By Cathy Candisky for the Public Children Services Association of Ohio.
Broadcast version by Nadia Ramlagan reporting for the Public Children Services Association of Ohio-Ohio News Connection Collaboration.

Twice in the last year, Zoey, a 16-year-old in foster care, had to spend the night in the Franklin County Children Services office.

She had nowhere else to go.

"It was bad," recalled the soft-spoken Zoey, a stuffed bunny clutched under her arm. "It wasn't scary. It was just uncomfortable."

Zoey, who asked to be identified by only her first name, ate canned ravioli and camped out on a sofa in a windowless visitation room she shared with another girl.

"We didn't watch TV. We just sat here staring at each other," Zoey said. "How do you sleep on this hard couch and a pillow that was flat?

"We stayed in here and we did nothing."

Across Ohio, a shortage of foster families, group homes, residential treatment facilities and other placements has overwhelmed child welfare agencies. Frequently, it means youth in their custody are housed in offices, hospital emergency rooms and other ill-suited places for days, weeks and sometimes longer.

In the year ending June 2022, 503 children in foster care spent at least one night in county government offices across Ohio, according to a state report. Dozens more youth stayed in hospitals even though they weren't sick and there was no medical reason for them being there.

Child welfare officials say it's the last option for already traumatized kids with severe behavioral health issues and developmental disabilities. There simply are not enough places offering the treatment they need.

"Residential facilities have been serving children with less significant needs and the children that we are left placing are those that have very deep-end type of issues and significant traumas that have been repeatedly occurring throughout their lives," said Donna Seed, director of social services at Lucas County Children Services.

"They [have] issues that can range from delinquency to gang issues to significant developmental delays to ranges on the autism spectrum, or even medical issues."

Kellijo Jeffries, director of Portage County Job and Family Services, recently was unable to find placement for an 11-year-old girl with developmental disabilities who sometimes was aggressive as well as two youth who had attempted suicide.

Foster families, group homes and treatment facilities commonly share when they deny placement that the youth's needs are too great, or they don't have appropriate services or enough staff to meet the child's need, Jeffries said. "Until we have capacity and the right facilities and options for these kids, we're going to continue to spin."

In the case of the youth with developmental disabilities, her placement provider took the child to the hospital when she wouldn't go to sleep, started banging her head and refused her medication. The placement provider then notified the agency that it could not take her back because of insufficient staff and her aggressive behavior.

The two youth who had recently attempted suicide were discharged from a Northeast Ohio hospital, but because the agency could not secure immediate placement, despite collaborative efforts with county and state agencies, both children remained in the hospital for days after discharge.

The system not only is failing these youth, it's compounding their problems, said Angela Sausser, executive director of the Public Children Services Association of Ohio.

"This kid is being told essentially that you're not wanted. No one wants you. You can't be with your family. They may not want you because of your behaviors, or can't take care of you because of your behaviors, and now nobody else wants you and you're stuck in this cold government agency eating takeout and showering at the YMCA. Children experience trauma from being removed from their own homes. By not having a placement option readily available, we are just adding to the child's trauma."

Nearly 15,000 youth are in state custody and about a fourth of them have complex issues including mental illness, developmental disabilities, and kids from the juvenile justice system, some involved in felony-level crimes.

Approximately 1 in 4 of youth in state custody are there for these other reasons, with no history of abuse and neglect. Sausser said it's time to ask why children services has become the "system of last resort" when other systems cannot meet the needs of these youth.

Foster children's health care is covered by Medicaid while they are in custody. Medicaid is required to meet their physical, developmental, and mental health needs, but while screening and diagnosis for behavioral health conditions is common among foster youth, appropriate and available treatment for those with aggressive behaviors resulting from mental illness, developmental disabilities or trauma is in short supply.

Caseworkers say the number of youth needing intensive, long-term treatment has grown, making it harder to find a foster family or group home to take them. The longer kids wait for placement, the longer they wait for treatment, and for many youth their conditions worsen.

"It is truly additional trauma. It can worsen acute symptoms," Dr. Katherine Junger, associate medical director of mental and behavioral health for Cincinnati Children's Hospital Medical Center, said of kids stuck at the hospital.

"It leaves them feeling helpless and hopeless and, quite frankly, rejected and removed from society."

The nation's largest pediatric psychiatric unit with 100 inpatient beds, Cincinnati Children's had 22 youth in its emergency room waiting for placement in April. Another 22 children remained in inpatient beds because appropriate home- or community-based treatment was unavailable.

The inpatient unit is designed for short-term crisis stabilization where youth stay five to seven days before they are discharged and moved to long-term care.

When forced to stay longer, Junger said, "they can actually get sicker while they're in the hospital because they're at this level of care that is inappropriate for their needs but it's where they can be safe until we can find a better place for them to be."

Next: "Someone is going to end up very hurt and [my child] is going to be scarred for life by something she can't come back from."


Cathy Candisky wrote this article for the Public Children Services Association of Ohio.


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The need for child care and early learning is critical, especially in rural Arkansas. One nonprofit is working to fill those gaps by giving providers a chance to get more education.

The Career Pathways Program with Save the Children partners with universities to grow the workforce of child care and preschool providers.

Joyce Taylor, Eastern Arkansas parent-family community engagement coordinator for Save the Children, had more than 20 years' experience with Head Start and said the program gave her the opportunity to pursue a bachelor's degree. It also provides her with resources she can use, in the classroom and with families.

"In particular, we have a family with a child that is autistic," Taylor noted. "Mom is working with the child at home. So I have things that I can share with that family, so she can continue to work with her child."

More than 153,000 openings for child care workers are projected over the next decade, largely driven by the need to replace those who have left the field or retired, according to the Bureau of Labor Statistics.

Taylor pointed out some children have challenging behaviors, and may have a lot of things going on at home. It is her job to help them thrive in preschool.

"Because we're the first start, when they come into Head Start, that's their first opportunity to be in a learning environment," Taylor explained. "It's up to us to do everything that we can do, to help make that first experience successful."

Karen Harrison, managing director of career in education workforce development for Save the Children, said rural areas have access to fewer resources compared to urban areas, so the program focuses on addressing the specific gaps in rural communities. She added the Pathways program aims to reduce barriers to obtaining a higher-ed credential or degree.

"All of our pathways come with incentives," Harrison emphasized. "We either pay all or partial of their tuition; we pay stipends, for books, supplies and materials. We also give 'barrier reduction' stipends. We know that child care for participants themselves can be an issue; transportation, technology needs."

Harrison added the pathway begins with a Child Development Associate credential, followed by an associate degree, and ultimately a bachelor's degree. In the process, they improve the career opportunities for workers, as well as the quality of early learning.

A persistent child care worker shortage across New Hampshire is leaving families with few options.

The state is currently short more than 7,000 child care positions but low wages and burnout are driving workers from the field and forcing some centers to close.

Shannon Tremblay, director of the New Hampshire Child Care Advisory Council, said workers are struggling to care for their own families with wages barely above the federal poverty line.

"No one wants to come in for a low wage," Tremblay pointed out. "No one wants to come in making $15 an hour, working long hours in a stressful environment."

Tremblay argued greater state investment will create long-term benefits for both parents and children, some of whom may have disabilities or behavioral issues which could be identified earlier by trained child care staff.

Last year, state lawmakers invested more than $60 million in child care services, including $15 million for the creation of child care workforce grants and investments in the state's Family Resource Centers.

Tremblay emphasized the end of career and technical education programs in New Hampshire high schools broke the pipeline of workers entering the field, putting greater pressure on current staff to do it all.

"Our providers are the case manager, the cook, the plumber," Tremblay observed. "They want to provide that high-quality care and right now it's just, they can't do it."

Tremblay stressed pandemic-era funding to support the child care industry will run out in September, so state lawmakers need to act. She added the state could increase wages so the burden does not fall on New Hampshire families, who currently spend roughly $24,000 a year on care for two children under age five.

The child welfare system in Pennsylvania faces a staffing crisis affecting children and families throughout the system.

The Child Welfare Resource Center said about 30 counties report caseworker vacancy rates of 30% or higher

Terry Clark, president and CEO of the Pennsylvania Council of Children, Youth and Family Services, at a state Senate hearing on child welfare, challenged the Departments of Education and Human Services to work together to develop a STEM-focused model for human services. It could offer young people opportunities for training, apprenticeships and careers in child welfare, juvenile justice and behavioral health.

"We spend a lot of time focusing on colleges and universities," Clark noted. "But we believe we might want to back this up a little bit, and start looking at middle schools and high schools. Try to reinvigorate, get younger students motivated and trying to come into this field."

Clark pointed out some agencies have asked supervisors and even people from other departments to take on casework responsibilities. A recent Philadelphia study found Community Umbrella Agencies had an average 45% turnover rate, with vacancies ranging from 21-60 positions.

Clark observed private providers face workforce challenges similar to the county child welfare agencies. He emphasized counties are beginning to explore more contractual relationships with private providers for needed work.

"Counties are starting to put out RFPs, calls for private providers to help supplement their workforce," Clark stressed. "That means they're asking private providers to take on roles and functions that, in the past, were primarily done by counties themselves."

Clark argued competitive wages are seen as crucial to attract and retain child welfare workers, and county funding often falls short. He added student loan forgiveness and fellowship programs may be promising ways to bring new people into the field, but lawmakers would have to agree.

"There have been House bills and different Senate bills that have been introduced, or at least in draft form over the years," Clark acknowledged. "We hope that there's continued discussion about those, because if we can get some movement on those, we think those will really help."

He told legislators the turnover trends will not change significantly without increased investment in workers.