Ways to make it work
The animals at Morning Star Boys' Ranch in Spokane County — horses, goats, chickens and lambs — provide comfort to 23 foster children. They help the boys soothe the extreme behaviors and emotions that landed the children at the ranch. On the last weekend of June, however, this foster-care group home added a new and disturbing creature: the coronavirus.
As at Spruce Street, the virus posed a test that has challenged foster care facilities across Washington since the spring: how to treat foster children who test positive for the coronavirus or show COVID-19 symptoms in small group settings without making employees or even more children sick.
At Morning Star, the solution was simple and elegant: relocate the coronavirus-positive boys to a yet-unused but fully operational wing of the home, complete with air conditioning and new bedding. Guided by the local public health department, Morning Star succeeded in getting the children to isolate and recover in the wing. DCYF didn't make any changes to Morning Star's state contract during the outbreak, Morning Star said.
Talking about the coronavirus-induced financial strain and staffing issues for group homes, noted Carroll of Secret Harbor: "The pressures are enormous."
"All of these decisions about whether your program stays open ... the business impact of these things is enormous," Carroll said.
Secret Harbor runs a six-bed group home for 10- to 14-year-old foster boys in Sedro-Woolley and a six-bed home for 14- to 21-year-old foster boys and young men in Burlington. It has shelled out $4,000 for 1,000 N95 masks as part of its coronavirus preparedness. Carroll said he doesn't plan to ask DCYF to compensate Secret Harbor for even part of the outlay. "We wouldn't ask for that," Carroll said. "It's just part of the price of doing business right now."
Secret Harbor also has been adding hazard-duty pay to its workers' salaries as incentive to keep coming to work amid the coronavirus epidemic. Any worker who has direct contact with the boys has received a $3 per hour increase, which has translated into an additional $11,000 per month in staff salaries, Carroll said.
"It all boils down to workforce," he explained. "You can have people well enough to come to work, but they have to be willing to come to work."
Like Cedar Creek, "we're trying to protect the home environment as much as we can," Carroll said. Before guests enter the group homes — whether DCYF case workers or Carroll himself — a staffer checks their temperature, asks about COVID-19 symptoms and discusses recent community activities. If a foster child leaves the home, he is accompanied by a staffer, who can keep tabs on his activities.
Any group home that finds itself with a foster child who has COVID-19 symptoms or "a known exposure" to coronavirus should "immediately contact" its local health department for guidance, according to a memo issued by the Washington State Department of Health.
DCYF is "supporting licensed-by-DCYF group care foster care providers to comply with DOH guidance," DCYF spokeswoman Johnson said by email.
In Washington, local health departments have primary responsibility for handling coronavirus cases in their jurisdictions, since the Washington Administrative Code gives them primary responsibility for "notifiable conditions," according to Department of Health spokeswoman Amy Reynolds. Local health departments typically cover a county.
Morning Star notified the Spokane Regional Health District on June 29, the day the facility learned it had a coronavirus problem, said Kim Morin, a spokeswoman for the group home.
After working that weekend with the foster boys, an employee had developed a migraine on June 28 and a fever the next day, then alerted Morning Star. Rapid coronavirus testing yielded the news that every boy whom the employee had worked with was positive for the virus.
In all, nine boys at the home tested positive, seven of them asymptomatic and two of them with low-grade fevers, nausea, vomiting and severe headaches. Among employees, 11 had positive virus test results, and all of them had symptoms, though mild, according to Morin.
All of the positive tests and symptoms belonged to foster children and employees at Morning Star's Murphy House Therapeutic Residential program, which has 23 beds for boys ages 6 through 13½. Morning Star's other services, such as its foster care licensing, weren't touched by the outbreak, Morin said.
Guided by the Spokane health department, Morning Star moved all of the coronavirus-positive boys into an empty, newly built wing that has an additional eight beds. In dealing with the coronavirus outbreak, "our greatest asset was having that separate wing," Morin said.
Morin also said "having a really great relationship with whoever your regional health district is" will be a plus for any other group home experiencing a COVID-19 outbreak. "Our health district here ... has been a dream" to work with, she said.
Mark Springer, an epidemiologist with the Spokane Regional Health District was one of the consultants on the Morning Star situation. He said his health department gave its approval to "cohorting," in which two Morning Star staffers who had tested positive for coronavirus, but recovered from their symptoms, worked in the wing with the foster boys.
"That was a perfect opportunity for cohorting," Springer said, and it helped Morning Star at a moment when it was short-staffed, he added.
Each foster care group home is supposed to review and update its "infection control preparedness plan" in order to ready itself for a COVID-19 outbreak, according to the memo from the Department of Health.
Group homes already had developed disease control plans prior to the coronavirus epidemic as part of their accreditation process, according to DCYF. In March, acting on Department of Health guidance, DCYF requested that all foster care group homes come up with COVID-19 prevention and intervention plans specific to their programs and facilities, including quarantine and isolation plans, Johnson said.
The Department of Health memo calls for group homes to "work with DCYF and local public health to fill staffing gaps." It notes that DCYF has a "temporary youth worker staffing pool" and that "most local public health agencies maintain volunteer registries."
In the latest iteration of its memo, dated July 9, the Department of Health advises foster-care group homes to tell symptomatic children and their coronavirus-exposed roommates to stay in their rooms. When that isn't possible, the home should group symptomatic children together in one part of the facility "or use the facility as a group quarantine space."
The memo also outlines contingencies for when a foster child can't be isolated in the home, instructing it to "work with local public health to plan for an alternate strategy," such as a stand-alone cottage, a hotel room staffed by a nurse or, in the case of severe symptoms, a hospital room. It also pointed out that trauma-informed strategies for quarantine and isolation should be developed.
Woodward, the program manager at Cedar Creek, which serves disturbed foster youth, is keenly aware of the difficulty of trying to get emotionally traumatized foster children to comply with strict coronavirus measures. The foster girls who land in Cedar Creek's special behavioral rehabilitation beds are ones whose behavior has made it impossible for DCYF to place them in a regular foster home, Woodward said. The girls' problems are so extreme that, should Cedar Creek not work for them, the next placement for them would be a bed in CLIP, or the Children's Long-Term Inpatient Program, an intensive inpatient psychiatric treatment program.
"Trying to keep those youth in quarantine or to keep their masks on or not spit on or assault staff is a task in and of itself," she said.
InvestigateWest is a Seattle-based nonprofit newsroom producing journalism for the common good. Learn more and sign up to receive alerts about future stories at http://www.invw.org/newsletters/.
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