‘Someone’s going to sue’: RI parks at-risk children in hospitals amid workforce crisis

PROVIDENCE, R.I. (WPRI) – Hundreds of toddlers aren’t receiving early childhood intervention. Dozens of children and teenagers are currently parked in psychiatric and children’s hospitals. Rhode Island is getting fined $1,000 per day for the improper placement of children under state care.

These are just some of the symptoms of Rhode Island’s understaffed social service network, which advocates warn is in danger of collapsing because of an exodus of underpaid employees and an inability to hire new ones.

The situation has deteriorated so quickly in recent months that advocates and nonprofits which depend on taxpayer money to staff social-service programs, such as Early Intervention and group homes, are beginning to discuss lawsuits both behind the scenes and publicly.

“Someone’s going to sue DCYF,” said Jennifer Griffith, the state’s child advocate, who monitors the R.I. Department of Children, Youth and Families (DCYF). “It could be the ACLU. It could be me.”

“We are not serving the children the way we should by law or by moral code,” she added during a R.I. House Oversight Committee hearing on Nov. 17. 

Like other sectors of the economy, nonprofits are struggling to hire and retain workers, a problem advocates argue is exacerbated by their inability to pay higher wages due to limited state funding.

The state’s network of social-service providers is largely dependent on taxpayer money, which nonprofit leaders argue hasn’t increased sufficiently for more than a decade – even as living costs have soared.

John Kelly, president and CEO of Meeting Street, said the state should start valuing the professions accordingly.

“We talk about how important they are,” Kelly said. “We talk about how important early childhood is. And then we never put money there, and we keep wondering why people keep leaving these fields.”

Hundreds of toddlers waiting for services

The provider crisis is especially problematic for Early Intervention, a federal program designed to help toddlers from birth to three years old who have any type of developmental delay.

According to one estimate shared with lawmakers, Early Intervention providers are operating with 27% less staff compared with before the pandemic. And as of last week, all nine of the state’s Early Intervention providers have stopped accepting new families — a potentially dire situation considering an estimated 75 new infants and toddlers seek Early Intervention services each week.

“We have been unable to take on new children since the end of September,” said Kelly, whose organization is one of the state’s nine providers. They say receiving Early Intervention could mean the difference between a child speaking or not speaking when they grow up.

“Based on our referral rate, we know there’s 200 children and families that we haven’t been able to take on so far,” Kelly added during a Nov. 16 House Finance Committee hearing. “And I don’t know when we’re going to open our doors to new referrals.”

Because the state isn’t accepting any new referrals, Rhode Island has created an Early Intervention waiting list, but advocates argue that move is illegal under federal law. The nonprofits have told lawmakers the dynamic is the equivalent of putting a child on a waiting list to attend first grade at a public school.

Kelly said it’s difficult to know when the situation might change. He said he’s been unable to recruit new staff and it’s becoming increasingly difficult for him to retain his current staff at the wages available.

He said his biggest competition has become DCYF, since the General Assembly added dozens of new full-time positions that pay tens of thousands of dollars more than than what’s offered in the nonprofit sector, where wages have remained flat.

According to one estimate provided to lawmakers, reimbursement rates for Early Intervention providers haven’t increased since 2002. By comparison, advocates estimate the actual cost of operating the federal program has increased more than 50% during that time.

“The work is tough, and the pay is not what it should be,” Kelly told lawmakers.

Stuck at a psychiatric hospital for 400 to 500 days

Yet the shortage of Early Intervention services is only one of the problems affecting Rhode Island children in need of assistance.

A year ago, a Target 12 investigation revealed at least 20 people affiliated with DCYF had been stuck living without formal education for months at Bradley Hospital, an East Providence psychiatric and behavioral care facility where the typical stay is supposed to last six to nine days.

The investigation evoked outrage from lawmakers and spurred a host of policy changes that state officials promised would help rectify the issue. Earlier this month, Griffith said the number of children and teenagers currently stuck at Bradley “who don’t belong there” is closer to 30.

“There are 30 of them at Bradley Hospital, not leaving their room, not going to school, not going outside,” Griffith said, adding that some had been there nearly two years.

As of last week, about 10 more children were stuck living at Hasbro Children’s Hospital, she added. Target 12 has confirmed the improper placement of children at a hospital has resulted in DCYF getting fined $1,000 per day.

A DCYF spokesperson on Monday did not immediately respond to questions regarding the fines, but the penalties began in late October, suggesting the total so far could be about $30,000.

“We all experienced corona,” Griffith said. “We were stuck inside. What’d we do? Ninety days and it turned June. Not these kids – 400 to 500 days in the hospital. You can’t go visit someone there.”

Elsewhere in the state’s child welfare system, Griffith said there are teenagers in the R.I. Training School, a correctional facility for underage Rhode Islanders, who also should be transferred to community-based living facilities — such as group homes — but have nowhere to go in Rhode Island.

And she said the situation is especially challenging for teenage girls, as the state doesn’t have any girls-specific facilities akin to the boys-specific Harmony Hill in Glocester or Ocean Tides in Narragansett.

Griffith estimated the state is currently footing the bill for about 67 underage Rhode Islanders to live in out-of-state facilities in Massachusetts, New Hampshire and Vermont. Roughly 44 of them are girls, she added, and the overall cost to the state is upward of $8 million per year.

“Where’s the girl’s school?” she asked. “Where’s the place they can go?”

Griffith said she’s planning to submit a proposal for the state to use some of its federal COVID-19 relief funds to try and address some of the persistent problems found throughout state’s child welfare system.

DCYF is currently soliciting bids for more in-state placements that would add about 12 more beds. But Griffith argued “that wouldn’t even address half the kids stuck at Bradley,” saying the state needs a much large facility for children currently in need of services.

The child advocate, however, said no amount of beds or much-needed facilities would make much sense if the nonprofit sector can’t appropriately staff the programs that go along with them.

“How can I expect any of our Rhode Island providers to open a new building when they can’t even staff the ones they have now?” Griffith said.

DCYF interim director Kevin Aucoin told lawmakers his agency is trying to address many of the issues, including having some initial discussions with community providers about reopening centers for boys and girls. The child welfare agency has also expanded its search for relatives and reached out to foster care families to create a list of people who would be willing to take “emergency placements of children,” he said.

“To be honest with you, that is a tall task,” he said during the Oversight hearing.

But he largely agreed with providers that they aren’t receiving enough money for workers, saying he’s proposed in his budget that rates get increased for the next fiscal year. He underscored the need by pointing out that job vacancies among providers had increased from 168 slots before the pandemic to roughly 350 as of October.

“That’s the magnitude of what our providers are facing,” he said.

‘Go back to waitressing, or do something else’

Nonprofit leaders are seeking tens of millions of dollars and an increase in reimbursement rates they estimate will help address some of the current workforce problems, along with years of underfunding publicly funded social-service programs.

They also estimate it would also allow them to appropriately staff programs across the state.

Gov. Dan McKee in October proposed a $113 million supplemental spending plan that contains some extra money for child welfare programs, including upward of $5 million for Early Intervention. Another $13 million is proposed for a child care initiative and $12.5 million more would go toward staff of service providers that contract with DCYF.

Other items in the proposal include expanding broadband, addressing the state’s housing shortage and allocating $32 million for small businesses assistance. The total supplemental budget represents 10% of the state’s $1.1 billion allocation from the federal American Rescue Plan Act (ARPA) State Fiscal Recovery Fund.

Lawmakers so far have taken no action on McKee’s proposal or other requests for federal relief dollars. And House Speaker Joseph Shekarchi and Senate President Dominick Ruggerio have offered little indication that legislators will reconvene to decide on any major issues ahead of the regular session, scheduled for January.

In a joint statement Monday to Target 12, Shekarchi and Ruggerio said they have been meeting with Early Intervention providers and “are very concerned about the challenges they are facing.” But they pushed back on the idea that they aren’t taking action, and pointed to existing federal relief funding already available to the McKee administration outside the ARPA money.

“Our intent remains to review the proposed ARPA expenditures as expeditiously as possible and to convene the Senate and House in the near future to address the immediate needs of struggling Rhode Island residents and businesses through an initial appropriation of ARPA funding,” Shekarchi and Ruggerio said.

“As that process is ongoing, $24 million in CARES Act funding remains immediately available to help alleviate some of the challenges the Early Intervention program is experiencing,” they said. “We encourage the governor to use his existing authority to allocate necessary funds for Early Intervention providers as soon as is feasible.”

The prospect of lawmakers waiting until after the new year to tackle the issues has heightened concerns among providers, who predict the problems will only worsen with each passing week.

Kelly told lawmakers earlier this month the issue has become so severe that the state is in danger of losing its reputation for having one of the best Early Intervention programs in the country, and argued that a boost in funding to make wages more competitive is the solution.

Griffith offered a more specific example, noting the $14 to $16 per hour wages currently offered to the workers in the state’s provider network. She pointed out those wages are far less than what could be earned in other, less-stressful jobs currently available in the regional job market.

“Working these hours and dealing with what they deal with – I too would prefer to go to Lowe’s,” she said. “I too would prefer to go to Amazon, go back to waitressing, or do something else.”