By Anne Blythe

Whenever children are removed from their homes as social workers and others try to protect them from abuse, neglect or other dangerous situations, it can be emotionally wrenching for them.

Some have been even further traumatized in North Carolina recently by having to sleep in the offices of social service departments, in hospital emergency rooms or local hotel rooms as child welfare workers search for a safe bed and temporary housing.

Further complicating the situation is that more children are coming into the state’s child welfare program with complex behavioral problems, according to a report released last week by the state Department of Health and Human Services.

Dozens of children across the state need immediate protection on a weekly basis, a number that often far exceeds the availability of services and foster care spaces at that crucial moment, according to the new $60.1 million Transforming Child Welfare and Family Well-Being Together: A Coordinated Action Plan for Better Outcomes.

“‘Living’ in these inappropriate settings compounds the trauma that children experienced during separation from their families and natural support systems,” the action plan states. “The longer children are separated from their families, the less likely they are to be reunified with them, and they run a higher risk of experiencing poor health and social outcomes, including homelessness and involvement with the justice system.”

Research shows that such adverse experiences result not only in poor mental health outcomes, but poor health outcomes overall. Multiple studies have found that childhood experiences such as abuse, being separated from parents, witnessing violence and other traumatic events put children at increased risk for problems such as heart disease, cancer and diabetes as they age. The greater the tally of such experiences, the studies show, the greater the risk for serious health problems later in life.

Karen McLeod is president and chief executive officer of Benchmarks, an umbrella non-profit organization that advocates for groups that provide care for children and families. The development of an integrated plan is a “great first step,” she said.

Much has been going on to protect the welfare of the state’s children and families, but often that work is done in silos, in part because of how federal funding comes to the state with very specific instructions for how it can be used.

The opioid epidemic, the pandemic and more families struggling to make ends meet have contributed to the increase in children coming into the child welfare system with complex behavioral problems, McLeod said.

Bringing different stakeholders together to create a shared vision they can all operate under will go a long way toward providing quicker and better care for children coming into the foster care system with greater health needs, McLeod added.

McLeod is part of a 38-member team from an array of DHHS divisions, county social services offices and her organization, along with the NC Healthcare Association, the NC Association of Health Plans, Alliance Health, UNC Health Care, Vaya Health, the UNC School of Government and the General Assembly. The group has met for months discussing the child welfare issue and developing steps to tackle some of the problems.

The report released on Wednesday is the first of a series of recommendations the team plans to release throughout the year. Among other things, the group recommends adding three additional employees across DHHS to strengthen its rapid response team that meets daily to help county social service providers and others across the state find solutions for children being housed in inappropriate places.

“This action plan exemplifies the kind of multi-sector work NCDHHS is committed to leading as we build on lessons learned and capabilities we developed during the pandemic to recover stronger,” Health and Human Services Secretary Kody Kinsley said in a statement. “We are focused on three priorities: investing in behavioral health and resilience, supporting child and family wellbeing, and building a strong and inclusive workforce. It won’t be easy, but we can solve the crisis for kids with complex needs and their families by taking coordinated action across these three priorities.”

Building and expanding pilot programs

Among the recommendations are:

  • Provide more community-based comprehensive services for children and families so they can stay together in their homes if possible;
  • Create new programs to provide more crisis housing and beds in facilities across the state;
  • Build coordinated and integrated systems through which children in crises can be quickly connected with mental health support close to home; and
  • Provide administrators with more leeway and new enforcement options so that new providers can be licensed more readily and get to work caring for children

Kinsley, who was sworn in as secretary of health and human services on Jan. 1, has spoken often about strengthening behavioral health services and doing more through collaboration to ensure the health and well-being of North Carolina children and their families as the state moves beyond the pandemic.

Thirteen recommendations are included in the report developed by the transformation group. Some come with recommendations for new funding. Others come with no new price tags but shift how and where such services will be provided.

If the team gets its way, several pilot programs will be extended to all 100 counties and new ones will be created to test in selected counties.

Among the pilot program suggestions are:

  • Expanding the High-Fidelity Wraparound Services pilot program available currently in 33 counties to all 100 at a price tag of $5.1 million in recurring funds.
  • Launching Sobriety, Treatment and Recovery Teams, or START, pilot programs in 10 counties using funds from the Substance Abuse Block Grant in the American Rescue Plan Act for two years. Then the plan is to look for $2.8 million in recurring funds from the state legislature to continue the program.
  • Expanding the Mobile Outreach Response Engagement Stabilization (MORES) crisis intervention teams program to all 100 counties, which will cost $28 million in recurring funds.
  • Establishing Placement First pilot programs through which an estimated 60 to 159 children can be placed quickly in foster or kinship homes or small group homes for up to 90 days with intensive support while there and for up to two years afterward. That would cost $8 million in recurring funds.

Tracking beds, increasing hotline volume

During the coronavirus pandemic, the public health team created new databases and infrastructure so health care systems, labs and pharmacies could share information about vaccines, COVID tests and hospital capacity to help guide the state’s response.

Kinsley has said that he hopes DHHS can build on those systems and track more information about the availability of behavioral health crisis beds across the state. The goal is to share that information quickly with providers who might be experiencing a shortage in their area so children and others won’t have to stay in office settings, emergency rooms or other places where they can languish, sometimes for weeks.

There are other suggestions for more coordinated statewide approaches such as:

  • Creating a bed tracking and crisis referral system that allows for crisis beds to be tracked in real time, a program that would cost $10 million in recurring funds.
  • Beefing up staffing at 988, the new mental health crisis hotline that is set to launch this summer at a price tag of $2.7 million in recurring funds.
  • Expanding the reach of the NC Psychiatric Access Line, or NC-PAL, to include more primary care providers across the state. No new funding is necessary.
  • Establishing 10 licensed emergency respite programs that can deploy support teams to give parents in foster care, kinship homes and other families temporary relief from intensive parenting responsibilities to protect children in foster care from potential abuse or neglect. The program would be supported with $3.6 million in recurring funds to provide the state share that would be matched by federal Medicaid dollars.
  • Building a professional foster parenting program through which the foster parents could receive specialized training and resources to care for children with higher behavioral or physical health needs. The pilot would start with 10 to 12 professional foster parent families who would be given a living wage and trauma-based training to serve 25 to 35 children at a time. The price tag is $2 million in recurring funding. More would be needed for a statewide program.

Additionally, the report recommends requiring contracts with Community Care of North Carolina and the six state-funded mental health managed care organizations (known as LME-MCOs) for more intensive and coordinated care for children in foster care or aging out of the system. No new funding would be necessary.

A recommendation that comes with a recurring cost of $200,000 would be to give DHHS additional staffing to process, monitor and report on new program applications more efficiently so children could get support and services more quickly.

“County departments of social services have appreciated working with NCDHHS and multiple stakeholders on the coordinated action plan with interventions that can help children in our care now,” John Eller,  director of Mecklenburg County social services, said in a statement. “The children we care for often have very complex needs related to the significant trauma that they and their families have experienced. We stand ready to act collectively to support these children and families to improve outcomes.”

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Anne Blythe, a reporter in North Carolina for more than three decades, writes about oral health care, children's health and other topics for North Carolina Health News.