For Annette Smith, one final indignity remained for her client, a 17-year-old foster youth in Eugene, Oregon, who died by suicide last year: At the funeral home viewing, he was clad in a hospital gown.
“He was failed even in the end,” said Smith, a public defender. “It’s so easy for these kids to be unseen and unheard.”
Having been in foster care for all but about two years of his life, Jacob Doriety had shuttled through more than 50 placements, a hospitalization after a previous suicide attempt, and, finally, a hotel room.
Despite no one believing that hotels provide the kind of safe and supportive setting for foster youth with mental health issues, across the country, they continue to be sent there — as was Kanaiyah Ward, a 16-year-old girl who died of an intentional overdose of a common antihistamine in a Residence Inn in Baltimore on Sept. 22.
“It’s a systemic problem. It’s a systemic failure,” said Robert Basler, an associate vice-president of Arrow Child & Family Ministries, which provides foster care services in Maryland and Texas. “You don’t have enough resources. There are not enough, or we wouldn’t be in this place.”
‘Not willing to let it go’
The practice of using hotels, once sporadic, grew more common around 10 years ago and surged during the COVID pandemic when fewer foster homes were willing to take in youth and residential treatment facilities restricted admissions.
Whether in the wake of tragic events or to settle lawsuits that advocates have filed against child welfare agencies, Maryland and other states have been working to reduce the use of hotels and address what they say is their root cause — the lack of sufficient placements for youth with the most challenging needs.
Basler is a member of a workgroup created by the Maryland General Assembly and charged with studying the issue of youth staying in hotels, hospitals and even social service agency buildings rather than in a foster home or treatment facility. The group’s work had been delayed by the amount of time it took to vet and seat its members, and they met for the first time on Oct. 2, a day after its final report and recommendations were initially due.
As Kanaiyah’s death casts even more urgency on their work, the workgroup — which includes advocates, treatment providers and representatives of state agencies and medical and social worker associations — hopes to complete an interim report by March and a final one by April, said Ted Gallo, executive director of the Maryland State Council on Child Abuse and Neglect, an advisory body.
“We need to remain invested long-term,” Gallo said. “We’ve got a dedicated group that’s very familiar with this problem, and they’re not willing to let it go.”
The group will be looking at current resources available in the state as well as what other states are doing, he said.
‘Less bad than hotels’
And indeed, multiple states have wrestled with the issue.
In Washington state, two short-term homes, with three or four bedrooms and supervised by child welfare staff, house teenagers who otherwise might be sent to hotels. The kids tend to like the homes, where they share meals and, unlike in other facilities, are allowed to use their cellphones, said Jenny Heddin, deputy secretary and chief of staff of Washington’s Department of Children, Youth & Families.
Still, she said they remain a temporary measure, “sort of a harm reduction approach,” until they can get the youth in a more permanent placement.
“They are less bad than hotels,” Heddin said, “but they’re still not great, right?”
The agency is undergoing reform as part of a 2022 settlement of a suit by advocates who alleged it had failed to provide safe and stable placements for foster youth. According to news reports, one child even spent the night in a car for lack of an appropriate placement.
Jean Strout, senior attorney with the National Center for Youth Law, one of the groups that sued the department, said even before the settlement, the judge in the case ordered the agency to stop housing children in offices, hotels and other unlicensed settings.
“It was not a big battle,” she said. “Where things get more nuanced is, what do you do instead?”
She said she hopes the focus can shift to providing more individualized solutions for the hard-to-place youth and addressing the underlying issues with their families that led to them being removed in the first place.
“You can’t just keep growing the foster system and trying to find more foster families,” Strout said.
Traumatized children
She and other advocates say states need to look at more creative ways of caring for the kinds of youth who tend to end up in hotels — they are generally older, for example, and have physical and mental health needs beyond what a typical foster home can provide.
A child welfare research group, Chapin Hall, which has studied Maryland’s foster care system, said a sampling of the youth who stayed in hotels, offices or hospitals found that all of them had attention deficit or impulse control problems. Nearly all suffered from depression or a mood disorder, and almost 60% of them were deemed at risk of suicide, the researchers found.
“We’re dealing with traumatized children who are acting like traumatized children,” Gallo said.
The Chapin Hall report is just one of many to document failings of the child welfare system, but also the heartbreaking level of needs it faced.
“[The child] was shot … and is paralyzed from his waist down,” a case reviewer wrote of one youth, going on to note that his “mother is deceased, and his father is incarcerated.”
Such needs are beyond what the foster system was initially designed to handle, said Richard P. Barth, a professor at the University of Maryland, Baltimore, School of Social Work.
“The child welfare system is for protecting children from their parents,” said Barth, who has published widely on foster care. “What happened in many cases was the mental health system let these kids float over to the child welfare system.”
Barth said the trend away from group facilities in favor of a home setting doesn’t work for all foster youth who need more than a bed to sleep in.
“Kids get hospitalized, birth or foster parents don’t want to pick them up because they’re concerned about their safety, so the child welfare system ends up overseeing these cases and trying to find homes for them,” he said. “That’s why we end up with hotels.”
A ‘constellation’ of kids
The search for placements for high-need foster youth has led some states to try a model pioneered by the Mockingbird Society in Washington State, in which foster homes are clustered together in a “constellation.” They support one another, particularly in caring for youth with behavioral health needs. The homes are grouped around a “hub” home, typically an experienced foster care provider that the other families can turn to, especially if they need respite, and they gather frequently.
KVC Kansas, a behavioral health care system, launched two constellations, each with a capacity of 10 homes, to fill a gaping need for foster homes that could provide higher-level, therapeutic care.
“We had a lot of homes that were on the cusp of being able to provide higher care,” said Angela Hedrick, KVC Kansas vice president. “We felt that if they had that additional network of support amongst other foster families, who know what it’s like to do that, they might be able to take that extra step and provide that care.”
Hedrick said the networks have worked so well, KVC hopes to add additional ones. According to the Mockingbird Society, a 25-year-old advocacy organization, five child welfare agencies operate in the U.S. with constellations, and the concept has proved particularly popular abroad, with networks operating in countries including the United Kingdom, Australia and Japan.
Those who work in child welfare say the village concept is an apt one when it comes to the needs of foster children.
“We can’t do this by ourselves,” Heddin said. “We really require other state agencies and systems to step up. So if a young person needs drug treatment…. or if they need residential care of some kind, they should be able to get that.”
If you or someone you know needs help, the national suicide and crisis lifeline in the U.S. is available by calling or texting 988.
Have a news tip? Contact Jean Marbella at jmarbella@baltsun.com, 410-332-6060, or @jeanmarbella.bsky.social.
