‘We didn’t get it right.’ How California law to help foster kids created a bottleneck in care

If all goes according to plan, Alyssum Maguire makes it home for dinner with her husband and 11-year-old daughter twice a month. Once every few months, she might fit in a hike to clear her head.

The rest of her days and nights are spent at Progress Ranch in Davis, home for a dozen boys ages 6 to 13 with serious mental and behavioral health issues, often the result of childhood trauma. Many are from the foster care system, where they endured multiple placements with relatives, foster families and psychiatric hospitals.

A staff of nearly 50 provides round-the-clock care at the non-profit agency, which is funded by the state and community donors. Maguire, 45, speaks to visitors about the work with passion and intensity. When she talks to the boys, however, a gentleness shines through.

“Did you hear what she said?” Maguire asks one youngster after his counselor told him not to eat blueberries on the living room couch. It’s a chilly Saturday morning in December, and the boys are listening to holiday music and decorating their Christmas tree. Instead of towering above the young man, she sits next to him on the sofa, tucking strands of her long brown hair behind her ear.

“Why don’t you take that into the kitchen?” she suggests.

Maguire and Progress Ranch are also part of a 58,000-youth foster care system in California stressed by the unintended consequences of a well-intentioned law.

The Continuum of Care Reform (CCR) passed in 2015, phased out most group homes in favor of family placements as the best way to keep more kids in school and out of jail.

Group living was reserved only for those with the highest behavioral needs. Homes like Progress Ranch were encouraged to convert into “short-term residential therapeutic programs,” or STRTPs. They offer more intensive mental health treatment, with the goal of eventually placing children with their birth families, relatives or foster families.

Since California started implementing the reforms five years ago, the number of foster kids living in congregate care settings dropped significantly.

But as group homes have shut down, the state has been unable to recruit enough foster families to meet the surge of children needing placement. Additionally, many agencies couldn’t do what Progress Ranch did, shifting from a traditional group setting to a STRTP given the steep costs of rigorous mental health programming.

Since 2017, California has lost about 4,000 beds in group homes that couldn’t make the transition to STRTP.

Youth welfare advocates, such as the California Alliance of Family and Child Services, say the state badly underestimated the costs of operating facilities for children with the highest behavioral and mental health needs. Many who helped craft the policy agree.

“We didn’t get it right,” said Diana Boyer, director of policy for child welfare and older adult services at the County Welfare Directors Association. “We essentially concentrated the highest acuity kids into a one-size-fits-all model that wasn’t adequately funded.”

The state’s Department of Social Services said the level of financial support for STRTPs, set in 2017, is under review. But spokesman Scott Murray said CCR has been a success.

“CCR...was founded upon the collective belief among stakeholders involved in California’s child welfare system that all children served by the foster care system need, deserve, and have an ability to be part of a loving family, and not to grow up in a congregate setting,” Murray said in an email.

“CCR has directly resulted in more children being placed with their own relatives or in other home-based settings.”

Roadblocks and debt

The bed shortage has led to some extreme circumstances. In October 2021, The Fresno Bee reported that Fresno County foster youth were sleeping on conference tables or the floor of the Child Protective Services’ office.

“We had eight kids on our waiting list last month for one available spot,” Maguire said. “The need is great.”

She hopes one day Progress Ranch can expand to help meet the need for STRTP beds. But there are roadblocks.

To add more beds, Progress would have to acquire another house. But before it can buy more property, the organization must figure out how to cover $200,000 in outstanding COVID costs (the state already reimbursed nearly $112,000).

Even if it could afford expansion, a half-century-old law limits how many beds Progress can add. The federal Medicare and Medicaid Act of 1965 says that any residential mental health facility with more than 16 beds qualifies as an “institution of mental disease” (IMD). Such places would lose Medicaid dollars.

The exclusion was intended to end large-scale institutionalization of the mentally ill and to shift the cost of psychiatric care from the federal government to the states.

Congress considered bipartisan legislation in 2021 to exempt foster care facilities from IMD designation. Neither the House nor Senate versions came up for a vote.. A letter in support of the exemption was signed by the California Alliance and 615 other child and family welfare organizations across the country,

“Ultimately, without the exemption...thousands of children in foster care who are vulnerable will be pushed into more restrictive placements, non-therapeutic shelters, unlicensed or unstable settings, or they will bounce from placement to placement without addressing their true needs,” the letter said.

Progress Ranch only serves 12 boys at a time, so it isn’t in danger of losing funding immediately. But the non-profit is struggling to make ends meet. The only path toward sustainable funding, and meeting the need for STRTP beds, is to expand.

Meanwhile, high needs kids are left waiting in shelters and hospitals because STRTPs don’t have enough room for them, and other placement options wouldn’t be safe for them.

“STRTPs are really, really necessary,” Maguire said. “Of course, nobody wants a 7-year-old in residential treatment. But also, nobody wants a 7-year-old sleeping in a hallway, or a social workers office, or in a psychiatric hospital,” she added.

“The alternatives for our kids aren’t good.”

Sowing seeds for a career in mental health

Maguire grew up in Three Rivers, a small Tulare County town near the entrance to Sequoia National Park. People there rarely spoke about mental health or sought professionals help.

At 17, she was devastated when her younger brother was hit and killed by a car. She took that trauma with her the following year when she moved eight hours away to Feather River College in Quincy. It was her first time away from home. The separation and loss of her brother left her with insomnia and frightening flashbacks. Only years later did she realize she was suffering from untreated depression.

“That was a hard time, and I didn’t really seek support,” Maguire said. “It just wasn’t how I was raised,” she continued. “You stayed out of systems.”

Maguire dreamed of becoming an elementary school teacher. After graduating from Feather River with an associate degree in outdoor recreation leadership, she moved on to Chico State University for her bachelor’s in liberal studies.

Scholarships only covered part of her costs, and her family couldn’t afford to help pay for her degree. While hunting for jobs, she saw an ad for child care worker at a local group home.

“They hired me, thank god, and that just changed my life,” she said.

In college, Maguire didn’t understand the complexities of mental health or how to seek treatment. Her first job in Chico opened her eyes to what trauma could do.

“All of a sudden, it was like, ‘Oh my gosh, I was having a mental health issue,’” she said. “I could’ve gotten help for that.”

That realization launched Maguire on a career in mental health and youth advocacy. Fast forward 25 years – through a master’s degree, a series of jobs and rounds of burnout – she wants to pay forward to the Progress Ranch staff all the mentorship and support she received.

“My whole team – we all live and breathe it,” Maguire said of working in mental healthcare. “On some level it feels like a lifestyle choice and it’s all about teaming up and supporting our kiddos.”

Nurturing the Progress Ranch family

Progress Ranch isn’t a ranch at all. It’s two ordinary-looking houses on Davis’ northeast side, with little to indicate that they are each home to six kids with serious behavioral needs.

Maguire and her staff work every day to make the setting feel as loving and homelike as possible. Each house has two to three youth counselors onsite at all times.

“We’re sort of like therapeutic parents,” said Gonzalo Arriaga, a supervisor for one of the houses.

The boys sleep two to a bedroom, but still find ways to make the space their own. Each gets a shag rug to delineate “his space.” Chosen stuffed animals sit on their beds atop personalized quilts made by a local church group. And the kids get to select two pictures for decoration — one chose photos of astronauts for his wall.

As much as Progress works to create a home-like setting, it is still a mental health facility. The photos are bolted to the wall and covered with Plexiglas so they can’t be used as weapons. Curtains are hung with break-away rods so a child can’t use them to hang himself. Dining room chairs are a harder-to-break commercial grade furniture. Mandatory notices from various Yolo County departments hang on the wall in three languages.

The days begin around 6:30 a.m., and getting the boys up can be a challenge. Some have night terrors that keep them awake and leave them groggy come morning.

Staff drive them to schools in Davis, Sacramento and other districts. Many attend special non-public schools that provide additional behavioral support, Maguire said.

After school there is therapy, presented as games but designed to strengthen the social skills they will need to live with a family. Some struggle, for example, with physical aggression when they get frustrated. The boys work on responding calmly and safely with words rather than acting out.

They hosted a mock debate last month between Arriaga and fellow house supervisor Shemariah Lewis, who were running to be Progress Ranch’s “governor.” The boys took turns asking questions like whether they’d grant unlimited game time or let them eat ice cream for dinner. (Lewis eventually won the election.) Underneath the fun, the exercise helped the boys practice arguing and debating in a respectful way.

But sometimes the trauma can take over, with boys lashing out at counselors, the walls the furniture, and each other.

On that same cloudy December Saturday, the young man who was eating berries on the couch (by law the names of the boys are confidential) had another difficult moment. While learning to play the card game “Uno” with one of his counselors and a housemate, he tossed his cards away and stormed down the hall toward his room.

The first priority, Arriaga said, is to help the child calm their body and keep them from harming themselves or others. Then, they practice deep breaths, relaxing and expressing their needs with kind words.

“It’s not a babysitting job,” Arriaga said. “It comes with a lot of intensive behaviors.”

Some boys take medication as part of their treatment plan, but Progress Ranch tries to identify the underlying issues and find non-pharmaceutical approaches first. Those who are over-medicated are weaned off the harsher and more potent drugs like anti-psychotics and lithium.

Getting the boys out and involved in the community is also an important part of helping them feel like they’re living as close to a normal lifestyle as possible. Some of them are enrolled in activities like gymnastics, little league baseball, football and Boy Scouts.

“We try to give them a normal lifestyle,” Arriaga said.

During the week, Maguire spends most of her days handling administrative duties and logistics. Her best time to meet with the boys and get to know them is over the weekend — time she might otherwise spend with her own family.

“It’s so hard, honestly,” she said.. “But every minute of this work is worth it.”

Financial and bureaucratic barriers

The child desperately needed a root canal.

Nurse Alison Oliver remembers calling over 30 dentists, trying to find one who was reasonably close, trained in treating a child with trauma issues and who took Medi-Cal insurance. It was impossible to find anyone who checked all three boxes.

Ultimately, Progress Ranch paid out of pocket for the procedure.

“I spent hours – weeks – on just that one procedure for one of 12 children,” Oliver said. “It was just so frustrating.”

California reimburses STRTPs like Progress Ranch about $510 per day ($15,281 a month) for each foster child in their care. The money has to cover round-the-clock supervision by experienced counselors (pay starts at $20 an hour), mortgages on two houses, transportation, utilities, food and medical and mental health treatment.

“We’ve gotten really good at stretching dollars,” Maguire said.

She and a team of three shoulder the brunt of administrative duties so that most of their budget can go towards paying counselors and providing activities for the kids. They also rely heavily on donations from community organizations to pay for much-needed updates on the house, in addition to any unexpected expenses.

COVID hit Progress Ranch hard. Extra staff was brought on to support remote learning and care for kids in quarantine. An extra house was rented for isolation. High staff turnover meant hundreds of hours in overtime payments.

The agency racked up nearly $336,000 in expenses during the first 18 months of the pandemic. While the state reimbursed about a third of that, Progress is still struggling to find the extra $200,000.

Life after Progress

Maguire and her staff’s goal is to prepare their boys for life with a family — birth, extended, adoptive or foster. Last year, about 75% of the Progress boys graduated into family settings. The other 25% aged out of the program after turning 14 and transferred to a different STRTP. No one was discharged to a psychiatric hospital or law enforcement, Maguire emphasized.

Sometimes though, even if a child is ready to graduate from the program and take their new skills into the world, there isn’t always a place for them to go.

“There may not be a family out there that their social worker can find for them,” Maguire said, “which is really heartbreaking.”

Some end up living over a year at Progress Ranch. Extended stays can lead to regression into old, unhealthy patterns that they worked so hard to overcome.

In situations like this, Progress Ranch often steps in to try and find a home for the child, either in the Davis community or with relatives. They don’t get paid for this work, nor can they provide extensive support as the child transitions back to a family setting. California dedicated $150 million in last year’s budget to increase “family finding” efforts like these, but Progress Ranch likely won’t see any of that money.

“Our kids are so deserving,” Maguire said. “They’re just as deserving of love, support and a chance as any other child.”

This story was originally published January 16, 2023 at 6:00 AM.