DSS

Shows a woman hugging a little boy she's had in foster care. She is signing his adoption papers.

Foster care case numbers continue to climb in NC, as opioid crisis affects families

September 24, 2019 by Sarah Ovaska

Foster care case numbers continue to climb in NC, as opioid crisis affects families - North Carolina Health News

Record numbers of children, almost all of whom have trauma of their own, are entering the foster care system as a result of abuse and neglect.

By Sarah Ovaska-Few

North Carolina could use more people like Lisa Link, as the state grapples with record numbers of children entering and staying in the already stretched foster care system.

Link, an auto broker and owner of a small used-car lot in Charlotte, opted five years ago to become a foster parent after years of helping with family members’ children. She was single, in her early 40s, and wanted to help children coming out of difficult situations in need of a stable and loving home even if temporarily. More than 20 children have been under her care since, some for short stays of a few days or weeks and others for a year or more.

She cherishes being a dependable, caring presence for children who are often coming from chaotic or unpredictable households. She makes sure they get the childhood joys of playing at local parks or experiencing what might be new things such as eating out at a restaurant, a day at the nearby Carowinds amusement park, or going to museums.

“I’m going to take this a level up, where I can help children that needed help,” said Link, about her decision to become a foster parent. “That’s when I felt like this was my place and my calling.”

And something else happened she hadn’t expected or intended – she met her 6-year-old forever son, Latrell Ma’az Link, who has lived with Link since he was 3. Latrell ended up in the foster care system and Link’s home because of neglect. His adoption to Link was formalized last month.

“I’ve had him three years and wiped his little nose,” Link said. “I couldn’t see him going anywhere else.”

The foster care system in North Carolina continues to experience record levels of need, the increases believed to be yet another aspect of the devastation from the opioid abuse epidemic.

As of mid-summer, there were 11,700 children and teens younger than 20 in the foster care system. According to the N.C Department of Health and Human Services, that’s a 20 percent jump from just five years ago. Some of those children are in family foster homes such as Link’s. Other children stay with non-parental relatives as part of the state’s focus on kinship care to lessen the trauma experienced by children entering the system.

Those numbers also include more than 800 older teenagers. Those young people can opt to continue receiving support services such as health care through the age of 21 if they are working or in school, one of a series of reforms passed in 2017 by the state legislature.

Prescription drugs, heroin abuse behind surge

Opioid misuse and addictions are the likely culprits behind the recent growth, say those that work in and around the foster care systems. The effects of pervasive poverty, untreated mental illness and domestic violence also continue to be significant factors driving increases in foster care.

Parental substance abuse was the primary reason for the removal of a child for nearly 40 percent of the cases during the 2017-18 fiscal year, up from 30 percent five years ago and from 25 percent a decade ago, according to data provided by DHHS.

The state and most counties don’t track what specific substances – drugs or alcohol – were at the root of a family’s troubles, however. The actual number of affected children may be higher, as each county categorizes information differently. Some counties, for instance, report no substance abuse-related removals of children from homes, an unlikely scenario given the pervasiveness of addiction and the current opioid crisis.

At the state level, the focus on children removed from homes because of substance abuse is the same as any other scenario – a desire to get them in a stable and safe situation. Ideally, these children would be reunified with their parents, said Erin Baluyot, the interim program manager for DHHS’ State Foster Care and Adoption Services. If reunification is not a safe option and parental rights are terminated, the goal is to find a child an adoptive home as soon as possible.

“We do business as usual; our goal is to achieve permanency for children no matter the reason for them coming into foster care,” Baluyot said.

Sadly, children can spend years in the foster care system before being reunified with family members, or being adopted, according to DHHS.

More kids, more time

Statistics kept by the DHHS show the median time a child spends in the system was 525 days in the 2018 fiscal year that ended in June. That’s up by nearly 20 percent from four years prior, when the median stay was 441 days. The state is intent on reducing the amount of time children dwell in foster care, whether they end up going back to family or being adopted. This is one of the measurable goals in the department’s ongoing early childhood action plan.

Several high-profile deaths of children in recent years, including the 2016 drowning death of 3-year-old Rylan Ott, led to the state legislature passing changes in 2017 restructuring how child abuse investigations are handled across the state. The law was named for 3-year-old Rylan Ott, who wandered away from his Carthage home and drowned in a nearby pond. He had been returned to his mother’s home shortly before his death by the Moore County Department of Social Services, despite the mother’s erratic behavior and over a court-appointed guardian’s objections.

100 counties, one system

Though the state oversees North Carolina’s child welfare system, each of the state’s 100 counties is responsible for handling abuse and neglect claims in their respective areas, as well as the placements and well-being of children in foster care. That’s led to great disparities in how children fare in the foster care system, as the non-profit journalism outlet Carolina Public Press has highlighted in reports about Cherokee County. There, multiple children were improperly removed from their homes by county-level workers who also falsified records related to the children’s care. In addition, some children in the Western North Carolina county were put up for adoption without a judge’s knowledge or permission – major violations of the laws dictating how children are treated in the child welfare system.

Baluyot acknowledged those failings but also pointed out that there’s more to the system than tragic headlines.

“We always hear about the negative and bad things that happen, but a lot of good things happen too,” she said, pointing out that 1,300 to 1,400 children are adopted out of foster care each year. “It’s certainly a good thing. That’s 1,400 children we don’t have lingering in foster care.”

How to address the current influx of children in the foster care system is not a settled question.

A bill introduced last month in the state legislature is seeking to change how the state does business as usual. House Bill 918 would speed up the time to terminate parental rights to as little as nine months for children born with illicit drugs in their systems. The bill would also give a foster family nearly equal standing as biological family when deciding permanent placement for a child and also broadening the reasons why a child can be taken from a home.

The bill drew heated debate when it was heard in committee and has not progressed since late August.

Rising need across country

This trend of rising numbers of children in the child welfare system isn’t isolated to North Carolina. The U.S. has seen foster care cases steadily rise since 2012, following decades in which the numbers dropped, according to research published in July in JAMA – Pediatrics.

Parental drug abuse was a root cause of a child’s entry into foster care in 36 percent of cases in 2017. Young children – those under 5 – were most likely to be affected by removals because of substance abuse, according to the research. Young age is a particular concern given that those years are also when children form bonds with caretakers.

“[W]hen children enter foster care because of parental drug use, episode duration is longer and less likely to result in reunification with the parent,” wrote journal authors Angelica Meinhofer, a Cornell University researcher, and Yohanis Anglero-Diaz, a psychiatrist with Boston Children’s Hospital and Harvard Medical School.

Those trends are reflected in North Carolina, where more children 0 to 8 years old entered the foster care system last year than in previous years, according to DHHS data.

That creates a unique challenge for social workers, foster parents, teachers and other caregivers, given that those are critical ages in a child’s development.

Taking trauma into consideration

Entry into foster care, in addition to the circumstances that bring a child to the attention of child welfare workers, are considered traumatic events that carry long-term psychological and health effects. Public health researchers found in landmark research conducted two decades ago that adverse childhood experiences (ACES), events such as living in a household with domestic violence or substance abuse, can lead to a lifetime of both mental health and even physical health challenges.

Public health experts have in turn emphasized having more trauma-informed care in many settings, in hopes of lessening the impact of childhood trauma.

In the past, the number of foster care cases has decreased when the economy is doing well. That reduction is a sign that parents are able to find work and have fewer financial stressors to trigger abusive or neglectful behavior, said Ken Maxwell, head of Seven Homes, a privately run High Point nonprofit foster care placement and adoption agency that he co-founded in the mid-1990s.

Shows an African American woman and a little African American boy smiling, they're both dressed up. The little boy is in the foster care of the woman. — LIsa Link and son Latrell Link, 6, who she adopted after he spend three years in foster care in her home.

That’s not what’s happening now, Maxwell said. North Carolina’s foster care system has continuing to swell to record numbers despite the overall strength of the economy and historically low unemployment rates.

“We’re not seeing the numbers decline, we’re seeing the numbers increase,” he said. “The numbers are staying high because of substance abuse or opioid abuse.”

He also said that many of the birth families haven’t had interaction with the foster care system before, a departure from what he’s seen in other illicit drug crises. To him, it’s an indication of how quickly opioid addiction can overtake a person’s ability to maintain the regular rhythms and responsibilities of their lives.

“This sneaks up on families and they don’t realize it until they’re at risk of losing their kids,” Maxwell said. He has seen higher reunification rates, though, with children eventually being able to go back to their parents or with other family members.

Many of the children coming to Seven Homes needing temporary placements are young infants, and Maxwell has had difficulty finding enough foster families with the ability to take in newborns in need of around-the-clock care.

Though the rising numbers are not what anyone wants to see, Baluyot maintains the state currently has enough foster homes, though there’s always a need to recruit more.

Children with complex needs due to disabilities, mental health or behavioral issues as a result of sustained trauma or sibling groups may, however, end up facing longer waits for suitable homes, she said.

“We do have a lot of foster homes, it’s not like we’re in a crisis where we desperately need more,” she said.

How children fare at epicenter of opioid crisis

One county keeping track of the precise reasons why children enter foster care is New Hanover, home to Wilmington and among the most affected in the state and country by opioid misuse.

In 2013-14, 10 percent of the 189 children who entered the foster care system did so because of their caretakers’ heroin or opioid addictions. Substance use was a factor in 36 percent of cases overall, according to statistics provided by the New Hanover Department of Social Services.

Just four years later, nearly half of the 205 children entering the system came from homes where substance use was a factor, with opioids or heroin involved in 23 percent of the cases, according to 2017-18 data collected by New Hanover DSS.

Child welfare reforms

A 2017 state law enacted major changes in how the state’s child welfare and foster care agencies work. Here are some of the major pieces of Rylan’s Law, with changes currently being phased in at the state and local levels:

Requires social services observation before a child removed from custody is reunified with parents or other caretakers.
Funds to help foster care youth obtain driver’s licenses and insurance.
Shortens the amount of time to 65 days (from 180 days) for a parent to appeal court-ordered termination of parental rights.
Third-party assessment of North Carolina’s child welfare system and creation of working group looking at how to improve state oversight.
Requirement that counties agree to performance requirements set by the state, with a data dashboard later available to the public.
Allows counties to join regional departments of social services, to share resources and improve performances.
Creates goals to cut down on time children are in the foster care system and move to reunify families or start the adoption process.

Rylan’s Law followed a number of other laws that made it easier for foster youth to participate in school sports, to obtain driver’s licenses and insurance, and participate in other after school activities such as clubs and the prom.

Source: UNC School of Government, N.C. DHHS

The county also experienced an unexpected surge of need in 2016, when 280 children entered the foster care system. Their current living situations were deemed unsafe or babies born exposed to substances were unable to safely leave the hospitals with their mothers, said Mary Beth Rubright, the assistant director of social work for New Hanover Department of Social Services.

Children aren’t automatically or permanently taken away if there’s someone using drugs in the home, Rubright said. Instead, child protective services workers evaluate whether the home is safe and whether a family member can step in and provide stability if the current situation isn’t tenable.

Social workers are also steering parents toward resources for treating addiction, if applicable, and the courts often include it as a condition of being reunified with children.

“If they’re in recovery and in a program, it makes our job a whole lot easier,” she said.

Hospitals take a bigger role

There have been more babies born in the Wilmington area with opiates or other substances in their system than in the past, with social services getting involved with families in the first days, or even hours, of a child’s life, Rubright said.

In 2016, New Hanover DSS workers were notified of 54 babies born drug-positive, a term that includes both drugs being abused and those prescribed as a part of opiate recovery treatments. That went up by a startling 89 percent within two years, with 102 babies born drug-positive in 2018, Rubright said.

A big part of the increase is due to the county child welfare workers reaching out to local hospitals and making sure hospital staff were properly flagging them about children born drug-positive, a requirement under federal regulations. Reasons for notification include exposure to illicit drugs as well as to drugs such as buprenorphine or methadone that may be prescribed as part of an addiction treatment plan.

Hospital staff wasn’t consistently contacting DSS in those situations in the past, Rubright said.

To help those families, the county launched an intensive support program for mothers who give birth to children with drugs in their system. The goal: having the baby back in their mother’s care within 60 to 90 days, provided the household is assessed as safe by social workers.

The social worker running this program only has three cases at a time, down from the former average caseload of 15. This allows for more visits with the family to offer parenting support, to check in on the mother’s progress with substance abuse recovery programs and to help locate housing or other assistance, if needed.

It’s an expensive program for DSS to administer, at a cost of about $100,000 to pay for the single social worker assigned to the program and the related therapies and programs for affected parents. But the goal is to try and ensure the household is safe for a baby while setting up both mother and baby for longer-term success.

“It’s critical that you give [mothers] opportunities to bond with her children,” Rubright said. “The truth is that in the end, it’s a lot less expensive to pour those resources in on the front end.”

shows the front of the legislative building in Raleigh, general assembly

Computer glitches frustrate county workers, could eventually cost the state millions

March 22, 2019 by Rose Hoban

Computer glitches frustrate county workers, could eventually cost the state millions - North Carolina Health News

Software designed to track children in the child welfare system has been difficult to get up to speed, leading to frustration at county departments of social services. Department heads came to Raleigh for help from the NCGA.

By Rose Hoban

Once again, glitchy computer programs are creating headaches for the North Carolina Department of Health and Human Services and social workers across the state.

For many people who work in county social services departments , the culprit is a familiar one: NC FAST.

In 2013 and 2014, problems with implementing the computer system caused massive delays for families receiving Supplemental Nutrition Assistance Program benefits (formerly known as food stamps). Those software problems put the state at risk of losing federal funding for the entire SNAP program. Later in 2014, NC FAST caused a backlog of tens of thousands of Medicaid applications, again calling down the wrath of federal officials.

The issues were eventually resolved, but this week, NC FAST (short for Families Accessing Services Through Technology) was in the spotlight again, as lawmakers heard from DHHS’ child welfare program leaders about problems with the children’s services pieces of the program. A rollout of parts of NC FAST was supposed to help county social workers track children and troubled families through the social services and foster care systems. Instead, county social service directors told lawmakers about mass resignations of staff who cite their frustrations with NC FAST as part of the reason for heading out the door.

And the choices lawmakers need to make about how to address the problems will likely cost tens of millions of dollars, no matter how the state proceeds.

NC … SLOW?

The need for better tracking of families involved in the child welfare system was one of the reasons that North Carolina failed reviews by the federal Children’s Bureau and a private audit in 2016.

Two decades into the age of the Internet, most county DSSs still use paper files to keep records about child abuse, neglect and the services they receive. Social workers lack the basic ability to track troubled families with vulnerable children who may move across county lines. They also can’t access criminal records. The two reviews cited this lack of data, the inability to track where families are, and an inability to find children who fall through the cracks.

These pitfalls in the system were highlighted by the case of 3-year-old Rylan Ott, whose tragic 2015 death in Moore County inspired an eponymous law intended to overhaul the child welfare system.

NC FAST was created to provide a common platform for all of social services, from Medicaid eligibility to tracking troubled families and have all the information in one place.

“Since the rollout of NC FAST, aprox (sic) one year ago, I am not able to meet the administrative expectations and maintain a full-high caseload without extensive overtime hours worked.” – excerpt from resignation letter provided by Rowan County DSS to legislators.

Matt Salo from the National Association of Medicaid Directors said that issues with software packages for big state programs are a common complaint across states.

“When we convene members … the IT stuff is always in the ‘I’m really frustrated by this’ category,” Salo said. “In every single state, whenever they do this, there are delays, cost overruns and by the time the whole thing is built some portion of it is outdated.

“Nobody’s got an answer.”

Moving ahead

Despite those initial glitches and crashes, the systems for SNAP and Medicaid eligibility slowly improved. So, in 2015, state officials decided to move ahead with developing NC FAST modules to track children and families in the child welfare system. Work started in 2016.

An original five pilot counties started using the system in August 2017, among them was Sampson County, where Sarah Bradshaw is the director of social services.

She told NC Health News that in the first six months of deployment, she had a 60 percent turnover of her social work staff of about 40 workers.

“I cannot say that everyone leaves saying it was because of NC FAST. They don’t communicate it exactly that way,” Bradshaw said. “Seeing their tears and seeing their concerns we know that it doesn’t work for them and is causing frustration.”

The problems with the rollout were profound enough that DHHS delayed statewide deployment and added another six counties to the pilot program while they worked to get a fix.

“We went back to IBM … and said, ‘You all need to help us make the system better, and you need to do it for free, we really need you to do some work with us,’” DHHS’ Susan Perry-Manning told lawmakers. “We leaned heavily on them, we leaned heavily again on our pilot counties to help us with a redesign.”

But according to DSS directors who spoke up at the Joint Health and Human Services Appropriations committee meeting on Tuesday morning, NC FAST has continued to frustrate.

Big ticket

Thus far, the creation of the child welfare part of the system has cost $92 million with $42 million of that from the state and the remainder in federal dollars. And the budget calls for another $11 million in spending, with $5 million of that coming from the state.

DHHS and the pilot counties have been working with IBM to redesign the system, said Perry-Manning, and the newly redesigned intake and assessment portions went live in 19 counties in January.

If North Carolina decided to abandon this portion of NC FAST, Perry-Manning told lawmakers, the state would be on the hook for repaying the feds that $52 million and would be left to start from scratch, a process that could take years.

However, slowing down implementation to work out all the problems would cost about $1.5 million per month.

“I think with the redesign work that we’ve done so far, we are very close to having a usable product that places a reasonable amount of effort on counties, but not undue effort on counties,” Perry-Manning told NC Health News. “That said, I think the counties would, in fairness, have a different view right now.”

She admitted that there would always be some level of data entry to be done by county workers, which was one of the main complaints coming from DSS directors.

“It would be unfair to suggest that this particular technology product is ever going to operate like Facebook, or Amazon operates,” Perry-Manning said.

She argued that there’s been “a total redesign of the program,” and the bits that went live in January take some getting used to for the 23 counties that had previously only kept paper records.

“Imagine going from paper-based to where you have to enter everything into the computer,” said Susan Osborne, Assistant Secretary for County Operations for Human Services at DHHS. Osborne herself weathered issues with NC FAST’s troubled SNAP rollout while she was the DSS director in Alamance County, so she has been key in reassuring county DSS directors during the recent implementations.

Not every county director is unhappy. Crystal Mitchell from Orange County rose to tell lawmakers on Wednesday that her staff “enjoys” using NC FAST and that she’s seeing benefits in her department.

“A couple of those benefits include transparency and data visibility,” she said during the appropriations committee meeting’s public comment period. “We’ve been able to see the benefits of that with other counties that are in NC FAST, with families that have moved away from Orange County or they have history in other counties, that data is at our fingertips.”

Mitchell acknowledged some of the problems with the system, and the need for improvement.

“We would be remiss if we did not acknowledge NC FAST’s willingness to partner with us, the Division’s willingness to partner with us, to hear our feedback, we feel like that feedback has been considered,” Mitchell said. “There’s been redesign that’s occurred within the system and we’ve been impressed with that redesign.”

Perry-Manning seems to have convinced lawmakers for the time being to keep moving forward. On Wednesday, a bill that would have suspended development of the child welfare portions of NC FAST was amended to delay any further rollouts until October.

“I think we are within striking distance of making this system workable,” she said.

shows children looking frightened as they tumble down a slide

Children Face Struggles in Some North Carolina Counties, Stats Show

August 1, 2018 by Carolina Public Press

Children Face Struggles in Some North Carolina Counties, Stats Show - North Carolina Health News

Results from this year's Kids Count Data Book shows North Carolina rates highest in education at 22nd in the U.S, but lowest in family and community at 36th.

By Karrigan Monk

Carolina Public Press

The numbers say North Carolina is middle-of-the-road edging toward poor in some categories when it comes to the well-being of the state’s children, with some counties posting alarmingly high numbers for neglect cases and children in foster care.

But children are more than just numbers, and even accurate data often reflects difficult and complex situations. Sometimes the data points toward solutions. Sometimes it can obscure the everyday realities in resource-deprived communities.

Kids County graphic showing rate of low birthweight, prenatal care and other infant health metrics — On infant wellness metrics, North Carolina ranked 29th in the U.S. Image, data courtesy: Annie E Casey Foundation/ NC Child

Carolina Public Press recently talked with DSS officials in three northeastern counties that posted low indicators for child well-being in new data published by the Annie E. Casey Foundation.

Kids Count statistics

Since 1990, the Annie E. Casey Foundation has analyzed 16 key indicators to determine the well-being of children across the nation. The indicators each fall into one of four categories: economic well-being, education, health, and family and community.

Based on these indicators, North Carolina has been ranked 32nd overall in the 2018 Kids Count Data Book. Of the four categories, North Carolina rates highest in education at 22nd, but lowest in family and community at 36th.

“Our ranking in each domain is dependent on our own progress but also that of every other state,” said Whitney Tucker, research director at NC Child, a Raleigh-based children’s advocacy organization.

“In all but one indicator within the family and community domain, North Carolina has actually shown improvement from 2010 to 2016. This domain highlights the fact that while our state is moving in the right direction for families, we’re not taking big enough steps as quickly as other states to promote the things we want to see.”

Kids Count graphic represents metrics such as infant mortality rate and the number of children without health insurance — On overall child well being metrics, North Carolina ranked 32nd in the U.S. Image, data courtesy: Annie E Casey Foundation/ NC Child

NC Child works with the Annie E. Casey Foundation to provide accurate data for the state. NC Child also complies data cards for each of North Carolina’s 100 counties using similar categories.

Based on the research, NC Child found 7.1 children per 1,000 are in foster care in North Carolina, an increase from 6.8 from the previous year. Similarly, 56.3 children per 1,000 have been assessed for abuse or neglect, down from 57.2.

Pointing toward improvements

Several counties ranked well above this statewide average, including a number in the state’s northeastern region. That’s not a surprise, but a call to action, according to Nancy Connor, the Williamston-based supervisor of Martin County Child Protective Services.

Connor said the data represents her county well, even though Martin County has a rate of 14.7 children per 1,000 in foster care, more than double the statewide average.

Kids Count graphic showing metrics such as number of children subject to abuse and neglect, or living in foster care — On family and community metrics, North Carolina ranked 36th in the U.S. Image, data courtesy: Annie E Casey Foundation/ NC Child

Connor points to the county assuming custody of two large sibling groups for this statistical spike. Even so, she said, her county could use more resources in terms of employment and mental health services.

“Martin County’s primary goal is to ensure the safety of children by assessing and investigating reports of abuse, neglect and dependency,” Connor said.

“In that process, we provide families with resources to adequately meet their needs by linking the family with providers within and outside of the county. We provide community outreach to educate and bring awareness to services we provide and preventative measures to ensure the safety of our children.”

Still, Connor said, the outreach and services may not be enough if the county lacks the economic resources to help the families of these children.

“Parents need high-paying jobs, affordable housing and child care,” Connor said. “Families need accessible mental health providers and available resources within the community for children with special needs.”

Tucker agrees that more resources should be available to children. Because of new legislation, only 3,700 North Carolina children will gain access to services provided by Child Care Subsidy, which uses state and federal money to help families with the cost of child care, Tucker said. The waiting list has more than 50,000 children.

Tucker said she would like to see money that was recently taken away from child welfare by legislators be returned so that North Carolina’s children can be properly cared for.

“North Carolina has a variety of critical programs to help children and families, but many need to be scaled up so that all children can access them,” Tucker said. “The network of public programs generally does a great job for kids, but not for parents, and we know that kids need strong families to thrive.”

What data doesn’t show

DSS officials in several northeastern counties said they were surprised North Carolina ranked so low in the family and community category, and questioned whether the numbers accurately represent their trends.

Teresa Gilliam, the Jackson-based supervisor of Northampton County DSS’ children services, said the data does not fairly or accurately represent her county nor does she believe North Carolina should be ranked so low.

State intervention in Cherokee County

Not every county with troubling children’s well-being numbers was located in the same part of the state, and not every one of them has the same history.

Cherokee County, in the state’s far west, has some of the highest incidences of foster care and assessment for abuse and neglect at 26.5 per 1,000 and 118 per 1,000, respectively. Its history may include some of the same resource challenges as other rural counties but also involves poor decisions made by adults in positions of authority.

The N.C. Department of Health and Human Services took control of Cherokee County Department of Social Services in March after a three-month investigation of the system.

Kelly Haight, state Department of Health and Human Services spokesperson, said the investigation revealed Cherokee County DSS had since 2009 been sidestepping the required court mandates to place children in foster care, instead using a policy of custody visitation agreements. DHHS has since advised all counties that this is unacceptable.

“(DHHS) will work with county leadership to develop a plan to return administration of child welfare services to Cherokee DSS upon completion of training, hiring staff in key positions and ensuring effective supervision of child welfare services,” Haight said.

“The Cherokee County Board of County Commissioners and the Cherokee County Social Services Board have supported our intervention.”

Cherokee County DSS Cindy Palmer was suspended, and the department’s actions under her are the subject of a State Bureau of Investigation probe.

Cherokee County DSS did not respond to requests for comment from Carolina Public Press.

shows people at a table, one woman is talking

Much-needed Social Services Reforms Underway

March 14, 2018 by Rose Hoban

Much-needed Social Services Reforms Underway - North Carolina Health News

A multidisciplinary group has been working since October on changes to be made to the social services system. The activity comes in the wake of some high-profile deaths of children in the system.

By Rose Hoban

A 3-year-old boy drowns while in his mother’s care. A 14-month-old boy dies of malnutrition. A 14-year-old overdoses on antidepressants. These are all children who died while in the care of the social services system.

And lawmakers want these deaths to stop.

Now, after close to a dozen meetings, members of a group working on a reorganization of North Carolina’s social service system say they’re making progress with reform.

The Social Services Working Group was created as a result of the Child Protection and Accountability Act (HB 630), passed in 2017 and intended to reorganize the child welfare system, and with it, the rest of social services.

The law allows for the state to take over county social services agencies that are having difficulties, but more important, it creates a regional system that allows for more day-to-day state oversight of a system that’s currently run by counties.

“We have children, we have families, we have elderly that are hurting in this state and we can’t keep turning our backs,” said Sen. Tamara Barringer (R-Cary)

“Some of the counties are doing really good work in some areas, no county is doing perfectly,” she said. Barringer said the goal is to create “the same high-quality care for all vulnerable people no matter what county.”

Thorny problems

According to Barringer, who sponsored HB 630, the measure was needed because of significant gaps in the child welfare system. The bill was combined with another measure named for 3-year-old Rylan Ott, who died after being returned to his mother by the Moore County Department of Social Services, despite her erratic behavior.

The state’s child welfare system has had problems for a while. Those problems were laid bare in a now-infamous 2013 incident in Union County when a child being fostered by a local social services supervisor was found in his underwear, shackled to a rural porch, with a dead chicken hung around his neck.

Further problems were highlighted in a review released in late 2015 by the federal Children’s Bureau that concluded that North Carolina did not meet standards in any of seven outcomes measures, such as children being protected from abuse or neglect. In early 2016, a private consulting firm found inadequate funding for child welfare, the need for better training of child social workers, lack of adequate state authority to address problems at the local level, high worker caseloads, and high staff turnover.

shows a group of people at tables, looking at documents, a man stands at the front of the room, tking notes on a whiteboard — Members of the Social Services Working Group review documents during a meeting on Monday at the UNC-Chapel Hill School of Government. Photo credit: Rose Hoban

At the time state officials pointed to the difficulty of having state oversight of county-based systems, noting that it was difficult to identify problems in such a sprawling system and harder still to make improvements in county agencies answerable primarily to local governments.

Barringer and others moved to provide some state oversight at the regional level.

Oversight welcomed

Initially, the thought of creating the oversight structure was a difficult sell, said Rep. Sarah Stevens (R-Mt. Airy), who championed the child welfare measures in the House.

“The additional thought of regional takeover was … it was the end of the world,” Stevens said.

States such as Pennsylvania, Virginia and Georgia have enacted similar regional oversight offices for local social service agencies. In fact, North Carolina is in the minority of states that retain so much local control over social services.

Stevens and Barringer co-chair the 18-member working group, which includes four county commissioners and three county DSS directors, who quickly embraced the concept of having a regional presence for state supervision as a way to increase support for counties.

“We really thought that county directors who run their social services may have some hostility,” Stevens said. “But they came right on board and said we understand and we do need that help and we can’t do everything.”

Part of the meeting at the UNC-Chapel Hill School of Government on Monday was a discussion of what to call the regional administrator; the group eventually settled on labeling the position as a “director.”

Solutions evolving

At the legislature on Tuesday, DHHS Deputy Secretary Susan Perry-Manning gave an interim report to legislators on the progress of improving the child welfare system that is ongoing even as the work group is devising larger plans.

For instance, Perry-Manning said the agency was doing a better job of getting out into counties to investigate child deaths within five days, whereas in the past, it had taken a lot longer.

“We’re going into counties, really doing record review, providing feedback to social services directors relatively quickly, and providing guidance and tech assistance as we go,” said Assistant Sec. Michael Becketts, who oversees the Division of Social Services.

Both Perry-Manning and Becketts have worked with Barringer as part of the social services working group, and Barringer expressed her support of them, before venting her frustration with the current system.

“It’s appalling that we have 100 counties and depending on what county we’re in you get a different outcome, you get a different level of service,” she said. “One of the things that the Rylan’s law and the work we’ve been doing over the last year is to see that no longer happens.”

Governor’s Budget has Rough Cuts for Health & Human Services

May 17, 2012 by Rose Hoban

Governor’s Budget has Rough Cuts for Health & Human Services - North Carolina Health News

At the short session begins, state officials and advocates are bracing for painful cuts to the health and human services budget, and preparing to push back.

By Rose Hoban

State health officials presented the governor’s proposed budget before the House Health and Human Services Appropriations Committee today, and while there were a few bright spots in the budget, there’s a lot of pain, especially in children’s services.

Secretary of Health and Human Services Al Delia delivered the good news first: money to increase the number of community mental health beds around the state, funding for the NC Pre-K program, and the introduction of ‘smart cards’ to identify recipients of Medicaid and social service payments and reduce fraud.

: Division of Social Services head Sherry Bradsher (left) explains some of the cuts to her budget after Wednesday’s meeting

But the pain comes quickly in this year’s budget, even if a proposed three-quarters of a cent sales tax could make it through the legislature. And though the governor has proposed to spend $20.9 billion, up from $19.7 billion last year, there still are plenty of cuts.

Republicans in the General Assembly have vowed not to increase taxes, so the budget they propose later this week is likely to be even more painful.

Nothing in Wednesday’s meeting got as much attention as cuts to children’s services around the state. Those cuts come, in part, as the result of automatic spending cuts mandated by Congress’ debt ceiling deal struck last summer. Congressional leaders were unable to come to an agreement on ways to trim the federal budget, so automatic cuts to defense programs and to social service programs will be included in this next federal fiscal year.

And the cuts are also the result of steady reductions in federal allocation to states for the welfare program, known as Temporary Aid to Needy Families (TANF). Congress has kept funding flatlined for the past few years, and supplemental dollars for the program have not been reauthorized by Washington.

“We are going to experience a significant reduction in the TANF program,” Sherry Bradsher, director of the state Division of Social Services told the committee.

Bad for children

Bradsher told lawmakers that county officials had asked for ‘maximum flexibility’ in how the state allocates dollars to counties. She went on to detail how state officials are working with county social services directors to strategically move money from block grants around, in order to protect the most vital services.

Block grants are large chunks of money given to counties to pay for services. Some grants have strict guidelines for spending, while others allow local officials more ability to prioritize, while still meeting mandated services.

Children’s protective services will see a total of about 20 percent taken out of state dollars. But Bradsher said actual cuts won’t be so bad, because county managers are permitted to move money from the Work First (welfare-to-work program) block grants to children’s protective services to make up some of the losses. Even still, she admitted the cuts would be deep.

“Without question, i believe we will lose child protective serves workers across the state,” Bradsher told legislators. “These cuts are bad. They’re bad for children. and they’re bad for our chiidren’s protective services program.”

Some counties have more resources to make up for their losses.

“Many have contracts with not for profits to do prevention, some have contracts with employment agencies, such as Goodwill, to support their employment programs, some are spending 70 percent of their Work First block grants on child welfare, some are spending 40 percent of their Work First block grants on child welfare…” Bradsher said. “It varies from county to county across the state.”

Committee members expressed their commitment to preserving services for children.

“I agree this isn’t the best place to be cutting and understand that the federal government needs to be cutting back on dollars,” said committee co-chair Justin Burr (R-Albemarle) “i think that’s critical… that as a committee we meet that obligation and keep those dollars that are going to making sure that children are protected and safe in their communities.”

Other cuts to children’s services:

Child care subsidies will be cut, but Bradsher said the cuts will primarily affect families on the waiting list for child care. “There won’t be any adverse impact on kids currently being served in the program,” she said.
Teen pregnancy prevention services will see a 19 percent cut. According to Bradsher, that will mean a reduction in services. North Carolina’s teen pregnancy rate is 49.7 pregnancies per thousand girls between the ages of 15-19, down from a peak of 105.4 per thousand in 1990.
Adoption and foster care services will see cuts, some of which will be mitigated by federal money.

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