DEPT. OF SOCIAL SERVICES: Ross touts therapeutic foster care


Director says option could ‘increase household income’


BAKERSVILLE – The Mitchell County Board of Commissioners held its regular Department of Social Services session Monday, May 4, where DSS Director Sara Ross discussed the possible benefits of therapeutic foster care in the county. 

Therapeutic foster care, or TFC, provides children, most of whom struggle with significant emotional or behavioral issues, a more specialized level of care than traditional care. Children in TFC receive more in-home visits, and foster parents are required to complete more training. 

“Therapeutic foster care case management means that we go out to that home once a week, and we provide therapeutic interventions,” Ross said. “We’re helping them look at the behaviors and how they might be able to be more therapeutic in their intervention.”

A child can be approved for therapeutic foster care if they have endured any level of trauma, Ross said.

“If we’re involved, the kid has endured trauma, whether it be abuse or neglect,” she said. “We’re not taking a child because everything’s roses at that home.”

Ross added most children who are approved for TFC are between the ages of 5 and 17 because “to be able to identify whether their behavior is normal for development versus traumatic behavior is really hard between zero and 4-years-old.”

Ross said encouraging more TFC in the county will provide children with more services and the county with another revenue stream through Medicaid reimbursement.

The current rate of Medicaid reimbursement for therapeutic foster care is $88.38 per child per day. Ross said if the 30 children in DSS custody between the ages of 6 and 17 were approved for TFC, they would see $954,504 in Medicaid reimbursement in a year. Ross suggested the county would split the reimbursement “50/50,” with half going to the county to fund DSS and half going to the foster parents, approximately $477,000 each.

“Because each therapeutic foster home can be licensed up to two children, one home could potentially look at gaining $31,816.80 annually,” Ross said. “If they only had one child, they could increase their household income by $15,908.40.”

Mitchell County has been unable to support TFC in the past because the county lacked the resources to support a full-time therapist licensed to submit comprehensive clinical assessments to Medicaid, Ross said. 

“There’s not enough business up here to sustain staff,” she said. “So, they just constantly do this turnover, or we have to borrow somebody from Marion or Yancey or Asheville to come up and do assessments, and it just doesn’t happen.”

To combat this, Ross said her Intake and Assessment Supervisor, who is now a licensed social worker with an LCSWA, can also serve as her clinical supervisor. This means she will be licensed to complete comprehensive clinical assessments to determine if a child should be put into therapeutic foster care. Ross said they have not applied for a license to be able to submit Medicaid reimbursement yet, but they are now “positioned to be able to do this.”

“We don’t have to grow staff, and the caseload size is the same,” Ross said. “It doesn’t change anything other than to get money for doing it, and we would see [the foster children] four times a month instead of one to two.”

Additionally, Ross said there have been “discussions” about the Medicaid reimbursement rate increasing in the future due to provisions and defunding of congregate care facilities being implemented in 2021 because of the Family First Prevention Services Act. 

Ross said congregate care, also known as “group homes,” are being defunded because “the evidence shows that it’s not effective for children.”

“There’s lots of trauma that then gets re-traumatized in group homes, unfortunately,” Ross said. “Really, the truth is, the reimbursement rates for group homes is so low that the only staff that they can staff it with are, like, 19, 20-year-olds. So, if you can imagine a 19-year-old being responsible for 24-hour-a-day kids that are 17-years-old, it just doesn’t end well.”

Following the board’s DSS public session, the board went into closed session to “hear or investigate a complaint, charge, or grievance by or against a public officer or employee.”