NH health officials outline children’s behavioral health strategy, residential oversight and new YDC build

Associate Commissioner Trish Tilly of the New Hampshire Department of Health and Human Services told the Finance Division III committee that the department is prioritizing children’s behavioral health, expanding oversight of residential placements and advancing a replacement for the Sununu Youth Development Center.

Tilly told members the department will focus on the children’s behavioral health system, the Division for Children, Youth and Families (DCYF) residential care and juvenile justice, and the adult mental health system. “I am gonna focus on 3 things. I am gonna focus on our children's behavioral health system. I'm gonna focus a bit on DCYF... and then I'm gonna talk a little bit about the adult mental health system,” she said.

The department said statewide survey data show nearly 4 in 10 New Hampshire high school students report feeling “sad or hopeless,” and about 1 in 5 high‑school‑age youth have considered suicide in the past year; Tilly cited the Youth Risk Behavior Surveillance System as the source. She said those figures underscore the need for a system that provides “the right services for the right kids at the right time.”

Why it matters: committee members were told children’s behavioral health demand is both widespread and intensifying since the pandemic. Tilly and staff said the state has pursued a decade of planning and legislation to build a “system of care” that emphasizes community‑based prevention and treatment as well as improved quality and oversight for the far smaller number of youth who need residential care.

What the system looks like: Tilly described a tiered “system of care” that ranges from universal screening and well‑child visits up to intensive crisis response and residential treatment. She said about 95% of children who receive children’s behavioral health services are served in community‑based settings; that figure, she clarified, applies to children already receiving services, not to all children in the state.

Oversight of residential placements: the department reported it has 349 youth in residential treatment as of a January data pull; 262 of those were located in New Hampshire, with the remainder placed elsewhere in New England or outside the region when specialized care is required. Tilly said the department is “putting boots on the ground” for inspections and quality oversight of out‑of‑state residential programs and is coordinating with the Office of the Child Advocate. She said that increased oversight carries travel and staffing costs and will be part of forthcoming budget discussions.

DCYF practice and data modernization: Tilly praised DCYF director Marie Noonan’s work to strengthen practice, increase kinship placements and reduce reliance on congregate care. The department said it is replacing its legacy case management system with a federally funded enterprise system called Granite Families. Federal funding from the Administration for Children and Families (ACF) is being used for design and implementation; department staff said the federal program provides a 50% match for the project. The department said it has secured federal approval for the contract and expects to present the procurement to the Governor’s Council soon.

Sununu Youth Development Center replacement: Tilly said construction of the new youth development center on the Hampstead Hospital property has begun. Tree clearing started in November and excavation began in December; the department expects the foundation to be poured around Feb. 17. The replacement facility is designed for a baseline census of 12 youth with surge capacity up to 18, the department said; the smaller footprint is intended to lower operating costs compared with the current Manchester campus. Tilly and other officials said some shared‑services opportunities with the adjacent hospital are under discussion as Dartmouth Health finalizes a lease for the Hampstead Hospital site.

Foster care, kinship and rates: committee members pressed the department on foster‑care capacity and compensation. Tilly said foster rates have lagged far below residential costs; residential treatment costs the state “upwards from $300… up to $1,800 a day,” while daily foster care rates vary by case and age. Department staff later provided a rate range for various foster categories (daily rates reported to committee documents range roughly from $34.28 to about $64.61 depending on program and need). The department said it is preparing proposals for higher foster and intensive foster rates to support families who care for more complex youth, and that recruitment and supports (respite, transportation, peer networks) are part of capacity improvements.

Assessment and next steps: the department said it is completing a national assessment of children’s system‑of‑care models and expects a final report in March; committee members requested a follow‑up presentation with budget numbers after the Governor’s budget is released. Tilly emphasized measuring outcomes with standardized assessments and expanding the department’s data and analytics capacity so the state can track whether investments improve population‑level child functioning over time.

Caveats: Tilly acknowledged data limitations, including multi‑year horizons for prevention returns on investment and the difficulty of quantifying the share of children in the community who are unserved. She said youth behavioral health data are collected biennially and that 2025 data capture is ongoing.

What committee members asked for: the department agreed to return with a focused presentation on out‑of‑state residential oversight and inspection funding, provide cost‑benefit analyses for selected evidence‑based prevention programs, and share detailed foster‑care and kinship rate matrices for the committee’s budget work.