In the last five years, the state has worked to rebuild New Hampshire's child welfare system following deep cuts to the agency’s budget and resources, and other high-profile missteps
Joe Ribsam was hired in 2017 to lead that transformation. He's stepping down from his role as director of the Division of Children, Youth and Families in June.
NHPR’s All Things Considered host Julia Furukawa spoke with Ribsam about how the state's child welfare system has changed under his leadership and what work remains.
A lightly edited transcript of the version of their interview as prepared for broadcast is below. You can listen to their full conversation using the player above.
Transcript
In your time as director, the state has invested heavily in expanding mental health services for youth here in New Hampshire. How would you compare where we stand right now to where we stood five years ago?
Five years ago, we honestly did not even have something that we could call a children's behavioral health care system. If you go back to 2008 and you look at the 10-year mental health plan that was written, the word child doesn't even appear one time. That's very different today. We've invested quite a lot in trying to build a comprehensive system for children's behavioral health, including things like mobile crisis response, to have a clinician be able to come out in a crisis within an hour, including high fidelity wraparound services for kids with intensive needs so that those kids can be kept in their community and have people that can come into their home, have peer support for their parents. And seeing that become a reality is great. That being said, workforce is still an issue. Not every kid is getting access to everything that they need. So, there's still plenty of work to be done. But the foundation is there. The system is there. And as long as we remain committed to it,we'll find we're going to have a lot of kids doing a lot better.
As you mentioned, there is still some more work to do. The latest report that we have from the Office of the Child Advocate noted that children are sometimes waiting four weeks to eight months to see a mental health professional. What more could the state be doing to change that?
There's a whole lot that goes into that, right? Because it's not just mental health professionals, right? It's the same issue that we see in our child welfare system, in our juvenile justice system, for providers in our healthcare system, right? And I think there's been a long time where folks have expected that the helpers, the people that work with people to help people, are willing to do that work for less than they deserve. And I think we've seen a shift in the economy recently that shows that, in fact, we need to rethink that model.
And I'm glad to say that we're seeing some progress in that respect. We're seeing salary enhancements for folks that do the child protection type work. We're seeing Medicaid rates being seriously considered in the budget process that are intended specifically to try to elevate those wages and those rates that we pay to folks that do this work, to be able to attract people and keep people in this work. One of the things that brings me hope about this is that — well, a couple of things. One, when you look at data around what young folks are looking for today and work, it's not just money, it's purpose. And this is the type of work that is purposeful and meaningful, right? So, if we're able to get people a living wage that they can be comfortable with, I think we're going to find a lot of young people willing to step into this work. But they need to get to that point where they can sustain themselves and their families.
I think the other thing that I point to is, I think back to my time working in New Jersey before I came to New Hampshire, where we also built a comparable system of care. And when we did that, we actually saw pretty much the same thing where as the system grew, we didn't have the clinicians to meet the demand. And what you saw was schools of social work started popping up to have more people be qualified for that work. And we're actually seeing the same thing here in New Hampshire happening now with New England College actually developing a new social work school and expansions in UNH's school of social work. So, it takes a while for the market to adjust to that growth. But what I've seen in New Jersey and what I'm starting to see emerge here is that the market is starting to adjust.
There are multiple children on DCYF's radar who have died or gone missing in recent years: Harmony Montgomery, Jaevion Riley, Dennis Vaughan Jr. Why does New Hampshire keep failing these vulnerable kids? And why do the agencies responsible for keeping them safe keep letting them fall through the cracks?
First, these are all awful, awful situations. And folks feel deeply the pain that comes along with this, the folks who do this work every day, the families, of course. You know, they're tragic situations. The systems of child protection aren't really the place that we need to be putting the most attention when it comes to trying to help kids and families. The systems actually that need the most attention are the systems that keep kids and families out of child protection, keep kids and families strong and safe together and are able to identify needs and meet needs quickly.
And what happens in a lot of these situations is that you have a vast system of people — lawyers, judges, court-appointed special advocates, providers — who are all engaged with these families and trying to make the best decisions they can to try to do right by these families and have the right outcomes. But families are incredibly complex. People are incredibly complex. And families are incredibly messy. People are incredibly messy. It's very, very difficult and challenging to always make the right decisions in those high-stakes situations. And the best way to solve that is to avoid those high-stakes situations from having to come up at all. And the best way that we do that is by actually getting kids and families what they need early before child protection ever even has to be called.
And what would that look like to you?
Some of that work has happened here already, right? So, when I talk about a children's behavioral health care system where, in the past, the only way a family could get that help for a kid was going to court. They'd come to DCYF. We were the de facto children's behavioral health care system, and they'd have to go to court and ask a judge to order services for their kids, which, you know, is a scary thing for a family. So, what a family does is they delay care. They delay treatment.
But it's true in other types of systems, too. You think about all the things that kids and families need, right? You think about economic supports, you think about natural supports. Those are the people around them that help them. You think about community, you think about housing, you think about substance use treatment. You think about all of those things, all of those things that help make sure that kids and families are strong before DCYF's phone ever rings. And those are the things that we need to keep building out and having support for to make sure that their needs are met and that DCYF never has to get involved at all.
We're living through a pandemic and an economic downturn, and it's putting even more of a strain on families here in New Hampshire. Are you concerned about the impact that these ongoing stressors might have on kids who are already vulnerable in this state or the systems that support them?
What we've seen just in the last year of data, in terms of our call volume, is a couple types of allegations have kind of been rising up. Allegations related to economic supports for families have actually ticked up a little bit over the past year. And not the number of allegations related to substance abuse, but the acuity of the substance abuse cases that we're getting, has actually ticked up over the past year. And specifically, thinking about things like fentanyl becoming more and more prevalent and just what a dangerous substance that is and that folks — you know, they're dying when they're using fentanyl. And we've actually seen the number of parents involved in DCYF cases, whether it's during an assessment or prior to an assessment, we get involved afterwards. But the number of parents of kids dying from fentanyl overdoses more frequently than other substance abuse overdoses in the past few years. And it's just devastating.
So, I think keeping our attention on helping to move the dial back on those things. And then you also have to relieve an increased demand for mental health services, right? We talked already about the children's system of care that's being developed and that, you know, five years ago there wasn't even any system. And I'm terrified about where we would have been had we not built what we've built. But we need to kind of keep doubling down on that. The demand is still out there, and the demand today is greater than it was five years ago. So, the state needs to keep investing.
