control,” Nowviskie said. Crisis counties are currently Barbour, Berkeley, Boone, Braxton, Cabell, Clay, Fayette, Jefferson, Kanawha, Marion, Monongalia, Morgan, Preston, Raleigh and Taylor counties.

They also hope to recruit new workers with the Title IV-E Education and Training grant. Graduates from schools of social work in West Virginia, including Marshall University’s, who agree to work for DHHR can receive a full tuition waiver and a stipend. They must work for DHHR as long as they received the stipend.

Job classifications have been restructured to create an improved career ladder and add increased support staff. DHHR also plans to request more funding from the Legislature for increased staffing.

DHHR is also working to reduce caseloads and eliminate the case backlog, Nowviskie reported. They have increased crisis support team staff to help handle caseloads in crisis counties and have streamlined the new worker training to reduce delays before new workers receive a caseload.

A spokesperson for DHHR said as of Aug. 31, the statewide “allocated” caseload — meaning if all positions were filled — was 15 cases per worker and a functional caseload was 21 cases per worker. Functional caseload is the number of cases per available worker. It subtracts vacant positions, staff in training and staff on extended leave who are not available to work.

DHHR also wants to provide more help for the workers themselves, working to develop a formal mentoring program for CPS staff. Nowviskie said experienced staff provide guidance and help with career development. The goal is to enhance engagement, reduce turnover and improve knowledge transfer.

DHHR is also partnering with Casey Family Programs, the nation’s largest foundation working to reduce the need for foster care, to put a “reflective supervision” program into practice for CPS supervisors and their staff.

Nowviskie said the reflective supervision program will involve regularly scheduled, structured coaching sessions between an employee and their supervisor focusing on experiences, thoughts, feelings and values connected with the job. Nowviskie said these meetings are not to focus on compliance, but rather be supportive and positive sessions designed to guide and support the employee.

Supervisors will be trained to deal with topics like work/life balance and secondary trauma.

Contracting help

While the state works to keep its own system afloat, help is needed now. DHHR already contracts with an administrative services organization to help clear backlogs in “crisis counties,” but will soon add a second contracted organization to manage the health care needs of the foster youth.

DHHR released the bid for its managed care contract in August and the awardee should be announced this week. The 3 1/2-year contract would be about $200 million per year.

DHHR decided to move forward with managed care a few years ago, and got the final approval from the Legislature this past session.

The transition to a single managed care organization (MCO) will take place by Jan. 1, 2020. The MCO must offer a seamless approach to servicing clients’ needs; deliver needed supports and services in the most integrated, appropriate and cost-effective way possible; offer a continuum of acute care services, which includes an array of home- and community-based options; and include a comprehensive quality approach across the entire continuum of care services.

The MCO must also organize an advisory group of foster, adoptive and kinship parents to discuss issues with the MCO and find solutions. This advisory group must meet quarterly in the first year and deliver a report to the Legislature.

The legislative bill also required DHHR to hire an ombudsman to advocate the rights of foster parents and investigate grievances against the MCO.

The bill also required the MCO to have 80% of its employees working in West Virginia.

Throughout the legislative session, advocates and foster families expressed concern about the use of an MCO, citing bad outcomes in other states.

Marissa Sanders, organizer of the West Virginia Foster, Adoptive & Kinship Parents Network, said DHHR did make some changes based on comments families submitted, but they still have concerns the transition is happening too quickly.

“The biggest concern I am hearing is that children in foster care, and foster parents, will get lost in the new system, and that people who are not familiar with the children will be making decisions about their health,” Sanders said. “Another big concern is the speed with which we are rolling it out.”

Foster parents have been given no concrete information about how the system will work, Sanders said.

“Staff cannot be trained in the complex needs of foster and adoptive families in such a short amount of time,” she said. “There continue to be concerns about network adequacy and losing foster parents by further complicating the system.”

Federal changes

All of this is occurring simultaneously with a shift in policy at the federal level.

The Family First Prevention Services Act, passed in 2018, goes into effect this October. The act changes how child welfare is funded, allowing for more preventative services to help keep children in their homes, like providing substance use disorder treatment to parents.

It also shifts funding away from group home settings, only providing for a few specific populations of youth.

Five providers of children’s residential services will be converting 42 existing beds into Qualified Residential Treatment Programs, meaning they can serve children with serious emotional or behavioral disorders. These are children who cannot be maintained in their own homes or in a foster home. Between Cammack and Pressley Ridge, there are 12 QRTPs in Cabell County.

Recent guidance from the Centers for Medicare and Medicaid Services will have an impact on future decisions related to QRTP expansion, said Laura Barno, Family First implementation director for DHHR.

“Though the requirements have been implemented to begin Oct. 1, the philosophy and prevention services will grow over the next five years,” Barno said. “The philosophy of Family First is to provide services to prevent the child from being removed from their homes when possible. It will take time for all child welfare stakeholders to become comfortable with this philosophy.”

Barno said the system won’t look entirely different come October.

“The past year has been about building a stronger foundation for prevention,” she said. “The opportunities with the Act will need to be integrated into the fabric of our child welfare system. Family First won’t exist in a vacuum, but will be a key piece among other initiatives to help reduce out-of-home placements.”

Sanders said foster families have some concerns about Family First as well.

“Some of the information that has been shared has led foster families to fear that children will be left in unsafe situations without proper supervision, especially given the current CPS staffing shortages,” Sanders said.

However, if it works the way it’s supposed to, Family First will be a huge benefit to foster and adoptive families, Sanders said, especially if it increases the availability of high-quality services and service providers.

“Family First could reduce the number of children coming into care, which would reduce caseloads over time,” she said. “That would be helpful to foster families.”

Bills have been introduced in Congress to assist states in the transition to Family First. The Family First Transition and Support Act, introduced in the Senate by Ohio Sen. Sherrod Brown, would expand funding for kinship support services, invest in child welfare caseworker training and development, enhance the child welfare Court Improvement Program (CIP), and provide new resources to help states serve older kids and recruit and retain foster parents.

Both the Senate and the House versions of the bill have not left committees.

Follow reporter Taylor Stuck on Twitter and Facebook @TaylorStuckHD.

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