Out-of-State Placements Reporting Pursuant to A.B. 298

Pursuant to AB 298 from the 80th Legislative Session

n or before August 1 of each year, an agency providing child welfare services shall publish on its Internet website a report which includes, without limitation:

Information on whether the agency achieved the goals established pursuant to paragraph (b) of subsection 1 for each quarter of the immediately preceding year.
The number of children placed outside this State for more than 15 days during the immediately preceding year, including placements in residential treatment facilities.
The reasons for the placements described above.
A summary of changes that could prevent these out-of-state placements.
A summary of changes or actions necessary to allow children currently placed out-of-state to return.

(a) Efforts to Recruit and Retain Specialized Foster Homes

During FY25, Washoe County Human Services Agency (WCHSA) implemented the following initiatives:

Maintained communication with Specialized Foster Care (SFC) providers via regular emails, quarterly in-person support meetings, and direct collaboration with SFC agencies.
Invited SFC agencies to host booths at WCHSA’s Walk with the FAM in September 2024, a community event raising awareness about the need for foster and adoptive parents in Washoe County, allowing agencies to recruit foster homes.

(b) FY 2025 Monthly Average Out-of-State Placements (>15 Days)

Residential Treatment Center: Average 4 per month
Parent Placement: Average 1 per month
Relative Placement: Average 13 per month
Non-Relative Permanent Placement: Average 3 per month
Hospital: Average 0 per month
Total Number of Kids: Average 20 per month
Median Age in RTC: Average 13.5
Average Median Age in RTC for FY: Average 13.5

Note: Children placed out-of-state with parents, relatives, or non-relatives generally have a plan to achieve permanency and are not typically expected to return to Washoe County.

(c)(d)(e) Reasons for Out-of-State Residential Treatment

Primary Reasons:

Child’s needs cannot be met in a community SFC home and require a higher level of care.
Limited local options for a comprehensive continuum of behavioral health services, including:
- Acute Psychiatric Inpatient Care: One adolescent-focused facility, no pediatric admissions for FY2024.
- Residential Treatment Centers (RTC): Two centers with limited populations; one is female-only, one has a small pediatric unit (no placements yet).
- Psychiatric Residential Treatment Facilities (PRTFs): One facility, often denies youth with histories of aggression or elopement.
- Psychiatric Care: Psychiatrists and medication management.
- Rehabilitative Mental Health Services:
  - Partial Hospitalization Programming (PHP) – two programs.
  - Intensive Outpatient (IOP) – four programs, with waitlists.
  - Day Treatment – limited admissions due to age and aggression in milieu.
  - Crisis Stabilization Services – unavailable in Washoe County.
  - Crisis Triage Center (CTC) – unavailable in Washoe County.

Prevention and Clinical Services

WCHSA emphasizes prevention to maintain children safely in the community:

Implemented Intensive In-Home Services to reduce foster care entries due to mental/behavioral health needs.
Clinical Services Team (CST) provides:
- Crisis intervention and assessments for children entering care.
- Short-term therapies for individuals, families, and groups.
- Care coordination before, during, and after foster care placements.
Maintained rotational on-call Clinical Supervisors and staff for seven-day emergency response.
Engaged community mental health professionals for emergency shelter check-ins.
Enhanced behavioral services documentation via CaseWorthy for Medicaid billing.
Clinicians trained in evidence-based treatment modalities (CPP, TF-CBT, EMDR).

Adoption Support

Pre- and post-adoption services to prevent re-entry into foster care due to behavioral/mental health needs.
Assistance in accessing community services, safety planning, higher level of care identification, and insurance problem-solving.
Implementation of support groups for adoptive parents and teens.

Voucher Program for Mental/Behavioral Health/Substance Abuse Services

Expanded community provider options for services not covered by Medicaid or with long waitlists.
Over 20 contracted providers offer timely access to essential services (neuropsychological evaluations, psychosexual assessments, etc.).

1915i Home and Community-Based Services Application

Children in Specialized Foster Care can receive:
- Crisis Stabilization Services
- Intensive In-Home Supports
- Coaching and support for foster parents
Goal: maintain placement stability, resolve behavioral health issues, and increase success with reunification or permanent placement.
Currently, one SFC agency is qualified and billing under the 1915i waiver.

Support for Foster Families and SFC Agencies

Respite services, funding, training, support groups, and quality parenting initiatives.
Implementation of 30-day preservation plans to stabilize at-risk placements.