HR0422 101ST GENERAL ASSEMBLY

HR0422 LRB101 12627 MST 61097 r

HOUSE RESOLUTION

WHEREAS, The Department of Children and Family Services is required by the Children and Family Services Act [20 ILCS 505/7] to place children in its care in safe and adequate placements consistent with each child's health, safety, and best interests; and

WHEREAS, The Department of Children and Family Services has adopted rules, entitled "Placement Selection Criteria", [89 Ill. Adm. Code Part 301.60] that provide that "all placement decisions will be made consistent with the safety, best interests and special needs of the child" and that consideration shall be given to, "the least restrictive setting appropriate for the child which most closely approximates a family"; and

WHEREAS, The Department of Children and Family Services has adopted procedures, entitled "Psychiatric Hospitalization, Basic Premises Regarding Psychiatric Hospitalization" [DCFS Procedures 301.110(b)], that provide that "a psychiatric hospitalization is not a placement" and that "discharge and placement planning shall begin from the moment of admission"; and

WHEREAS, The Department of Children and Family Services is the party to a federal court consent decree [B.H. et al., 88 C 5599, N.D. ILL] that provides that emergency shelter placements "shall be limited to 30 days"; and

WHEREAS, Children in the custody of the Department of Children and Family Services are being left in psychiatric hospitals after their treatment is complete because there is insufficient in-state capacity in the types of the programs the children need, including residential treatment centers and specialized and therapeutic foster homes; and

WHEREAS, The cost of leaving children in psychiatric hospitals is significantly higher than providing the care the children actually need and is not subject to federal reimbursement pursuant to Title IV-E; therefore, be it

RESOLVED, BY THE HOUSE OF REPRESENTATIVES OF THE ONE HUNDRED FIRST GENERAL ASSEMBLY OF THE STATE OF ILLINOIS, that the Auditor General is directed to conduct a performance audit of the Department of Children and Family Services to review and assess the Department's ability to meet the placement needs of the children in its custody and its compliance with its obligations to place children in its care in placements consistent with their best interests and to make recommendations regarding how the Department can develop a responsive behavioral health continuum of care process that produces good outcomes for children and families in Illinois; and be it further

RESOLVED, That the audit include, but not be limited to, the following:

(1) A review and analysis of systems issues impacting the timely and appropriate placement of children in the custody of the Department of Children and Family Services, including, but not limited to:

(a) The current referral and admission process for children and youth requiring placement in a residential treatment center;

(b) The role of residential treatment centers in the continuum of care;

(c) The evidence-based models currently utilized in residential treatment settings;

(d) Identification of any gaps in the continuum of care from psychiatric hospitalization to traditional foster care/home settings;

(e) The status of the Department's progress toward achieving appropriate and timely step-down placements for children at any stage in the continuum of care; and

(f) How priorities should be changed to ensure timely access to appropriate residential and foster care resources;

(2) A review and analysis of how youth enter and exit residential treatment programs, including, but not limited to, the following:

(a) The number of youth who entered a residential placement in the last 10 fiscal years;

(b) The number of youth who entered residential settings outside of Illinois;

(c) The number of planned and unplanned exits from residential treatment by type (for example, child was psychiatrically hospitalized, placed in a foster home, returned to parent, etc.);

(d) A description of the current step-down process from residential treatment;

(e) A description of how the Department determines appropriate clinical placements for youth needing residential care; and

(f) Recommendations regarding changes that should be made to the process of matching children to the appropriate clinical setting, including timeframes;

(3) A review and analysis of date tracking of outcomes for children in psychiatric hospitals longer than necessary, including, but not limited to:

(a) How demographic and clinical data regarding children in psychiatric hospitals longer than necessary is collected, made available, and utilized; and

(b) The current demographic of children in the residential care service continuum, including youth who are in psychiatric hospitals longer than necessary, on waiting lists for residential placements, and in residential placements ready for step-down, including:

1. Ethnicity

2. Gender

3. Age

4. Geographic origin

5. Permanency goal

6. Current residential placement if applicable

7. Case management responsibilities

8. Diagnosis

9. Length of stay

10. Length of stay beyond targeted discharge date;

(4) A review and analysis of the following contracting and monitoring issues impacting the timely and appropriate placement of children in the custody of the Department of Children and Family Services, including, but not limited to:

(a) An assessment of current residential bed capacity and utilization; what capacity and utilization are needed to meet the demand? Are there facilities with unused physical capacity that could be utilized if need was determined?;

(b) Analysis of the effectiveness of the current funding structure, including analysis of the no-decline and bed hold component in contracts;

(c) How residential specialty population providers are identified in the matching process;

(d) How community-based behavioral health resources are identified, quantified, and evaluated; and

(e) Whether community-based behavioral health organizations have adequate resources (funding, staff, equipment, facilities, training, etc.) to achieve appropriate service delivery and timely placements for youth;

(5) A review and analysis of the following contracting and monitoring issues impacting the timely and appropriate placement of children in the Department's custody, including, but not limited to:

(a) How residential programs are monitored. What dashboards are utilized? Are the outcome measures quantitative or qualitative? Are the measures effective? What outcome measures should be utilized?;

(b) The current performance of Illinois' residential continuum of care and how it compares to generally accepted national practice standards and outcome measures; and

(c) Residential continuum of care systems in other comparable jurisdictions in terms of costs of staff by type, overall costs and other cost centers; and be it further

RESOLVED, That the Department of Children and Family Services shall cooperate fully and promptly with the Auditor General's Office in conducting this audit; and be it further

RESOLVED, That the Auditor General commence this audit as soon as possible and distribute the report upon completion in accordance with Section 3-14 of the Illinois State Auditing Act; and be it further

RESOLVED, That a copy of this resolution be delivered to the Auditor General and the Illinois Department of Children and Family Services.