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County staff warn rising residential treatment rates strain out-of-home care budget
Summary
Washington County Human Services reported steep increases in child-placing agency and residential treatment daily rates over the past five years, saying county placements are down but per-bed costs have risen roughly 68% overall, pressuring budgets despite efforts to serve more youth in community settings.
Human Services staff told the county committee that, though the department has reduced the number of youth placed in residential treatment overall, sharply rising daily rates for child-placing agencies (CPAs) and residential treatment facilities have increased total out-of-home care costs.
Coral, Human Services staff, presented five-year trends for child-placing agencies and residential treatment. She said treatment-foster ("level 3") agency rates and residential rates have climbed: "rates have basically gone up about 68% in the last...five years," Coral said, and several specific residential providers have nearly doubled rates over that period.
Coral outlined the continuum of care: in-home services, level-2 foster homes licensed by the county, level-3 treatment foster homes operated by private agencies (which include an administration rate to fund agency supervision and clinical supports), and residential treatment, which removes a youth from the community to a facility providing clinical care and education. She noted Washington County pays a daily rate that typically includes room and board, clinical treatment, and educational costs; staff said Wisconsin counties cover a broader share of residential costs than many other states.
The presentation named commonly used vendors and programs (Pillar & Vine, Foundations, Rawhide, Genesee Lake School, Family Services, Youth Villages, Chaddock, Milwaukee Academy and others) and said the county sometimes must place youth out of state when no in-state options match needs. Staff described rare but high-cost placements (for example, at Winnebago or Trempealeau ' an Institute for Mental Disease) that can absorb very large sums for an individual case and drive budget volatility.
Julie Driscoll and Coral said the department has pursued community-based approaches such as family-centered treatment and Comprehensive Community Services (CCS) to reduce out-of-home placements and shorten stays for those who must be placed. County leadership said those programmatic steps have reduced placement counts in some years but not fully offset the effect of rising daily rates.
Supervisors asked about value and outcomes, noting that residential and out-of-state placements reduce family contact and often correlate with long stays. Staff said the county closely monitors high-cost cases and pursues alternative placements and daily review, but that a small number of high-needs children remain the primary driver of cost increases.
