When Minnesota Parents Give Up Their Kids to Foster Care: An Imprint Look at a Nationwide Predicament

Argie Manolis of Morris, Minnesota, knew the 7-year-old boy who showed up at her doorstep one night eight years ago would require special care. His biological parents had significant mental health challenges, and the boy had endured abuse in their care. 

Manolis and her spouse, a nurse, had fostered local kids before in their rural town in the western part of the state. They had experience caring for children with complex behavioral needs. And they were happy to help. 

After three years of fostering the child, an adoption was finalized. He wore a red bowtie to the court hearing and got to bang the judge’s gavel.

But that initially joyful period became more troubled for the boy, who between the ages of 7 and 14 has been diagnosed with bipolar disorder, autism, PTSD and low cognitive functioning. The Imprint is not naming him to protect his privacy. His adoptive mother said he became increasingly aggressive toward his siblings and those who cared for him. 

The breaking point came last year when he threatened his 5-year-old sibling and punched his adoptive mom in the head. As she had in the past, Manolis called 911 and he was taken to a local hospital. When emergency room staff asked Manolis to bring her son home, she told them she simply couldn’t.

“No parent ever wants to leave a child in an emergency room,” she said. “But I feared for the safety of my family. And I felt that we were failing to give our son the help he needed.”

Although most children enter foster care because their parents are accused of abuse or neglect, a significant number, like the boy Manolis adopted, are voluntarily handed over by parents who say they cannot manage their behaviors at home due to severe mental health conditions. Unlike most foster care cases, these parents seek out a period of separation, at least temporarily, to get help for their children or to keep others in the household safe. 

Data obtained from Minnesota’s Department of Children, Youth, and Families shows that last year, of the 4,166 new entries into out-of-home care, 489 — or almost 12% — involved parents who sought intensive mental health treatment for their kids. In Minnesota, these kids are categorized as foster youth who enter the system under a “placement for treatment” designation.

The numbers tallied for The Imprint included children 3 and older who were removed from home due to “relinquishment,” or entered foster care under a “voluntary placement agreement” for reasons related to disability and behavioral health needs, including alcohol or drug abuse. Most of these children entered the foster care system for a congregate care placement in a group home or institution, not another family home. 

Such entries to foster care are not unique to the state, which has a county-run child welfare system. 

A federal research brief released in January that evaluated “custody relinquishments” from 2017 to 2019 found that four out of five such cases involved teenagers, the vast majority diagnosed with mental health disorders. The study found relinquishments amounted to 5% of all foster care entries nationwide.

Suzanne Arntson, deputy director of Scott County Health and Human Services, described two main pathways that Child Protective Services enters Minnesota families’ lives. In some instances, parents themselves contact the local CPS office, reporting they can no longer care for their kids. In others, parents like Manolis say they can’t bring children in crisis home following a psychiatric hospitalization or police hold.

“Kids being boarded in emergency rooms — not for treatment, but just to be kept safe — is a crisis.”

— Todd Archbold, private mental health treatment provider

In either instance, child welfare agencies here and in other parts of the country make clear they do not automatically consider these kids eligible for foster care. 

“Ultimately, the parent is the one who initiates the placement process, but we don’t jump to that conclusion,” Arnston said. “We do assessments to determine what the child’s needs are, whether all in-home interventions and outpatient options have been exhausted.”

Arnston emphasized that children thrive in families, not institutions, and the goal is to get them home in 30 to 90 days. 

“We need to connect these kids with services before a crisis arises,” she said. “That can keep kids at home.”

Neerja Singh, area manager of children’s mental health at Hennepin County Human Services, agreed.

“Whether it’s 10 days or 10 months, it’s a big deal to remove a kid from home,” Singh said. “We do a thorough evaluation and assessment that takes into account a child’s needs — and the parent’s ability to meet those needs — before determining next steps.”

When a parent approaches Hennepin County Human Services to request what is known as a “voluntary foster care agreement,” sometimes they are just burned out and need a break. In those cases, 24-7 respite care is available that can include “in-home supervision and engagement.” The goal, she said, “is to get parents and their kids the help they need before a crisis arises.”

When parents decline to bring kids in psychiatric crises home from emergency rooms after a temporary stabilization period, it falls on Child Protective Services to find a residential placement. But pandemic-fueled facility closures and bed and staffing shortages have limited access for families in need. And if there’s no bed available through the foster care system, the child is sent home.

“Those kids may return to an emergency room again and again until they get the help they need,” Singh said.

ER as last resort

In the beginning, the future seemed hopeful for the lanky boy with inquisitive eyes who had joined the Manolis family.

“He’s an amazing kid,” said Manolis, who directs community partnerships in rural towns for the University of Minnesota Morris. “He was so curious about us, nature, the world. He knew that he’s connected to everybody, and everything in it.”

Over the next five years, more children, both fostered and adopted, joined the family at the couple’s home in Morris, population of 5,140. The rural town rises up from the prairie to the west of the Pomme de Terre River, attracting thousands to the Stevens County Fair each summer.

As Manolis’s son received his various diagnoses, she said, life had become strained in the household, the violent episodes mounting. Last year, when he was 15, he woke up late one September day and asked for help to shower — which was a daily routine. Manolis asked him to wait for a few minutes while she made breakfast for his siblings. His mood quickly escalated and he exploded, she said.

“To say that the system is flawed is inaccurate. There is no coherent system to help these kids and their parents.”

— Sue Abderholden, Minnesota chapter of the National Alliance on Mental Illness

Youth like Manolis’s son wrestle with complex psychological diagnoses, trauma, autism and other mental health challenges — and their parents often have exhausted all available resources. The recent federal study matched child welfare cases in Florida and Kentucky to Medicaid data, finding that 98% of the children involved had been diagnosed with a behavioral health condition; 1 in 5 also had a disability.

Manolis said by the time she took her son to the emergency room for psychiatric care for the first time in 2021, they had tried various parenting techniques, medications and therapy. He had monthly visits to a psychiatrist, weekly therapy sessions, special education services that included a one-to-one paraeducator, behavior, speech and occupational therapy. But it wasn’t enough.

The results of a recent neuropsychological assessment indicated the boy needed a minimum of 50 hours a week of in-home supervision, with two care staff present for safety reasons.

“But because we live in a rural area, we were never able to get enough staff,” Manolis said. “His behaviors would get worse when he wasn’t receiving the care and attention he needed.”

Landing in the emergency room in a psychiatric crisis last September prompted Manolis’s decision not to bring him home. She said by that point, after years of similar episodes, the 15-year-old was familiar to emergency room staff and local police. He’s been taken several times to emergency rooms in Morris, as well as the Twin Cities — stays ranging from a couple overstay hours in the ER to two months in a cancer ward when there was nowhere else to admit him. But this time, the hospital sought to release him after just an hour.

And the police, in turn, determined it was unsafe for him to return home, Manolis said, “so they charged him with domestic assault and interfering with a 911 call.”

He was then taken to a juvenile detention facility, where he remains today.

Nowhere to go

While this 15-year-old ended up in the justice system, other youth in similar circumstances end up “boarding” in local hospitals after immediate health crises have been treated.

Specific numbers are hard to come by. But a point-in-time count commissioned by the state Department of Mental Health examined a two-week period in 2023, finding that roughly 107 youth remained in the hospital simply because they had nowhere else to go. The authors of the study found the delays, lasting an average of 27 hours, were typically caused by a lack of inpatient beds, an absence of consent and cooperation by parents and guardians, or county workers still deciding on a next step.

Dr. Jeff Louie, chief of pediatric emergency medicine at the University of Minnesota, said boarding youth with severe mental health needs creates a cascade of challenges for short-staffed departments like his. He has seen kids remain in the ER for 12 days or as long as a month.

“Since Covid hit, we’ve seen a huge influx of kids who exhibit aggressive behavior; some are suicidal,” Louie said. “There’s been times when I have up to 10 kids in beds in the halls, because we don’t have a room for them.”

Todd Archbold, a former social worker-turned CEO of the private mental health treatment provider PrairieCare, noted a similar trend.

“Kids being boarded in emergency rooms — not for treatment, but just to be kept safe — is a crisis,” he said.

Adding to the difficulty are a shortage of treatment beds in residential facilities, fueled by pandemic-era facility closures and and staffing shortages.

In The Imprint’s most recent annual tally of foster homes and families, the number of congregate care providers in Minnesota has dropped from 292 providers in 2020 offering 2,996 beds to the 2023 count: 255 providers offering 2,463 beds.

Without intensive community services and sometimes just based on the needs of the child, parents seek out residential treatment. But there are often long waiting lists which leads to these children boarding in the ER,” said Sue Abderholden, executive director at the Minnesota chapter of the National Alliance on Mental Illness.

Abderholden said Minnesota’s mental health care system lacks “upstream” treatment options before things feel out-of-control at home, as well as availability in residential facilities.

“To say that the system is flawed is inaccurate. There is no coherent system to help these kids and their parents,” Aberholden said. “Though the need has been growing, we haven’t done the necessary work to lay the foundation for that system.”

Parents in jeopardy after relinquishment?

County officials say parents who decline to retrieve their children from hospitals will be questioned by CPS to determine if they are neglecting their children — or whether they truly have no other option and the crisis reveals no flaw in their parenting that would warrant court intervention. In most relinquishment cases, Arntson said, formal accusations of child neglect are not filed against these parents. Their children enter foster care as voluntary placements that do not require parents to attend court hearings or to surrender their decision-making rights while placements are sought.

To strengthen the practice, state lawmakers introduced a bill during this year’s legislative session that would ensure parents who relinquish their children are not accused of neglect.

The legislation, authored by Minnesota state Sen. Erin Maye Quade, is designed “to clarify that a child who has a mental, physical, or emotional condition is not considered neglected solely because the child remains in an emergency department or hospital setting due to a lack of access to necessary services and the child cannot be safely discharged to their family.”

The provision was included in a larger comprehensive Health and Human Services bill signed into law by Gov. Tim Walz in June.

If mental health services are hard to access in metro areas like the Twin Cities, they’re even more scarce in far-flung rural areas like Morris, where Manolis lives with her spouse and their other adopted children.

“We’re educated parents, we have deep experience with fostering and adoption,” she said after testifying in support of the bill in March. “Thinking about those parents who are in similar situations being subjected to negligence investigations keeps me up at night.”

While Maye Quade said the bill is a good first step, she hopes the Legislature will also appropriate more funds to increase early childhood interventions, community-based outpatient services, improve training of staff who provide specialized care and treatment of youth, and fund more in-patient beds for acute crises.

Other states have taken similar measures to avoid parental relinquishments, including an expansion of intensive outpatient care, multisystemic therapy that involves families, schools, treatment providers and community members, and respite centers that offer families short-term cooling off periods. Legislation pending in Texas would enhance funding for such interventions, as will a law recently passed in Iowa that expands mental health care services.

“It’s important to note that a lot of these kids are on waiting lists,” Maye Quade told The Imprint about the problems in Minnesota. “Providers have agreed that residential treatment is the best next step. But the backlog is so long, there’s no bed to discharge them to.”

With too few options in her region, Manolis said her son remains in a juvenile detention center — an outcome no one wanted to see. 

And for her part, after an initial interview, Stevens County social workers did not pursue a parental neglect case against her because she agreed to a voluntary placement agreement.

“But, had we not done that, CPS would have had to move forward with a court-ordered neglect screening,” said Manolis. “If CPS opened a case against us, we could both lose our jobs,” she said of her spouse. “We could also lose the other kids in our home, who are adopted and have been through high-level trauma.”

Nonetheless, she said she’s still seeking treatment options for her son, who she describes as “smart and sensitive.”

Manolis added that she believes her son’s healing process will not be linear. In the past, it’s felt “impossible” to know what triggers him, she said, and there’s still much to be learned about his diagnoses and how to treat them.

“We need to create a society that accommodates people like him so that he can feel loved and accepted,” Manolis said. “If we can find meaning in his life, he will too.”

UPDATE: This story has been updated to clarify a paraphrased quote from Sue Abderholden.