Clay County Social Services reports higher case complexity, provider shortages and looming new mandates

Clay County Social Services presented an annual departmental update April 1 that outlined staffing levels, caseload trends, fiscal pressures and upcoming legislative and administrative changes affecting behavioral health, adult protection and child welfare.

Kirsten Lepard, who identified herself as supervisor of the behavioral health and adult protection division, and leaders of the child protection unit told the board that caseloads have grown more complex even where case counts on paper have fallen. Supervisors stressed shortages of state‑operated treatment beds, earlier discharges from regional facilities, limited community placement options, and provider workforce gaps as the principal operational constraints driving county costs.

In adult mental health, staff said the county has five full‑time employees in the unit — four who focus on civil commitments and one targeted case manager who handles Rule 79 services. County staff noted an increase in civil matters that stem from Rule 20 criminal‑to‑civil conversions and reminded commissioners that “does not meet medical criteria” (DNMC) obligations for regional treatment center placements create substantial unreimbursed county costs; staff cited daily rates in regional facilities as high and said DNMC bills can exceed $2,000 per day for a single placement.

Substance‑use services include two licensed alcohol and drug counselors who perform comprehensive assessments and treatment coordination; staff reported the program has begun billing for treatment coordination, serving 40 clients in 2023, 57 in 2024, and 10 clients to date in 2025. Staff described treatment coordination as a service that can reduce emergency room use and other county costs by stabilizing housing, appointments and ancillary needs for individuals receiving substance‑use treatment.

Adult protection staff said screened reports and assessments have risen since the Vulnerable Adult Act redesign moved the county from a largely reactive intake model to a more proactive screening approach. The county partners with regional multi‑disciplinary teams and law enforcement and has added collaboration with the Moorhead Fire Department’s Community Risk Reduction Program.

On child protection, supervisors reported 2,364 total intakes in 2024 (this includes records requests and voluntary reports), with 1,595 child‑protection intakes that met state screening criteria and 305 child protection cases opened. In 2023 the county recorded 176 unduplicated children in out‑of‑home placement (down nine from the prior year); staff reported the net county cost of placements was about $3.1 million and that placement costs rose roughly $220,000 compared with the previous year. Staff said most children remain in non‑relative foster homes, with the West Central Regional Juvenile Center used for older youth with significant mental‑health or behavioral needs. Supervisors highlighted successful work to increase relative placements and said the county met several state performance measures: placing relatives within timelines, achieving 97.5% of required monthly face‑to‑face caseworker visits, and meeting the initial contact timeline 91.2% of the time. The county reported a 0% rate for maltreatment reoccurrence in the 12‑month federal/state measurement window.

Supervisors also summarized upcoming operational and legal changes. County staff described the Minnesota African American Family Preservation Act (MAFPA) as an expansion of active‑efforts requirements similar to ICWA; they said implementing the law statewide by Jan. 1, 2027 could require county hiring and other changes. Social Services provided an estimate to county administrators that meeting MAFPA’s active‑efforts requirements could require roughly four additional social‑work staff and a supervisor, with an estimated county cost in the low‑hundreds of thousands (staff presented a range during the meeting). Staff said they will continue planning regardless of whether additional state funding follows the new law.

The presentation also noted investments in staff training required to capture federal reimbursement: all caseworkers have completed motivational‑interviewing training required for Family First Prevention Services Act (FFPSA) claiming and will take quarterly fidelity reviews for certification. Supervisors described other local efforts, including the STAR (Student Attendance Review) pilot with Moorhead Public Schools to reduce truancy and related petitions, the parental support outreach contract, family group decision‑making meetings, respite and relative‑care recruitment, and a county‑funded sibling and in‑home support program.

Staff listed operational challenges that include: a shortage of provider capacity for intensive in‑home services; lack of foster homes for children 13 and older; limits on affordable housing and child care for infants; language and citizenship documentation barriers that delay access to benefits and waivers; and growing costs for interpretation services. Supervisors also said state facilities are sometimes discharging individuals earlier than county staff judges appropriate because of regional bed pressure, which increases county burdens for re‑entry support and monitoring.

Speakers urged continued county and intergovernmental advocacy to address state funding gaps and treatment capacity. Commissioners and the county attorney praised Social Services staff for the complexity and difficulty of the work and asked county administrators to continue elevating the county’s needs in state budget discussions.

Ending: Supervisors asked the board to note that many of the issues — bed shortages, provider shortages, and new state mandates — carry fiscal implications that will intersect with the county’s 2026 budget planning. Staff said they will continue program adjustments, pursue available revenue capture (treatment coordination billing, FFPSA claiming) and report back as state rules and funding clarifications evolve.