LINCOLN — The federal lawsuit called it “de facto homelessness.”
More than 42 times in five years, starting when she was 12, a Kansas girl identified as M.L. was bounced from foster home to group home and back again.
For weeks on end, she had to sleep in a new place every night and pack her things every morning. Sometimes, she was forced to stay overnight at a private child welfare agency’s office. Once she spent a full week there.
In one placement, she allegedly was sex trafficked. In another, she allegedly was physically assaulted by an employee of the private agency.
The agency in charge of M.L.’s case was St. Francis Ministries, the Salina, Kansas, nonprofit in line to take over managing Omaha-area child welfare cases next year.
Nebraska Department of Health and Human Services officials announced this month that they intend to award a five-year case management contract to St. Francis Ministries, formerly known as St. Francis Community Services. They hope to have the contract signed by July 1.
St. Francis, which is affiliated with the Episcopal Church, has subsidiaries in Nebraska and six other states, plus two Central American countries.
The contract would put St. Francis in charge of caring for abused and neglected children in Douglas and Sarpy Counties, about 40% of the state’s total. Omaha-based PromiseShip, which holds the current contract, has filed a protest of the state’s plan.
St. Francis’ history in Kansas, along with its proposal for the Nebraska contract, worry some Nebraska lawmakers and child advocates. In particular, they cite concerns about foster placement stability, case manager workloads and costs.
Sarah Helvey, staff attorney for the Nebraska Appleseed child welfare program, said she has big concerns in light of the multiple changes and disruptions in Nebraska’s child welfare system over the past decade.
“It’s important as we go into this that we don’t repeat the mistakes of the past,” she said.
Tom Blythe, chief operating officer for St. Francis, said he could not comment on specific cases or on the Nebraska contract proposal.
But he said the placement issues developed because the agencies were overwhelmed as the number of foster children increased more quickly than placements available.
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Placement stability. Kansas officials have contracted with St. Francis since 1996 to manage child welfare cases in the Wichita and western regions of the state. KVC Behavioral HealthCare, another private agency, handles cases in eastern Kansas.
The arrangement has had its share of controversy over the years. Two years ago, the Kansas Legislature created a special task force to examine the state’s troubled child welfare system.
The number of children being forced to stay in agency offices or moved from placement to placement, in a practice called “churning,” was a key focus of the task force. Testimony to the task force revealed that St. Francis had put 764 children into one-night placements between April and September last year. KVC had a similar number. Most were children with extreme needs.
Night-to-night placements were also central to a federal class-action lawsuit filed in November by Kansas Appleseed and other groups. The lawsuit cited statistics showing that foster children in Kansas were moved 7.1 times for every 1,000 days spent in foster care in 2017.
That’s well over the national goal of 4.12 moves per 1,000 days or Nebraska’s statewide rate of 2.56 moves per 1,000 days in January 2017.
The Kansas lawsuit alleged that in addition to causing trauma, multiple placement changes interfered with foster children getting needed mental health treatment and education.
Ten children were named as plaintiffs, including M.L. and two other girls whose cases were handled by St. Francis. The suit named the governor and other state officials as defendants, saying they were ultimately responsible for the child welfare system. Neither St. Francis nor KVC were named as defendants.
Blythe said the number of foster children in Kansas increased 45% since 2012, while the number of foster homes grew only 8% . At the same time, the number of psychiatric treatment facility beds for youths decreased. He also blamed legislative changes aimed at limiting the use of juvenile detention.
But he also said the number of children sleeping in agency offices has dropped significantly since April 2018, when 31 children stayed overnight in St. Francis offices. Three children stayed in the offices in April this year, followed by six children in May.
“We have a commitment to doing everything we can to make sure that doesn’t happen,” he said.
Caseloads. Another focus of the Kansas task force and of the federal lawsuit was the number of cases handled by case managers.
The lawsuit cited a 2016 state audit showing that caseloads frequently exceeded 30 cases during fiscal years 2014 through 2016, with indications of even higher numbers in the years following. The suit said that “excessive workloads” prevent caseworkers from doing essential tasks to protect children.
Blythe said caseloads increased because of the number of foster children and the limited pool of potential workers.
He said Kansas allows only licensed social workers to manage cases. Last year, St. Francis worked with the state to develop a policy allowing workers with related degrees to pick up some case responsibilities.
Still, Blythe said, caseloads for St. Francis workers remain around 30. He said the ideal would be to have case managers handle 20 to 25 cases. The agency’s proposal for a Nebraska contract was built around a target of 25 cases per case manager.
Caseloads have been a frequent concern in the Nebraska child welfare system as well. But a 2012 state law limits HHS workers to 12 to 17 cases. The law also applies to the private case management agency used in what the law defines as a pilot project in the Omaha area.
Helvey said she thinks that the law remains in effect and would apply to a new case management contractor in the Omaha area. She said the St. Francis proposal amounts to underbidding because it does not include enough workers to comply with state caseload limits.
HHS officials declined to comment on the concerns raised, citing the ongoing contract negotiations with St. Francis and a protest filed by PromiseShip. But spokesman Lee Rettig offered a statement saying that a final contract with St. Francis would have to comply with “all applicable state and federal laws.”
Costs. St. Francis won the Nebraska contract largely on the strength of its cost proposal. The agency offered to do the job over five years for $197 million, less than 60% of the bid from the current contractor, Omaha-based PromiseShip.
PromiseShip, a nonprofit formerly known as the Nebraska Families Collaborative, has contracted with the state for almost a decade to manage Omaha-area cases. It was formed by Boys Town and other private Omaha-area child welfare agencies. The current contract is worth up to $71.5 million annually. The agency proposed to continue doing the job for $341 million for five years.
State Sen. Sara Howard of Omaha, who chairs the Health and Human Services Committee, said she has concerns that St. Francis is bidding too low and could not fulfill the contract at the proposed rate.
St. Francis proposed to manage the first year of the contract for $18 million plus $1 million in startup costs. In the second year, its costs would jump to $41.4 million, with 5% increases planned for each succeeding year.
“That does not make sense to me,” Helvey said of the cost proposal. She noted that there were years in which Nebraska wound up having to pay PromiseShip more for services than had been planned in the initial contract.
Kansas went through a similar experience last fall with St. Francis.
The agency negotiated three additional payments from the state, along with a rate increase for the second half of the fiscal year ending June 30. A contract amendment signed in December said the additional money was needed to keep St. Francis from ending its contract with the state.
Blythe said the additional payments were required because of rising costs for out-of-home care. The new Kansas governor recognized those increased costs, once she took office in January, with the midyear rate increases.