Kids sliding down a tube slide
Getting a bill through the legislative process can be a long, tortuous process. Credit: dadblunders, flickr creative commons


Reductions to the state’s health and human services budget made during last year’s legislative session become reality.

By Rose Hoban

Federal law mandates that every state provide early-intervention services for children who have identified developmental delays, and until now North Carolina has provided those services through a network of 16 child-development service agencies (CDSAs).

But cuts to the CDSA budget made during the 2013 legislative session have meant that planners at the state Department of Health and Human Services have had to eliminate some positions and move around others in order to meet lawmakers’ goals. And although DHHS staff maintain that the same number of children will still be served, advocates for children worry what the cuts will mean.

During the past year, $8 million of one-time funds were cut from the CDSAs; the cut going forward is $10 million of the annual allocation.

According to the Division of Public Health’s Kevin Ryan, that meant cutting 77 vacant positions across the state this year to meet the $8 million reduction. In the coming year, the $10 million will entail reducing statewide staff by 160 full-time positions and closing four of the agencies.

Budget language instructed the department to prioritize centers with the highest caseloads in rural and underserved areas of the state.

“Faced with this challenge, we had a core goal. We tried to use innovative thinking to try to figure out how to best absorb $10 million in state funds and the elimination of 160 positions while still providing high-quality services to our families in every county of the state,” Ryan said.

He told lawmakers that the crux of the reduction plan would consolidate three state-run CDSAs in the eastern part of the state, with the child-development program run out of the East Carolina University School of Medicine. The idea is that ECU will pick up many of those workers and handle coordination for children in 28 eastern counties.

“That would be about a quarter of all of the infants and toddlers that we serve in this program in this consolidated CDSA,” Ryan said.

Early Intervention

Child-development experts say that early intervention for children with developmental delays is critical. To meet that, North Carolina’s CDSAs work with children from birth to 3 years of age.

If a physician, parent or day-care instructor notices that a child seems to have a developmental issue, people trained in assessment come to the child’s home for an evaluation. Ryan told lawmakers that last year the program served 19,914 children, the highest rate ever.

Some of the children are found not to have problems, but others go on to receive in-home services such as speech therapy or physical therapy from the program.

Ryan explained that 70 percent of the children go on to make “greater than expected improvements” and more than half of the children who are diagnosed with a problem eventually catch up with their age cohort.

“Once you reach your third birthday, you’re out of our program; you graduate,” he told lawmakers on Wednesday.

Julia Adams, lobbyist for the Arc of North Carolina, said it’s critical to get involved with a family as soon as possible after a child is diagnosed with a developmental disability.

“Those early-intervention centers start preparing the family, working with the family, supporting the family – starting to make those contacts for the services that are out there for the family. Then you can actually see later on less services required for that same population,” she said.

Adams expressed concern that taking so much money out of the early-intervention system would make it harder for children to get the services they need, especially for many of the children who have significant developmental disabilities.

“This is a huge cut on top of multiple other cuts,” she said, “and this program is critical to those families.”

Spreading the pain

Ryan argued that the plan to consolidate in the eastern part of the state would not require families to travel farther to receive services, as reported in some media outlets, because CDSA services are provided in children’s homes. He also said the reductions would not reduce services in the eastern part of the state any more than services are being reduced in the rest of the state.

“We cannot continue to resource every CDSA at the same level when we have $10 million fewer than when we had $10 million more,” Ryan told lawmakers. “The purpose of the plan is not to eliminate services in any of those areas. But what we have to do is to take that $10 million reduction and distribute it across the entire state.”

“So the bottom line is, an individual family, child, who is in Bladen County or is in Perquimans County or is out in Hoke County or Allegheny County, they’re going to be receiving the same services they were receiving before, it’s just that the structure is different?” asked Rep. Nelson Dollar (R-Cary).

Ryan agreed, to a point. When pressed by another lawmaker, he admitted that making do with less money for record numbers of children would be “interesting.”

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