CHILD WELFARE: Navigating a Fractured System, Part 2

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January 13th, 2012

Omaha, NE – We continue our special report on child welfare in Nebraska today. In part one of our series, Child Welfare: Navigating a Fractured System, we talked to families whose children have been removed from the home, and are fighting to get them back. Today, we’ll talk to families whose children need help outside the home. In both cases, critics of the child welfare system say the state is making the wrong choice – one that’s more expensive for Nebraska and more traumatic for families.

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[audio:https://kvnonews.com/wp-content/uploads/2012/01/CHILD-WELFARE-PART-TWO-KVNO.mp3]

“When I found out he was going to be here in Omaha, I put my two week’s notice in, and drove him out here.” Shayla Alex is a young mom who moved from Scottsbluff to Omaha five years ago – to get help for her son.

Shayla Alex and her son Marcus, 12. (Photo courtesy Shayla Alex)

He was severely aggressive, and had been diagnosed with an “alphabet” of ailments. Between the ages of five and six, he was hospitalized six times. Five years ago, he spent eight months in Boys Town, a residential treatment center, and Alex said his behavior became much more manageable. Then, he hit puberty and his aggression got out of control.

“My son has beat me to a living pulp,” Alex said. “I’ve had black eyes, broken lips. And I’m not a small person. When he goes into a rage, even though he’s 12, he goes into a rage and there’s nothing that can stop him.”

Alex is trying to get her son back into Boys Town. But Nebraska’s Medicaid office said he no longer qualifies.

“And that is the most frustrating feeling in the world,” Alex said. “When there’s services that your child could benefit from, has proven to benefit from, but Medicaid just refuses to pay for them.”

“The decision to deny is done by psychiatrists who … have practices here in Nebraska,” said Vivianne Chaumont, the director of the Division of Medicaid and Long-Term Care at Nebraska’s Department of Health and Human Services. “And you can have the care,” she said. “What we decide is whether or not we’re going to pay for it. And that’s pretty standard practice.”

Sen. Kathy Campbell chairs the Health and Human Services Committee, which released an extensive report on child welfare reforms Dec. 15. The report included 18 recommendations, which included returning case management to the state. (Photo courtesy Nebraska Legislature)

Two years ago, Medicaid may have paid for Alex’s care. But Chaumont said the state was notified by the federal government that it was out of compliance. She said it was covering too many out-of-home services for children who shouldn’t qualify. Chaumont said the state developed a case plan to move into compliance, and that included a more restrictive definition of who qualifies for high-level treatment.

“It’s very complicated,” said Carolyn Rooker, the Executive Director of Voices for Children in Nebraska. “It’s very difficult to understand what is really the (federal government) saying that you can and can’t fund with Medicaid, and what the states are choosing not to, in terms of trying to save money.”

Rooker said the state is deliberately applying a narrow interpretation of federal guidelines to save money. “The interesting part of that,” she said, “is if they don’t fund those things, it ends up going to the child welfare system, and it costs more.”

If the state denies a child services through Medicaid, their family is often left with the option of turning the child over to state custody in order to receive those services. That costs the state more because it loses the federal match that’s provided through Medicaid.

While there are some community-based services available to children, the residential treatment that Shayla Alex wants to see available to her son, is typically not covered by any other program.

Sarah Forrest, a policy coordinator for Voices for Children in Nebraska, says Nebraska has never invested enough in strong, in-home, community-based supports. And while residential treatment should be a last-resort option, she says, it’s sometimes the only option for families who have not received help, while their child’s behavioral problems worsen.

Child welfare is set to be a top priority for Nebraska lawmakers this legislative session. Bills have already been introduced to increase oversight of the system. (Photo by Robyn Wisch)

Part of this gap in services came to light in the headline-grabbing “safe haven” debacle in Nebraska in 2008. At that time, the state’s safe haven laws were expanded to allow parents to drop off their children at local hospitals, and hand them over to state custody, no questions asked. States typically apply “safe haven” laws to newborn babies, in an attempt to prevent children being abandoned.

A resulting series of drop-offs of teen children with behavioral and mental health problems led the state to begin a massive reform effort to overhaul the child welfare system. The goal of reform was to lower the number of children in state custody – across the system. That meant providing more options for families struggling with children with behavioral health problems, so that turning them over to state custody would not be necessary; as well as improving in-home assistance for families living in poverty to reduce incidents of “neglect” that lead the state to intervene and remove children from their homes. (This issue is detailed in our first report in this series).

Senator Kathy Campbell, who chairs the Legislature’s Health and Human Services Committee, said when it comes to children with behavioral health issues, she’s concerned the state has not expanded and improved in-home and community-based services, before reducing other options like residential treatment. “We have to make sure services are there before we make changes,” she said.

Charles Gilmore and Latoria Cook shared their story of the battle to get their children back home in Part One of our series. (Photo by Robyn Wisch)

Vicki Maca is an administrator with the Department of Health and Human Services, and heads the child welfare reform efforts. She said part of the problem of reforming the system to make more sense for families, and make better choices, is coordinating the multiple agencies involved, and the multiple payers. “I think it is a challenge for us to coordinate and integrate services as much as possible,” she said. “And I think we get better at that each year and each month. And we still have work to do in that area, there’s no doubt about it.”

Joan Theye, whose story is also shared in Part One, is fighting to get her three daughters home. (Photo by Robyn Wisch)

Part of that coordination is also necessary to paint a clearer picture of where DHHS is spending money on child welfare, and where it could be saving. A recent audit of DHHS showed millions of dollars had been spent – unaccounted for – since reforms to the system began in 2009.

“I think that’s where the legislature has had some frustration in the last couple of years,” said Sen. Campbell. “Because we have not really been able to have a handle on what is the budget for child welfare – all the components to it, and what is being spent.”

Campbell’s committee released a comprehensive report in December that detailed some of those complaints, and made recommendations to help make the system more accountable. The report also made other recommendations, including returning duties like case management from private contractors to the state. Governor Dave Heineman has expressed some concern about those recommendations – and how much they will cost the state, although he said he’s open to discussion.

“A lot of this has been about money,” Maca said. “And I’ll just be very honest with you. That’s been a hard one for me as a social worker. A lot of the attention has been on the dollars and the funding and while that’s very, very important, I don’t want people to lose sight about what this is all about.”

“This is about keeping the most vulnerable population in our state, kids, safe.”

Child welfare is set to be one of the main priorities for Nebraska lawmakers at the Capitol this year. Legislation has already been introduced to roll back more planned cuts to Medicaid and increase oversight of the child welfare system. Vivianne Chaumont in the Medicaid office also said she is taking another look at some of those restrictions to see if there’s some flexibility there.

Shayla Alex will have to wait to see if any of those changes will affect her son. And in the meantime, she said she’ll to continue to ignore those voices telling her to give up her child. “Every time I turn around, people are coming to me saying just sign him over, sign him over to the state, just make him a state ward,” she said. “Why would I want to place him with people who don’t know him, don’t understand him?”

“I would never walk away from my son,” she said. “I will always love him, regardless of battle scars or not. I know deep inside that he would never want to do that to me.”

“He just doesn’t know what else to do right now.”

7 Responses

  1. Richard Wexler says:

    One need only recall Nebraska’s “safe haven” debacle to know how desperate families can get to find help for their children when the state turns its back on them.

    But residential treatment almost never is the right answer. All it does is teach children how to live in institutions – indeed, once Marcus Alex was out of Boys Town he couldn’t cope.

    Study after study has found residential treatment is a failure. Details are on our website here: http://bit.ly/6neiVw But that does *not* mean families like the Alex family should simply be abandoned. Rather, Nebraska needs a comprehensive system of Wraparound – which brings everything a family needs into that family’s own home. It’s far more successful than institutionalization, and it costs less.

    In 2009, the Family Advocacy Movement, an Omaha-based group of families fighting the blunders of DHHS, brought the father of Wraparound, Karl Dennis, to Nebraska to explain how it works. This post to the NCCPR Child Welfare Blog has a link to a video of that presentation: http://bit.ly/gu31Jt

    Top state child welfare officials were there, they listened, and then they did nothing. So Nebraska continues to squander funds institutionalizing children who don’t need it and tearing apart families needlessly. In order to pay for it, they refuse the right kind of help to families in real need, like the Alex family.

    Richard Wexler
    Executive Director
    National Coalition for Child Protection Reform
    http://www.nccpr.org

    • Shayla Alex says:

      Thank you for listening to my story and recognizing the real issues! I appreciate your support and hope with a bit more time we will have a solution for our children in Nebraska!

  2. Frustrated In Omaha says:

    Privatization is horrible, but so is DHHS. I have had to retain an attorney because of the harassment that “voluntary” treatment can cause. Once you agree to get a child help, the therapists and private contractors believe they OWN you. If you don’t do exactly as they wish – all the while billing Medicaid and the state for services they are contracted, but refuse to provide – they call in DHHS and make allegations of emotional abuse, or safety risks. It is horrible when DHS invades your home, with sheriffs and police officers, separates your family into rooms in your home and interviews your family for 2 hours.
    Know your rights, unless they have a court order, they have no rights to your home. They make you think they have more control, in reality they don’t. We have to stand up for ourselves, DHS needs to be there for abused and neglected kids, and those parents should be punished. Decent hard working parents, trying to raise a family that have minor emotional children should be given support and help. Thank god they still care, it is easier to give up these days than fight for your kids.
    Thank you for doing a story and shedding light on this SHADY subject. Publish a story on your rights with DHS next time. 

  3. taxed enough says:

    Let’s get this straight – it is the breeding couple’s job to take care of their kids. Not the government’s job, not the taxpayer’s job.

  4. Leonard Henderson says:

    Since the subject in this episode seems to be mostly about children’s BEHAVIOR- How about we get really REALLY honest about it?

    It seems to be Politically Correct to characterize bad behavior as mental illness.

    Real mental illness is exactly what you would suppose it is. It does not matter how much “residential treatment” or counseling you do, the genuine mentally ill person is going to be “out of control”.

    With real MENTAL ILLNESS, the training is to TAKE THE MEDS. I don’t have the figures for HOW MANY HOSPITALIZATIONS it takes for genuinely mentally ill people to learn that if they want to be OK, the ONLY ANSWER is the meds.

    If someone can be “trained” to not misbehave and exert Self Control, they weren’t mentally ill, were they?

    “Behavior disorders” are of rather recent origin, relating directly to Dr Benjamin Spock (See HOW DR. SPOCK DESTROYED AMERICA – http://www.wnd.com/2009/01/87179), the banning of spanking, and eventually- punishment of any sort.

    Suffering consequences for bad behavior is how Self Control is learned, the lack of which has created a selfish and self-indulgent population over the past 50 years.

    A majority of America’s families now are single mothers with children. No male influence or authority allowed. The “Dumbing Down of America” was made pretty complete 40 years ago. Morals and Ethics have been eviscerated from society.

    Bureaucrats are now the “parenting expert”.

    It is our experience that Mommas aren’t made for all the demands, legal threats, coercion these bureaucracies dish out. If government is anything, it is OFFICIOUS and has been offering plenty of “unrequested and unwanted services, meddlesome advice” in America’s families under the banner of alleged “help”.

    “Destroy the family, you destroy the country.” -Vladimir Ilyich Lenin

    America is now at 100% debt. Which I think means SOMEBODY now OWNS AMERICA.

    I am guessing WHO that might be will be a surprise “for the children” who are supposed to PAY for all this.

    American Family Rights
    http://familyrilyrights.us
    “Until Every Child Comes Home”©
    “The Voice of America’s Families”©

  5. JMR says:

    This sound like the situation in Alabama before they were sued. Why doesn’t Nebraska do what Alabama did and avoid the coming lawsuit? From what I know it appears Nebraska far less safe for children than Alabama.

  6. Shayla says:

    I am one of the parents whom shared my story. It is very difficult to admit that as a parent, you are not enough to help your child. My son has multiple diagnosis – and multiple doctors/specialists agree on his diagnosis (so it isn’t just a made up alphabet name to cover up poor parenting!). I work VERY hard to keep him on a routine, provide rewards and use effective discipline & praise. He has an illness – not a lazy or careless parent, nor is he just a “bad kid”! What he needs is constant structure and discipline tactics that can follow him at home, school, in public, etc. I am only 1 person and it is impossible for me to provide him that! The outcome I would like to see for my son is a residential program that can provide him this structure and consistancy, and teach me the skills… and then he comes home where he & I continue to use those same skills to keep his improvements going! I’m not trying to “get rid of my son”… I’m trying to raise a well-balanced, productive member of society! But I can not do it alone! And I can not continue to be physically abused by him! But I will not doom him to the Juvenile Justice system either – where he will not get any therapuetic services, but will pick up even more undesireable behaviors! There is an answer out there for me & my son… and I know with support for my family & other Nebraska families we will make a difference for our children!

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