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Testimony on H.B. 49: Main Operating Budget for FY 2018-2019 Senate Finance: Health and Medicaid Subcommittee

Posted May 24, 2017 in Articles

Natalie A. Leek-Nelson, President and CEO
Providence House – A Crisis Nursery – Cleveland, OH – Cuyahoga County

Chairman Hackett, Vice Chair Tavares and members of the Subcommittee; thank you for allowing me to offer testimony on House Bill 49.

My name is Natalie Leek-Nelson, President and CEO of Providence House, a crisis nursery in Cleveland, Ohio that has supported over 8,000 children and families in crisis since 1981. I have served as the head of the organization for 16 years and bring over 25 years of experience in corporate and non-profit management to my role.

As Ohio’s first crisis nursery, Providence House has been licensed by the State of Ohio as a Crisis Care Facility since 1990 through the Department of Job and Family Services. Today we provide free, voluntary, non-custodial care for up to 30 children at time, newborn to age 10. Annually we receive over 1,000 inquiries for admission and are serving nearly 400 children from 200 families who are in crisis - and our waiting list continues to grow - nearly 100 children just last year. In Lorain County, Blessing House is the only other currently licensed crisis nursery in Ohio.

We are grateful to have received state support in the last two budget cycles. This has allowed existing crisis nurseries to protect children in situations where they were at risk of abuse or neglect, due to homelessness or unsafe housing, having a caregiver in need of medical or mental health services, substance abuse treatment, or families struggling with poverty, and community or domestic violence. We are helping families who are impacted by many of the state’s greatest challenges, such as the opioid epidemic and Ohio’s high infant mortality rate.

As just one example of our intervention and success with families facing these overwhelming challenges, I want to share the story of Paul, Jr. with you. Baby Jr. was born premature at 29 weeks and opiate addicted. His mother, who used throughout her pregnancy, refused treatment and walked away from her baby. Baby Jr.’s father stepped in and was supported by Providence House while his son stayed with us after he was weaned off of the opiates in the hospital. We provided medical support and loving care to help Baby Jr. who was not only premature, but also failure to thrive and had a gastrointestinal disorder which made him difficult to feed. While he stayed with us, we also helped his daddy, a first-time single father, learn nurturing parenting techniques, infant care practices, and medical skills so that he could care for his fragile baby. They were successfully reunified after 90- days, participated in our Aftercare Program, and remain safe, healthy and together today. Baby Jr.’s outcome could have been very different, and likely another tragic statistic in our State’s infant mortality and opioid outcomes, without our intervention.

At Providence House, we focus on proven prevention and early intervention services to strengthen and preserve families, support healthy child development, and reduce foster care placements. We use a two-generation approach to address needs of both the child and their parent. Children receive emergency shelter and direct care services, pediatric medical examinations, developmental assessments, and trauma screenings with onsite enrichment activities focused on educational, developmental, and social-emotional skill building while they stay with us for up to 60 to 90 days. Meanwhile, Licensed Social Workers work with parents to identify unmet needs and connect families to service providers ranging from mental health services and addiction services to employment agencies and early childcare programs, to assist parents in maintaining family stability. Social workers are also meeting with parents to build parenting skills and address the impact of trauma they may have experienced. Our direct services and intensive intervention are focused on ensuring long term safety, resiliency, and self-sufficiency for parents and the well-being of their children.

In 2016, 98% of the children who stayed at Providence House were reunified with their parent or guardian after an average length of stay of 20 days and 90% of families fully complied with our program requirements. This means that parents were actively engaged with all of our case management, parent education, and trauma services. 83% of parents who engaged in our services felt their family stability increased.

Through a long-term outcomes study conducted by Case Western Reserve University published in the national Children and Youth Services Review last year, we know that Providence House services have an enduring impact on families and significant economic benefits to our communities. The study compared the children we served to local foster care data and found that 82% of children who stayed at Providence House were never substantiated for abuse or neglect and never entered foster care. Knowing the average cost annually for each child in foster care is $25,782i, our services saved $8,404,932 in foster care costs just last year alone. Factor in additional costs for higher need childrenii and related medical and legal costs for foster care placements and this figure quadruples to nearly $30 Million annually. For just one county through just one Crisis Nursery. Imagine the impact and the savings that a network of Crisis Nursery services could have on the lives of children and the costs incurred by the State in foster care and over the lifetime of at-risk children. But we need your help to do it.

We know that the costs associated with child abuse and neglect are not just limited to those associated with foster care. When children experience maltreatment, it causes life-long cognitive, developmental, and social-emotional consequences with emerging research even linking child maltreatment and trauma to chronic health conditions in adulthood. While a child’s memory of maltreatment may fade, their brains and bodies remember it for the rest of their lives. Over one-third of adolescents who have been maltreated as children will have a substance abuse disorder by their 18th birthday and 80% of 21 year olds abused as children meet the criteria for at least one psychological disorder. Research indicates, almost to the birthday, when these children will become teen parents, drop out of school, be incarcerated, homeless, and even abuse their own children. Altogether, the average lifetime cost for each child maltreatment victim is over $210,000 including costs associated with productivity losses and impacting our medical, criminal justice, child welfare, and education systems. This means that the 17,693 children substantiated for abuse or neglect in Ohio in 2015 will cause over $3.7 trillioniii to be spent in direct and indirect costs over their lifetimes. And that’s just for the children maltreated in 2015. Year after year, these numbers compound as more and more children are substantiated for abuse and neglect – costing our state millions year in costs across our systems throughout their lives due to lack of early prevention and intervention.

Crisis Nursery programs like Providence House and Blessing House step in before abuse or neglect occurs to protect children and strengthen families before the intervention of law enforcement and child protection agencies is needed. Knowledge of our successful outcomes and interest in bringing the crisis nursery model to other Ohio communities like Columbus, Akron, and Cincinnati is growing. Providence House hopes to help replicate our model in these communities to provide a viable alternative to foster care and extended public systems involvement through our Every Child Ohio strategy. These additional crisis nurseries would generate exponential savings for these counties and the State.

The House included $150,000 each fiscal year to support children’s crisis care facilities. While we are extremely grateful for this support in a very tight budget cycle, this is a fifty percent reduction from the previous biennium and would result in fewer services we are able to provide to children and families during a time of increased need. To ensure that Ohio’s currently licensed children’s crisis care facilities can continue to protect children and serve families in crisis who need our services, I am asking you to support an amendment to dedicate $350,000 in each fiscal year of the upcoming biennium. These funds will be allocated to licensed Crisis Care Facilities based on the number of beds in a licensed crisis nursery; offering not only Providence House and Blessing House support to serve as many children and families as possible, but also provide a stream of state support for others who choose to open these facilities in Ohio.

Thank you again for the opportunity to speak with you about House Bill 49 and the amendment to support the vital work done by Crisis Nurseries to keep hundreds of children like Baby Jr. safe and their families together while bringing significant cost savings to the state. I am happy to answer any questions you may have.


i The average annual cost for a child in foster care is $25,782. (2011 White paper)


ii $91,250 per child in foster care with physical/mental/behavioral health problems and related costs


iii Children substantiated for abuse or neglect in Ohio 2015, Kids Count Data Center
(17,693 x $210,012 = $3,715,742,316)

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