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Board hears staffing and placement pressures in behavioral health, community support programs
Summary
County behavioral-health staff described staff vacancies, rising referrals to Children’s Long-Term Support (CLTS), out-of-county placement pressures and plans to recruit clinicians; the board discussed exploring specialty foster-care placements to reduce residential care costs.
Alicia (behavioral-health staff) and Caitlin (community support program staff) briefed the Sawyer County Health and Human Services Board on Sept. 9 about program workloads, vacancies and placement costs.
Alicia reported staff turnover in several programs and said the Children’s Long-Term Support (CLTS) program — the county’s largest program by referral volume — had new referrals and an increasing caseload. She said one CLTS staff member, Terry Brown, had resigned with a last day scheduled for Nov. 21; managers were arranging caseload coverage among existing staff and considering advertising for new applicants or a limited-term employee to fill gaps. Alicia said school re-openings typically bring an increase in CLTS referrals and that the county expected caseloads to rise above 60 children in the coming weeks.
Behavioral-health staff discussed pressures created by high-cost out-of-county placements, hospitalizations and residential treatment. The board and staff described one complex client moved to Winnebago and noted that transition to a crisis bed and then to a lower-cost setting can reduce long-term costs. Staff said they are working on crisis plans and coordinating with county legal counsel and courts to manage complex commitments.
Caitlin reported that the Community Support Program (CSP) served roughly the same number of clients (just under 50) and that the county expected to add a nurse practitioner to the behavioral-health team starting Oct. 1 to increase access to prescribers for an aging CSP population.
At the fiscal-performance discussion, staff described a potential strategy to reduce high costs for children in residential care: develop a locally based specialty foster-care program that would permit certain high-need children to remain in a specialized foster home while receiving CLTS supports. Staff said some state toolkits describe intensive or specialty foster-care options and that county foster-care staff were interested in piloting such placements to reduce reliance on group residential settings and the associated costs.
Board members pressed for details on billing, Medicaid eligibility and whether long-term placements can be covered by state programs. Staff clarified that Medicaid and long-term-care supports have eligibility rules — for example, CLTS eligibility depends on functional criteria tied to disability categories — and that mental-health diagnoses alone do not automatically qualify a person for long-term supports unless they meet the program’s functional criteria.
Staff said they will post recruitment announcements for open clinician positions, evaluate limited-term staffing options, and explore whether a specialty foster-care pilot could be developed locally to keep some children closer to home and reduce expensive residential placements.
