Vista Maria officials tell Wayne County committee residential program strained by regulations, staffing and insurance losses

Vista Maria officials told the Wayne County Health & Human Services Committee on a recent morning that the nonprofit’s residential program for girls is operating under severe strain because of changes in state rules, rising costs and staffing and insurance losses.

"We went on a placement suspension," said Kathy Regan, chief executive officer of Vista Maria, describing a roughly three-month pause in taking new residential placements. "All of our staff has been retrained... We also have made repairs to buildings, about a half million dollars of repairs, and we've started to intake children. So we have 11 on campus right now."

The update came during a discussion before a contract vote. Tawana Rogers Reese, vice president of community programs at Vista Maria, told commissioners the organization has revised protocols for children who leave campus and is working with the Dearborn Heights Police on procedures for responding to children who walk off site. "We don't...put hands on children. There are no seclusions and limited restraints that go on," Rogers Reese said, adding that the focus has shifted to therapeutic interventions to "keep the temperature down."

Why it matters: Vista Maria and other residential providers told the committee regulators’ restrictions on seclusion and restraint (put into effect in late 2022) have reduced the tools providers can use when youth become highly dysregulated, while the supply of psychiatric and residential beds for adolescents has fallen. "In 2020, there were 1,200 kids in residential beds. They're now available 450," Regan said. She warned that higher-acuity children now arrive in residential settings and that many former residential providers statewide have exited the space, leaving fewer options for children who need treatment beyond foster care or shelters.

Commissioners pressed staff on operational details, including admission criteria, lengths of stay and oversight. Regan said Vista Maria is licensed for 47 residential beds and owns five residential buildings but that staff limit occupancy in practice; one building housing girls currently has 11 residents and the program typically will not house more than 12 in that unit. She said the state’s policy of "no eject, no reject" prohibits providers from refusing referrals or ejecting residents without risking penalties: "We cannot reject a child that they refer... We also cannot eject a child regardless of what their behaviors are, or we will get fined," Regan said.

Commissioners and Vista Maria staff described other operational pressures: a recent decision by the organization’s workers’ compensation carrier to decline coverage for the coming year, higher rates charged by residential vendors and high staff turnover among direct-care workers. "We have experienced a 100% turnover in a year" for direct-care staff, staff said during the discussion.

Vista Maria and commissioners discussed partnerships that help assess and treat youth, including Detroit Wayne Integrated Health Network; staff said those agreements provide specialized assessments but that available capacity is insufficient. Commissioners suggested convening local, state and community stakeholders to seek solutions; Commissioner Baker McCormick offered to help convene interested parties to press for changes and coordination with state officials. "We need to figure that out," McCormick said.

Discussion vs. action: the committee heard the update and asked questions but did not take formal action on Vista Maria’s operational status during this agenda item. Commissioners agreed to work with administration staff to pursue a stakeholder meeting with state representatives and community partners to discuss capacity and regulatory impacts.

Context: Vista Maria staff said residential care represents a small proportion of the agency’s monthly caseload but consumes a large share of resources. Regan said the residential census has declined from a historical high ("we used to have 150 kids on our campus at one point") to the current 11 and that if costs and regulatory constraints continue, Vista Maria may face a decision about whether to continue operating residential programs.

Ending: Commissioners thanked Vista Maria leadership for the briefing and staff indicated they would follow up with commissioner offices on possible stakeholder convenings and further information on state-level discussions.