After Fort Behavioral shutdown, Texas lawmaker seeks answers about state’s safety net
A Texas lawmaker says the crisis for families after the state’s abrupt shutdown of a Fort Worth residential clinic exposed failings in the system meant to protect children.
Advocates agree with that assessment, saying Texas needs to develop a better safety net for the children who are displaced when the state closes a facility. The Star-Telegram reported in February that, after the state shut down Fort Behavioral Health, at least two children ended up in hospital emergency rooms because families had no other immediate options for intensive treatment.
State Sen. Charles Perry, a Lubbock Republican who is vice chair of the Senate’s Health and Human Services Commission, said there doesn’t appear to be a system in place to transition kids to new treatment plans.
“Do we have a plan of succession when we have to close (a facility) down? And I don’t think that we have a formal plan — I think we have people that step up and try to deal with it — but maybe we need to formalize that a little bit better,” Perry told the Star-Telegram.
It’s a question that Perry said he plans to raise during committee hearings this legislative session, spurred by the situation in Fort Worth.
The state Health and Human Services Commission in late January issued an emergency suspension for Fort Behavioral Health’s adolescent treatment programs, which include programming for autistic teens, teens with substance use disorders and teens in foster care. The state agency cited a concern of immediate risk to children’s safety, and told families they had about six hours to pick up their children.
And while a spokesperson for the state commission said the agency provided resources to families affected by the sudden shutdown, four families told the Star-Telegram that they did not receive any meaningful help. Two of those families’ teens ended up in emergency rooms following the shutdown, and all four families said the sudden change in care was detrimental to their children’s treatment progress.
The state has not released an investigation report or other findings about what triggered the Fort Behavioral shutdown. The facility in southwest Fort Worth was allowed to reopen in late February with conditions, after it contested the closure order in court. (Since the shutdown, representatives of Fort Behavioral Health have not responded to emails and calls requesting comment, and they asked Star-Telegram reporters who went to the facility to leave the premises.)
Advocates said there are times when the state does need to close down a facility to prevent or stop abuse and neglect. But the fallout for the Fort Behavioral families also underlined a gap in support for high-needs Texans, advocates said.
Sarah Worthington, the director of the Texas Foster Youth Justice Project, said that abruptly removing a child from a facility can trigger a range of tangible impacts, such as lost treatment records or suddenly changed medications. But it also breaks down a child’s trust in their treatment, forcing them to meet new providers, re-explain potentially traumatic histories and adjust to an entirely new environment.
“It’s like there’s no way for them to succeed, when they’re not given an opportunity to just have some stability,” Worthington said.
She said the state has a duty to protect children in private facilities such as Fort Behavioral Health, even if they aren’t in foster care, because those facilities are licensed and regulated by the state.
“The state is absolutely responsible, even for children who aren’t in foster care, to make sure that they’re safe, because they provide those licenses,” Worthington said. “They have a responsibility to protect children in any setting that provides care, whether that’s a behavioral hospital or just a daycare.”
No safety net
George Valles, an advocate supervisor at Disability Rights Texas, said he’s seen facility shutdowns in the past, similar to the one at Fort Behavioral and with similar outcomes for patients.
“I think it’s a case of a safety net needing to be developed,” Valles said.
When the state shut down Fort Behavioral Health, families were given mere hours’ notice to pick up their kids. That left families scrambling, with little time to form backup plans.
Valles said this last-minute notice is a sign that the state needs to be more transparent so families can find alternate resources for their children.
But being open with the families and residents of facilities would also mean that facility staff could find out about a shutdown ahead of time — which might trigger them leaving for other jobs while there are still patients in care. Valles said that, too, is something the state could help with.
“The state should be moving staff in to keep the facility functioning until the residents are successfully transitioned,” Valles said.
Perry, the state senator, similarly suggested that perhaps the state could set up a plan to take over facilities that have been flagged for closure. Under such a setup, the state could continue operating the facility until the kids are placed elsewhere.
“I think you can have a receivership kind of program where maybe you don’t close that facility and run them all out of there,” he said.
Perry said a receivership-style setup is just one idea, but that situations such as the Fort Behavioral Health shutdown underscore the need for some type of better framework.
‘We need more resources’
Worthington — of the Texas Foster Youth Justice Project — said the state should be providing more hands-on help in the case of a sudden shutdown.
She said the state should have trained staff who can help find new placements, review medications and track children as they adjust to their new treatment plans.
“That transition piece is what’s critical,” Worthington said.
Even with advance notice and state assistance, some families would struggle to find alternate resources for their kids, because of the shortage of facilities that care for high-needs patients, particularly if they’re young patients.
Jacquie Benestante, the executive director of the Autism Society of Texas, said it’s hard for families in any context to find a place to treat their children.
“It’s really awful for parents. There’s very few facilities that will take kids with autism and there’s very few quality facilities for autism and mental health, and it’s really hard,” she said.
Greg Hansch, the executive director of the National Alliance on Mental Illness Texas, said patients often don’t have many options when the state shuts down a facility. He said his organization hears from families who don’t live near any treatment centers, as well as families who say the treatment centers that are near them are very expensive.
“Shutting one down may need to happen, because of the risk of harm to kids, but we need to make sure that there are other resources available for these families when facilities are shut down,” Hansch said.
The state needs to invest more money, Hansch said, so there are places for kids to get the care they need.
“We need more resources,” Hansch said. “We need more options for this population.”
‘Very predictable’
Larkin Taylor-Parker believes the state failed the children at Fort Behavioral long before January’s shutdown.
Taylor-Parker is the legal director for the Autistic Self Advocacy Network, which primarily focuses on autistic people’s rights at the federal level. They said that stronger community- and home-based resources may have prevented some of the teens from needing to be placed in a residential treatment facility in the first place.
“The state didn’t provide adequate services well in advance of a crisis, to stave off a crisis,” Taylor-Parker said.
“I’m saddened, but I can’t say I’m surprised to see the same state service systems that created the conditions in which these poor kids were institutionalized, having to shut down that institution and then not doing a very good job of putting services into place to keep the children out of places like hospital ERs.”
Given that the families discharged from Fort Behavioral didn’t have access to many resources, Taylor-Parker said the catastrophic outcomes for some families was not surprising.
“In the absence of adequate home and community based services (and) a strong community mental health system that is equipped to serve adolescents and is equipped to serve people with intellectual and developmental disabilities, crises are predictable,” they said. “Very predictable.”
