Friday, November 30, 2007



It appears Raleigh's Dorothea Dix Hospital will not shut its doors by this February as state and local lawmakers had originally planned. Wake County officials are working to finalize a plan that would keep the state mental health hospital open until 2011. The change in plans makes 32 beds available to the county as it transitions patients to the John Umstead Hospital in Butner. John Tote, Executive Director of the Mental Health Association of North Carolina, says the debate about future use of the 306 acre Dix campus has overshadowed any plans for using some of the buildings there.

Is addiction a sickness?

Addiction a sickness, official says


Posted on Thursday, November 29, 2007

BENTONVILLE — The state’s drug director asserted Wednesday that addiction isn’t a moral issue but a physical illness, sparking a mini-debate with a lawmaker who said as a pastor he must disagree.

Fran Flener, who took the position May 1, told lawmakers that society should view addiction as a chronic disease that people relapse from, not a sign of moral weakness.

“Sometimes we think that those people that stay hooked on drugs just do that because they choose to,” she said. “I think these people who deal with treatment every day will tell you that’s not true. That’s not true at all.” Flener spoke at a joint meeting of the House and Senate Public Health, Welfare and Labor Committees, meeting at the Bentonville campus of the drug treatment program Decision Point Inc.

The drug director’s comments riled state Rep. Roy Ragland, R-Marshall, who’s been a pastor for 26 years.

“It’s a decision you make,” Ragland said of doing drugs. “Have we as a state decided meth [methamphetamine ] use is not morally wrong ?” Flener said there’s a difference between starting to use drugs and being an addict. Many people use drugs most of their lives — alcohol for example — and never become addicted, she said. There’s a growing pool of evidence that shows there’s a biological component, she said.

Ragland pointed to No. 5 on the “12 Steps” program hanging on the wall to his right. It reads: “Admitted to God, to ourselves and to another human being the exact nature of our wrongs.” Ragland told Larry Counts, chief executive officer of Decision Point, that if that’s part of the treatment program’s success, “that indicates to me that it is a moral wrong.” House Committee Chairman Eddie Cooper, D-Melbourne, later pointed out a lifelong friend of his in the audience, Donnie Vest of Melbourne. Vest, an alcoholic, checked in to Decision Point two weeks ago.

“He’s the most moral person I know,” Cooper said.

Vest said his addiction is “a mental problem, a sickness as physical as cancer.” He said he’s learning the tools to treat it.

“It’s like a fog coming off of the lake. That is definitely not a moral problem,” Vest said.

Flener serves as chairman of the state’s Drug Abuse Coordinating Council and said her job is to try to coordinate drug policy for the state and to ensure that grant funds are properly spent by drug task forces.

She said her office continues to work on trying again to get four counties — Benton, Washington, Jefferson and Pulaski — designated as High-Intensity Drug Trafficking Areas. State officials have campaigned for the designation for years, which would make Arkansas eligible for more federal money to fight the spread of illegal drugs, with money for overtime pay for police, for example.

The request has been denied three times by federal officials, but she said she’s hoping to hear maybe as early as January whether the fourth try will be successful.

From NASW National

November 27, 2007

Dear NASW State Chapters,

The NASW National Office is joining other national organizations in promoting the first National Healthcare Decisions Day (NHDD) on April 16, 2008. The NHDD Initiative is a collaboration of national, state and community organizations to encourage advance care planning for all adults with decision making capacity.

The objectives of National Healthcare Decisions Day are the following:

• To raise awareness through state and community coalitions about the importance of advance healthcare decision making;

• To have adults with decision making capacity to communicate and document their healthcare decisions, and identify a health care agent or proxy to make decisions for them if they cannot make decisions for themselves; and

• To educate related organizations and individuals about access to each state's advance directive documents available for free from Caring Connections at

As a result of NHDD, many more Americans can be expected to have thoughtful conversations about their healthcare decisions and complete advance directives to make their wishes known. NHDD focuses on this issue by drawing attention to advance healthcare planning from a variety of directions simultaneously.

NASW is asking chapters to consider:

1- Reviewing the information on the NHDD website at and to promote the initiative with members and related end-of-life or advance care planning groups that may want to sign on to the state and community campaigns that NHDD is trying to build.

2- Using different events and activities to promote the day, either in accordance with existing education efforts, or with collaborative efforts. The NHDD website provides ideas and outreach materials to organize your community or state efforts at .

3- Signing up at www.nationalhealthcaredecisionsday.orq/maintopics/sign up if your chapter or community group decides to get involved.

4- Using the NHDD email template to educate interested individuals and groups about advance care planning and the NHDD Initiative which can be viewed at: http://www.nationalhealthcaredecisionsday.orq/UserFiles/File/NHDD/Template email for affiliates(1).doc

For additional information or questions about this initiative, please contact: or Karyn Walsh, NASW Senior Policy Associate, at or by phone at 202-408-8600, ext. 448. Thank you for trying to make this an important day and initiative.

Best wishes,

Karyn Walsh, ACSW, LCSW
Senior Policy Associate

National Association of Social Workers
750 First Street NE, Suite 700
Washington, DC 20002-4241
Phone: 202-408-8600 x. 448
Fax: 202-336-8337

Important link!

InfoNet: An e-newsletter from Action for Children NC


Below are summaries of articles related to child well-being in North Carolina. Also provided are links to each article's full text.



U.S. Department of Health and Human Services
"HHS Launches Childhood Overweight and Obesity Prevention Initiative"

First Lady Laura Bush today saluted the U.S. Department of Health and Human Services' new Childhood Overweight and Obesity Prevention Initiative, announced today at the National Prevention Summit, which targets obesity prevention and the promotion of healthy weight for children.

Mrs. Bush delivered the keynote address at the summit, an annual HHS-hosted, cross-sector event that highlights new approaches to prevention and health promotion.

"Good health starts with good habits. By educating ourselves about our bodies -- and by taking simple steps to protect them -- we can prevent or delay some of today's most common and devastating health conditions," said Mrs. Bush.

"Our government is working to address one of the greatest dangers to America's young people: childhood overweight and obesity. Nearly one in five school-age children in the United States is overweight and the problem seems to be getting worse. Today, the Department of Health and Human Services is launching a new effort -- led by the acting surgeon general -- to coordinate and expand our government's existing childhood-overweight and -obesity prevention programs."

According to the Centers for Disease Control and Prevention, data from two National Health and Nutrition Examination Surveys (NHANES) (1976-1980 and 2003-2004) show that prevalence of childhood overweight is increasing. For children aged 2-5 years, the prevalence increased from 5.0 percent to 13.9 percent; for those aged 6-11 years, prevalence increased from 6.5 percent to 18.8 percent; and for those aged 12-19 years, prevalence increased from 5.0 percent to 17.4 percent.

"Overweight children have a higher risk of being overweight or obese as adults, and facing the health problems that can result," HHS Secretary Mike Leavitt said. "Parents, government officials, community and education leaders must work together to help the children. I'm pleased that Rear Admiral Steven Galson, the acting surgeon general, is leading this important initiative."
The East Carolinian
"ECU concludes childhood obesity study: Many participants see vast improvement"
By William Hall

Researchers from ECU's Brody School of Medicine recently concluded a three-year statewide evaluation of childhood obesity projects funded by the NC Health and Wellness Trust Fund.

Participants came from the local health departments, after-school programs, school systems and community-based organizations that were conducting the projects.

The 1,346 participating children ranged from ages 4 through 18, and researchers followed them to see what choices they made concerning food and drink.

Before the projects began, the participants had to fill out a survey documenting their average fruit and vegetable servings, snack choices and sweet beverage consumption.

44 percent of the participants were overweight when the projects began, but by the end of it, 90 percent of the children either stayed in their weight class or improved.

The percentage of children who preferred fruits rather than sweet or salty snacks went from 13.3 percent in the beginning to 17.5 percent in the end.
Raleigh News & Observer
"Indoor lifestyle, food choices put children's bones at risk"
By Lauran Neergaard, The Associated Press

WASHINGTON - Too little milk, sunshine and exercise: It's an anti-bone trifecta.
And for some kids, it is leading to rickets, the soft-bone scourge of the 19th century.

But cases of full-blown rickets are just the red flag: Bone specialists say possibly millions of seemingly healthy children aren't building as much strong bone as they should -- a gap that may leave them more vulnerable to bone-cracking osteoporosis later in life than their grandparents are.

"This potentially is a time-bomb," said Dr. Laura Tosi, bone health chief at Children's National Medical Center in Washington.

Now scientists are taking the first steps to track kids' bone quality and learn just how big a problem the anti-bone trio is causing, thanks to new research that shows just what "normal" bone density is for children of different ages.

Dr. Heidi Kalkwarf of the Cincinnati Children's Hospital led a national study that gave bone scans to 1,500 healthy children ages 6 to 17 to see how bone mass is accumulated. The result, published last summer, is the first bone-growth guide, just like height-and-weight charts, for pediatricians treating children at high risk of bone problems.

Next, the government-funded study is tracking those 1,500 children for seven more years to see how their bones turn out. Say a 7-year-old is in the 50th percentile for bone growth. Does she tend to stay at that level by age 14, or catch up to kids with denser bones? If not, is she more prone to fractures?

Ultimately, the question is what level is cause for concern.

"I don't know if we're raising a population that's going to be at risk" for osteoporosis, Kalkwarf said. "It's really hard to know what the cutoff is, how low is too low."

But almost half of peak bone mass develops during adolescence, and the concern is that missing out on the strongest possible bones in childhood could haunt people decades later. By the 30s, bone is broken down faster than it's rebuilt. Then it's a race to maintain bone and avoid the thin bones of osteoporosis in old age.

The Washington Post
"ATV Injuries on the Rise"
By Serena Gordon, HealthDay Reporter

(HealthDay News) -- While riding an all-terrain vehicle (ATV) may seem like a fun activity for your child, too often it can end in a serious injury and a trip to the emergency room.

In fact, deaths and hospital visits related to ATV use have more than doubled in the past decade, and a new study reports that the most common injuries that youngsters sustain include serious injuries such as broken legs and arms, skull fractures, brain injuries and hemorrhages.

"Parents need to understand that ATVs are not toys. We tend to think short-term and believe that we're giving children a toy or some kind of entertainment with an ATV," said study lead author Dr. Chetan Shah, a radiology fellow at the University of Arkansas for Medical Sciences and Arkansas Children's Hospital in Little Rock. "But, remember, a trip to the ER is in no way recreational."

According to statistics from the U.S. Consumer Product Safety Commission, 467 people died from ATV-related injuries in 2005. In 1995, that number was 200 people. In 2005, 136,700 Americans were treated in U.S. emergency rooms for ATV-related injuries, up from just 52,200 in 1995.

Because injuries and deaths from ATV use are rising so dramatically, Shah and his colleagues wanted to learn exactly who is getting injured and what types of injuries are occurring from ATV use.
Raleigh News & Observer
"Parents have good reason to worry about Internet use"
BY Gregory Ramey, Cox News Service

DAYTON, Ohio - Many parents are scared of their children's Internet usage, and the latest research indicates that they have good reasons for concern. With 87 percent of 12- to 17-year-olds now online, children are increasingly being exposed to dangers that they and their parents are ill-equipped to manage. Kids on the Internet need to deal with cyber porn, predators, bullies and social isolation.

A recent study published in Pediatrics found that 42 percent of youngsters 10 to 17 years of age had been exposed to pornography in the past year. Some of this is intentional, with boys seeking out sexually explicit material much more frequently than girls. However, the rates of incidental or unwarranted exposure are high and increasing, with about one-third of teens ending up on a pornography site when they were seeking other information.

This pornography is not the "mild" Playboy nudity of previous generations. I recently evaluated a 14-year-old who was referred to me for Internet addiction. He described visiting various pornographic sites that I could not even begin to imagine, nor write about in this column. Research is under way to try to understand what effects this is having on a generation of kids exposed and sometimes addicted to some of the most degrading images of human behavior.

The Pew Research Center indicated that about 32 percent of teens reported being the victim of cyber bullying. This involves spreading gossip online, sending threatening e-mail or posting embarrassing information or pictures.

Perhaps a parent's greatest fear is that a child will be contacted online and manipulated by a stranger. Parents should be concerned, as 32 percent of teens report being contacted online by someone who had no connection with them or their friends. This happens more often with girls than with boys (39 percent vs. 24 percent). Teens who post online photos or have profiles with a social network service are more likely to receive such contacts.

While the Internet can be a great way for many teens to connect with friends, it can also be an opportunity for teens to retreat from reality. A 2005 Professional Psychology: Research and Practice survey found that professionals expressed concerns about 15 percent of their clients having such problems.

Steps to take

Here's how parents can protect their children without isolating them...
Raleigh News & Observer
"Safety first, even at Christmas"
By Solja Nygard Frango

Until I had my son Stefan, I had hardly thought about our home’s potential safety hazards. But with an 11-month-old child crawling — and trying to walk — around the house, I quickly became aware of the electrical outlets, cords and little knickknacks.

While we have covered the outlets, hidden the cords and taken down the little decorative items, Christmas is likely to present new dangers. Holiday lights and the Christmas tree might be pretty, but for curious kids, they can be hazardous.
Angie’s List, where consumers share their ratings and reviews on local contractors and companies in more than 280 categories, gives the following safety tips for parents. The list can be found at

Wake County EITC Coalition Formed-Carolina Newswire
Please contact Lorraine McCurdy or 834-9300 for information on how you can get involved in Wake County’s EITC Coalition.

RALEIGH, N.C. -- Are you thinking about your 2007 taxes yet? It may seem a bit early, but not for the newly formed Wake County Earned Income Tax Credit (EITC) Coalition. Members of several nonprofit agencies, including the Family Resource Center of Raleigh, Fiscal Progress, Passage Home, AARP, and Triangle United Way, have partnered with Wake County Human Services and the Internal Revenue Service to form the Wake County EITC Coalition.

The purpose of the Coalition is to:
--Increase the awareness of EITC to Wake County Families
--Increase the number of tax clients taking advantage of free tax preparation sites
--Increase the number of volunteers who can provide free tax assistance to eligible tax payers

The Earned Income Tax Credit is a federal aid program targeting low and moderate-income workers. It reduces the tax burden on lower income workers, supplements their wages, and encourages greater participation in the workforce. It has the possibility of increasing the income of a working family by 10-15 percent.

According to Lorraine McCurdy with the Family Resource Center in Raleigh, “Consumers can take this opportunity to find out now if they are eligible for the Earned Income Tax Credit. They can also locate a Volunteer Income Tax Assistance (VITA) site in their community to prepare their income tax return for free to avoid the high cost of commercial preparers and Refund Anticipation Loans.”

In Wake County, IRS data indicate that for tax year 2005 over $80 million came back into the Wake County economy through the EITC. This makes the average tax refund available to low income and working families who qualify for the EITC equal to $1,837.

Right now is the time to train to be a volunteer to help in this county-wide effort to generate support for low-income working families. McCurdy says, "There is a great need for volunteer tax preparers in Wake County. Training takes place throughout the community during November and December."

Volunteers receive a great deal of training and those who come to the VITA sites are appreciative of the work volunteers do. Steve Fear from Chapel Hill has used VITA sites sponsored by Fiscal Progress and says, "I appreciate the knowledge and skill of the volunteers. Art has helped me with my tax return the past two years. I’ll see him next year!"

Morbidity and Mortality Weekly Report – Reports and Recommendations
"Effects on Violence of Laws and Policies Facilitating the Transfer of Youth from the Juvenile to the Adult Justice System"
A Report on Recommendations of the Center for Disease Control and Prevention (CDC) Task Force on Community Preventive Services

The independent, nonfederal Task Force on Community Preventive Services (Task Force), which directs the development of the Guide to Community Preventive Services (Community Guide), conducted a systematic review of published scientific evidence concerning the effectiveness of laws and policies that facilitate the transfer of juveniles to the adult criminal justice system to determine whether these transfers prevent or reduce violence among youth who have been transferred and among the juvenile population as a whole. For this review, transfer is defined as placing juveniles aged
<18 years under the jurisdiction of the adult criminal justice system. The review followed Community Guide methods for conducting a systematic review of literature and for providing recommendations to public health decision makers. Available evidence indicates that transfer to the adult criminal justice system typically increases rather than decreases rates of violence among transferred youth. Available evidence was insufficient to determine the effect of transfer laws and policies on levels of violent crime in the overall juvenile population. On the basis of these findings, the Task Force recommends against laws or policies facilitating the transfer of juveniles to the adult criminal justice system for the purpose of reducing violence.>--------------
New York Times
"Throwing Away Young People: Prison Suicide"

The United States made a horrific mistake when it embraced the practice of holding young teenagers in adult jails, often in connection with minor crimes that never lead to conviction.

Jail often turns these vulnerable young people into real criminals. It also puts them at risk of being battered, raped and pushed to suicide. The country needs to back away from these brutal, inhumane policies.

A new report by the Washington-based advocacy group, Campaign for Youth Justice, brings the suicide risks for young people in prison into frightening focus.

According to the report, people under 18 who are housed in adult jails are 19 times more likely to commit suicide while behind bars than young people on the outside. And they are 36 times more likely to kill themselves in an adult jail than young people held in juvenile facilities.

Law enforcement officials seem to think that no harm can come of holding young people in adult jails for short periods of time. But, according to the study, statistics show that suicides in jails were "heavily concentrated in the first week spent in custody (48%), with almost a quarter of suicides taking place on the day of admission to jail (14%) or on the following day (9%)."

The highest suicide rates are found in the smallest facilities, perhaps because those facilities have small staffs and are unable to keep watch over troubled inmates.

Why do so many young people kill themselves in jail? Probably because the majority of them suffer from mental illnesses that go untreated behind bars. Indeed, according to the study, as many as two-thirds of the young male detainees and three-quarters of young women detainees meet the criteria for one or more psychiatric disorders.
"Studies: Hispanic youth look for acceptance, often turn to gangs"
By The Associated Press

Hispanic youths in North Carolina, struggling to find acceptance in U.S. culture, are increasingly turning to gangs and other self-destructive behavior, according to studies and those who follow the trends.

Nearly 9 percent of Hispanic high school students dropped out of high school in the 2005-06 school year — a rate higher than any other group in the state and double the rate of white students, according to state figures. More than half of Hispanic girls in North Carolina are expected to be pregnant before their 20th birthdays, according to the National Campaign to Prevent Teen Pregnancy.

And the problems are getting worse, according to a national survey by New York University professor Marcelo Suarez-Orozco, which found that immigrant teens were doing worse in school five years after the study began.

Meanwhile, more than 40 percent of Hispanic immigrant teenagers in North Carolina say they have faced ethnic discrimination, often from their classmates, according to a study of 300 people conducted by the University of North Carolina at Chapel Hill's School of Social Work.

That study found a population with emotional scars, uneducated parents and the pervasive feeling that they are not accepted by Americans...

...And if the students join gangs, Lassiter said, educators often write them off.

"The big misconception is that these kids are not savable, that once they're in, they're in for life," he said. "That's just not true. We need to ask ourselves: How do we serve these kids better?"

Thank you,

Action for Children North Carolina

Action for Children North Carolina | 919-834-6623 x229

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Thank you for helping make North Carolina the best place to be and raise a child!


North Carolina Ranks 27th in Study on Depression Status Across the Nation

North Carolina Ranks 27th in Study on Depression Status Across the Nation

First-of-Its-Kind Analysis Links Greater Access to Mental Health Treatments and Services to Better Depression Outcomes

Raleigh, North Carolina (November 29, 2007) – Depression is a chronic illness that exacts a significant toll on America's health and productivity. It affects more than 21 million American children and adults annually and is the leading cause of disability in the United States for individuals ages 15 to 44. According to Ranking America’s Mental Health: An Analysis of Depression Across the State, North Carolina ranked 27th in a first-of-its-kind report by Mental Health America that analyzed rates of depression and suicide among all 50 states and the District of Columbia. The study found that of North Carolina’s adult population, 7.65 percent experienced major depressive episode in the past year and 11.93 percent experienced serious psychological distress. On average, North Carolina reported 3.39 poor mental health days per month.

“This report provides an opportunity for North Carolina leaders to examine its citizens’ depression status and begin to allocate resources to improve North Carolina’s mental health,” said John Tote, MHA/NC Executive Director. “North Carolina can and should provide better treatment and services for our citizens suffering from this chronic illness. Depression is common, real and as the Ranking America’s Mental Health Report shows, it is treatable with adequate resources. Reducing depression in North Carolina should be a top priority.”

South Dakota ranked first as the healthiest state with respect to depression status. Following South Dakota were Hawaii, Iowa, Louisiana and Minnesota. Utah was ranked last, with the highest depression levels, preceded by West Virginia, Rhode Island, Kentucky and Nevada.

Ranking America’s Mental Health provides insight into each state’s depression status and suicide rate, enabling states to begin to address how to properly allocate resources to improve its population’s mental health.

Mental Health America found the following factors to be statistically significantly associated with better depression status and lower suicide rates:

· Mental health resources – On average, the higher the number of psychiatrists, psychologists and social workers per capita in a state, the lower the suicide rate.

· Barriers to treatment – The lower the percentage of the population reporting that they could not obtain healthcare because of costs, the lower the suicide rate and the better the state’s depression status. In addition, the lower the percentage of the population that reported unmet mental healthcare needs, the better the state’s depression status.

· Mental health treatment utilization – Holding the baseline level of depression in the state constant, the higher the percentage of the population receiving mental health treatment, the lower the suicide rate.

· Socioeconomic characteristics – The more educated the population and the greater the percentage with health insurance, the lower the suicide rate. The more educated the population, the better the state’s depression status.

“The findings of this study underscore the need to develop a public mental health surveillance system to monitor the mental health of Americans by examining depression and the states policies that may impact it,” said Dr. David Shern, president and CEO, Mental Health America. “Only with regular and ongoing measurement of key indicators of depression will we be able to understand how public policies impact a population’s depression level and suicide rate – and adjust these policies to benefit the millions of American affected by depression.”

To achieve top ranking in the country, South Dakota yielded the best results for the four measures used to develop a composite depression status indicator. Among adults, 7.31 percent experienced a major depressive episode in the past year and 11.6 percent experienced serious psychological distress. Among adolescents, 7.4 percent had a major depressive episode in the past year. On average, South Dakotans reported 2.41 poor mental health days per month.

Despite the fact that some states do better than others on rates of depression and suicide, no state can be satisfied with its current status. These rates can be driven lower with state policies designed to improve coverage, ending discriminatory practices in insurance, and assuring that qualified mental health professionals are available to serve everyone in need.”

For a complete ranking of all 50 states, visit

$27,000 fine follows probe in clinic deaths ERIC FRAZIER

Story can be found at:

$27,000 fine follows probe in clinic deaths ERIC FRAZIER

N.C. regulators probing the deaths of at least 13 patients in a Charlotte
company's methadone clinics have fined the firm $27,000 for violations of
safety-and-treatment rules.

A state report detailing the allegations specifically mentions the deaths of
two people who received methadone at a Statesville clinic run by McLeod
Addictive Disease Center, a nonprofit based in Charlotte.

The report says McLeod didn't follow precautions that might have prevented
the deaths, and then failed to report the fatalities to a state agency as

The fines were among the heaviest of more than 200 imposed this year by the
N.C. Division of Health Service, which oversees facilities ranging from
methadone clinics to group homes for mentally ill children. Methadone
clinics administer the drug to those recovering from addictions to heroin,
and increasingly, to powerful painkillers.

McLeod President Eugene Hall on Wednesday called the accusations untrue, and
accused investigators of being ill-informed about how his clinics work. He
said none of McLeod's seven other clinics were fined even though they
operate under the same rules and management as the Statesville office.

He said he will appeal. "This is just terribly frustrating and angering to

The fines stem from the state agency's investigation of at least 16 McLeod
patient deaths in just over a year. Officials list two probable
causes: methadone toxicity, and a lethal combination of methadone and other

State officials declined to comment Wednesday, saying they are wrapping up
their inquiry and wouldn't speak about their findings until complete.

They have said they began the investigation because of recent federal
advisories about the dangers of methadone.

They also have said they are checking for deaths in the 27 other methadone
programs around the state, but it's unclear whether any of those face the
intensive reviews given McLeod.

Regulators probed the Statesville clinic in October. Their report zeroes in
on the October 2006 death of a 28-year-old man. He died of acute methadone
and oxycodone toxicity, plus an abnormal build-up of fluid in the lungs
caused by heart failure.

Oxycodone, sometimes marketed under the better-known name of OxyContin, is a
powerful painkiller; methadone is sometimes used to wean people off
oxycodone addictions.

An autopsy report also showed that the man had ingested benzodiazepines --
sedatives doctors warn methadone patients against taking. The mixture can
send patients into a sleep so deep that they stop breathing and die.

Still, patients combine the drugs for the euphoric high they can't get from

According to the state report, the 28-year-old tested positive at least
three times for the sedatives after he began treatment.

`I wanna go up'

The state report also accuses McLeod of improperly increasing the man's
methadone dosage more quickly than a doctor recommended. The report quotes
the man's sister as telling the state: "They give you such high doses, it
just puts them to sleep."The dead man's father, who was also being treated
at the clinic, told the state if a patient wanted a higher dosage, "all you
had to do was stand at the window and say, `I wanna go up.' They never asked
you nothing."

The clinic's medical director told investigators the man's death prompted
policy changes at McLeod in April. The clinic began using a more immediate
test for benzodiazepines. It allowed doctors to keep prospective patients
out of the program until they gave up the sedatives.

Other changes included new limits on dosage increases and upgraded
patient-education sheets warning about the dangers of mixing drugs.

But the state report said the changes weren't enacted in time to save a
53-year-old woman who died in April, nine days after starting treatment. The
state report says her counselor's notes did not contain required
documentation about the risks of methadone.

She had a history of depression, and was taking Prozac and fentanyl, a

State rules required McLeod to report the deaths to the Division of Health
Service Regulation within 72 hours.

Investigation criticized

Hall said regulators at the N.C. Division of Mental Health told him to send
the reports to them. An official with that agency even praised the
thoroughness of McLeod's reporting, he added.

When officials at mental health failed to send the reports on to their
sister agency, they stacked up on one official's desk, he said. Some were
even misplaced, he said, requiring McLeod to re-send copies.

He accused regulators of using criteria not normally applied to methadone

"If these standards were to apply," he said, "there's no (methadone) program
in North Carolina that can operate."

Research Study Demonstrates Effectiveness of IFPS

NFPN News Notes - November 2007

Research Study Demonstrates Effectiveness of IFPS
The National Family Preservation Network (NFPN) has completed its research study on Intensive Family Preservation Services (IFPS) with very satisfactory findings. The study focused on factors of great urgency for the child welfare system in terms of identifying effective services for families. These factors include race (disproportionality), substance abuse, type of referring problem (abuse vs. neglect), differences between intact and reunifying families, and follow-up services.

NFPN recruited seven sites in seven states to submit data on their IFPS programs. State child welfare agencies or private providers included in the study were from the states of Colorado, Indiana, Maryland, Missouri, North Carolina, Pennsylvania, and Washington.

All of the sites have strong IFPS models with well-defined programs. Six of the seven sites also offer Intensive Family Reunification Services (IFRS) programs. Maryland provided only IFPS data and the Missouri site provided only IFRS data. All of the sites use the NCFAS and the NCFAS-R, where applicable, as family functioning assessment tools and for data collection. The reliability of both tools was confirmed in this study.

The findings for IFPS are extremely positive. Data were submitted on a total of nearly 1,200 families, although not all data items were available for all families. IFPS services achieved the same success rate (placement prevention) with families of color, substance abusing families, and families with referring issue of neglect (as opposed to abuse) as it did with all other types of families. These findings are highly significant for the child welfare system as it grapples with the issues of reducing disproportionality, dealing with a high number of substance-abusing families, and addressing families involved in chronic neglect. The findings strongly suggest that IFPS can be used effectively with these types of families.

The findings were mixed for families receiving reunification services (IFRS). There was a substantially smaller number of families in this category (332) and 22% dropped out prior to the close of services (twice the number of IFPS families that dropped out). Just over two-thirds of the children were reunited with their families at case closure. The domains of the NCFAS-R that measure parental/child ambivalence towards reunification and readiness for reunification had more negative changes than other scale items and were highly predictive of success or failure in reunifying families.

In terms of the factors looked at in this study, black families had lower rates of reunification with mixed race families having higher rates and white families in between. Substance abusing families showed substantial progress after receiving IFRS services and had no difference in placement rates from other families. IFRS services showed more success with families involved in physical abuse than with those involved in neglect.

Five of the seven sites provide step-down or follow-up services that were available to 83% of IFPS families and 71% of IFRS families in the study. However, very little is known about the type of services offered and who provides them.

In summary, this multi-state study demonstrates that strong IFPS programs are effective with a variety of families and presenting problems. The study definitely provides support for developing, strengthening, and expanding IFPS programs nationwide.

The study also shows that both IFPS and IFRS programs need to improve data collection, track families and outcomes over a longer period of time, and identify and track the services provided. More work is needed with IFRS in terms of model development. NFPN intends to focus more on IFRS in the future.

NFPN expresses its gratitude to the seven sites that participated in the study and to the Annie E. Casey Foundation for funding the project.

To view the entire research report, visit:

Wednesday, November 28, 2007

Action alert!



Last week Congress finished working out the differences between the House and the Senate on their Labor Health and Human Services (LHHS) Appropriations Bill that funds the Rape Prevention and Education (RPE) Program and other Violence Against Women Act (VAWA) programs administered by the US Department of Health and Human Services. This bill provided an increase in RPE funding for FY 2008 to $43.7 million! The bill must now be sent to the President, who has threatened to veto it (more on that below). Members of Congress must hear from you to vote to OVERRIDE President’s veto!

Your calls throughout the year made a difference and ensured that an increase was maintained when the House and Senate compromised on their LHHS bills. As you may recall, the House had level funded RPE while the Senate bill included an increase. Now we must keep our voices strong so Congress knows they must send a message to the President.

…And that’s exactly why we need you to KEEP MAKING CALLS about funding for VAWA programs administered by the US Department of Justice (DOJ)!

Let's ensure another victory for VAWA Funding! Make calls this week before Congress Adjourns for Thanksgiving and a 2-Week “Harvest Recess”!


Thanks for making calls in support of the Sexual Assault Services Program as well as all VAWA programs over the last two weeks. You made an impact on the informal negotiating on the Commerce, Justice, Science (CJS) Appropriations bill that funds VAWA programs administered by DOJ!

But the FORMAL negotiating -- where the Members of Congress themselves finish the compromise spending bill – started late last week and will continue into the early part of this week.


Check the list at the very bottom of this email to see which Senator or Representative to call. The list is in order by STATE. If you live in that state, call the Senator or Representative(s) on the list. Call them THIS WEEK!

Never called your Senators or Representatives before? Don't worry, it's easy!

When you call your Senator or Representative, your call will be answered by a receptionist. Tell him or her that you want to leave a message for the Senator or Representative. The receptionist will take down your message. Tell them:

"Thank you for working so hard to provide funding for the Sexual Assault Services Program (SASP) as well as funding increases for Violence Against Women Act programs and to raise the cap on the Victims of Crime Act Fund in the Fiscal Year 2008 Commerce, Justice, Science Appropriations bill."
"Please protect the $10 million appropriated to SASP as well as the increases that the House and the Senate have provided for VAWA and VOCA."
If you have time or the opportunity, tell them about why you need more funding:
Sexual assault is a devastating, life-threatening crime that faces our nation. It impacts men, women and children.
VAWA programs work: Tell them about successes in your local programs.
Rape crisis centers do wonderful work but they are underfunded and must place victims, (e.g., children) on waiting lists for services.
Some rape crisis centers are even closing their doors. Tell them about the unmet needs in your community.


VAWA Programs at DOJ

Thanks to YOUR ADVOCACY THIS YEAR, the House of Representatives and the Senate both recognized the urgent need for services for victims of domestic and sexual violence and voted to increase VAWA funding and raise the VOCA cap in their Commerce, Justice, Science (CJS) appropriations bills.

Now the House and Senate must resolve the differences in the two versions of their appropriations bills and create one final bill that is passed by Congress and signed by the President. To secure increases for VAWA and VOCA, we must make sure that victims’ voices are heard during this process.

Check out this link for more information on the budget and appropriations process:

As you will see, for some programs the House has allocated more funding while the Senate has allocated more funding for other programs. We are urging the Representatives and Senators to protect the larger increases in funding for each program.

The calls you made about VAWA and VOCA amendments made a tangible difference in the outcomes of those amendments. Amendments in the House passed by landslide margins!

We are on a roll but we haven't won yet! We need the final CJS Appropriations Bills to include the larger of the House or Senate numbers for each grant program.

VAWA Programs at HHS

The President has made it clear that he will veto this bill, and it does not appear Congress has enough votes to override the veto. This means that Congress must eventually reach a compromise with the White House and pass a second bill with less spending. The more calls we make about VAWA and SASP, the more likely it is that increases in VAWA and SASP will be maintained no matter what compromise is eventually reached. So don’t feel defeated by the veto threat – the only thing that will help us increase funding is your grassroots support.


Thanks again for all the amazing work you do. We know that you are busy empowering survivors and saving lives every day. Your voices – your stories – help Members of Congress understand the issues that truly impact upon victims and services – and how VAWA and VOCA programs save lives, rebuild families and prevent future crimes.

For more information, contact Ellen Fern ( or Michelle White (

Candidates for Lt. Gov. clash

Candidates for lieutenant gov. clash
Democratic frontrunners criticize each other's views on party positions, including abortion and death penalty

RALEIGH --The typically overshadowed race for lieutenant governor heated up Monday when two of the candidates for the Democratic nomination tussled over core issues for their party: abortion rights, death penalty reform, affirmative action and pollution control.

Hampton Dellinger, a Durham lawyer and former aide to Gov. Mike Easley, criticized N.C. Sen. Walter Dalton, of Rutherfordton, using a mix of Dalton's votes and past candidate questionnaires.

"These are mainstream Democratic issues," Dellinger said, "and my positions reflect where a majority of the party is."

Dalton shot back that the highlighted votes were not final votes on those bills, that he "stood firm" in order to get a better, final version of the legislation. He also adamantly defended one questionnaire answer but said he poorly worded another.

Dalton, 58, and Dellinger, 40, are the best-funded of the Democratic candidates. The initial sparring illuminates that, while Dellinger has not held elected office, Dalton's lengthy voting record can be picked apart and used against him.

Winston-Salem city Councilman Dan Besse and Canton Mayor Pat Smathers are also running for the Democratic nomination but trail in fundraising and organization.

There are no announced Republican candidates as yet.

Dellinger posted a letter to supporters on his Web site that highlights what he called his disagreements with Dalton. Here's a rundown:

Executions and the mentally retarded

Dalton voted in April 2001 against a ban on executing killers who are mentally retarded. Dellinger said he supports the law.Dalton said he opposes executing mentally retarded defendants, but the procedure for determining mental retardation was too loose in the bill passed by the Senate. The House tightened it up, and Dalton voted for the revised bill when it came back to the Senate.

Abortion and exceptions

In a 1998 questionnaire for Project Vote Smart, Dalton said abortion should be legal only during the first trimester or in cases of rape, incest or danger to the mother's life. Dellinger said the law also should allow an exception for the protection of the mother's health and criticized Dalton for supporting abortion rights after the first trimester "only in the narrowest of circumstances."

The questionnaire answer should have included an exception for the health of the mother, Dalton said. The U.S. Supreme Court has ruled that a woman's right to privacy predominates the issue, he said.

"As a matter of personal preference I don't know that I would go that far," Dalton said. "But I'm not a woman so those decisions have to be made between a woman and her doctor."

Color, gender and law

Dalton also said in the questionnaire that state government should always hire the "best qualified person," indicating he did not support taking race and gender into account in hiring."That was the whole intent of the civil rights laws if you were living back in 1964," he said, "that race should not be taken into consideration nor should gender."

At the same time, Dalton said, diversity of the work force should be considered but not the determining factor.

Dellinger said he supports affirmative action.

In the air

Dalton was one of only five senators to vote against the "clean smokestacks" bill in 2001, which would have raised electric rates to pay for pollution controls on coal-fired power plants. Dellinger said he supported the bill.

A later compromise avoided passing on the costs to consumers and was the version that became law. Dalton voted for that bill.

The earlier version "put the cleanup of dirty smokestacks on the consumer," he said.

Dellinger argued that the legislation empowered the state utilities commission to protect consumers in the first place.

"The clean smokestacks bill was too important the first time for anyone to rely on `I was for it after I was against it,' " Dellinger said.

Dalton said the criticism was actually a good sign.

"It shows I'm the frontrunner in the race," he said, "and he's resorting to attacking when we're ahead." Decision 2008

U.S. Senate Judiciary to Hold First JJDPA Hearing in 8 Years

November 27, 2007

Hearing Announcement
U.S. Senate Judiciary to Hold First JJDPA Hearing in 8 Years

We are pleased to announce that the United States Senate Committee on the Judiciary will hold a hearing on Reauthorization of the JJDPA on Wednesday, December 5, 2007 at 10:00 am EST. The hearing is titled “Reauthorization of the Juvenile Justice and Delinquency Prevention Act: Protecting Our Children and Our Communities” and will be held in Room 226 of the Senate Dirksen Office Building.

This will be the first Senate hearing held on the JJDPA in eight years.

The witness list is yet to be completed, but current invitees include Deirdre Garton, a former prosecutor and current Chair of the Wisconsin Governor’s Juvenile Justice Commission (the Wisconsin SAG); Anne Marie Ambrose, Director of Child Welfare and Juvenile Justice Services at the Office of Children, Youth and Families in the Department of Public Welfare for the Commonwealth of Pennsylvania; and Shay Bilchik, former Administrator for the Office of Juvenile Justice and Delinquency Prevention, former President & CEO of the Child Welfare League of America and Founder and Director of the Center for Juvenile Justice Reform at Georgetown University’s Public Policy Institute.

We will be reaching out to you to help you reach out to your U.S. Senators to encourage them to attend the hearing. In the meantime, please mark your calendars and prepare to join us on-line—the hearing will likely be Webcast live.

More information can be found at

This is likely to be the Web link for the Webcast as well.

Training announcement from USDOL

USDOL’s Faith Based & Community Initiatives is holding four 3-day training conferences on results management and data management for employment & training programs. One event will be held Jan 15-17, in Chapel Hill, NC. At the conclusion of your participation in this project, your organization will better be able to measure, manage, and communicate its results. This is a one year project.

For the three-part application and more information, please go to:

For more information contact:

Christopher Stio
Special Assistant
Center for Faith-Based & Community Initiatives
US Department of Labor
200 Constitution Ave, NW
Washington, DC 20210


Group sues to have state districts redrawn
Titan Barksdale, Staff Writer

A group of Republican voters in North Carolina allege in a federal lawsuit that state House and Senate districts are unconstitutional and should be redrawn in time for the 2008 primaries.
The suit alleges that several House and Senate districts do not meet the standard of the federal Voting Rights Act because they dilute minority voting power. The suit names about 20 counties where the districts they contend are unconstitutional are located.

The suit comes on the heels of a state Supreme Court ruling in August that said the General Assembly improperly carved up Pender County in southeastern North Carolina between two House districts. The lawsuit, filed this week in U.S. District Court in Raleigh, cites the Pender County ruling throughout.

The lawsuit names State Board of Elections Director Gary Bartlett, Attorney General Roy Cooper and board of elections members as defendants. Greensboro lawyer Bob Hunter, who has been involved in many redistricting battles, filed the lawsuit.

Hunter, former chairman of the State Board of Elections, asks in the suit that the board be prohibited from conducting elections until new districts are drawn.

The Supreme Court found that a House district that takes in most of Pender County and the northern portion of New Hanover County was unlawful because it does not have a majority black population.

The drawing of legislative district lines, done by the legislature every 10 years, is subject to the federal Voting Rights Act. The act requires states to create election districts that do not dilute minority voting power.

Hunter argues in the suit that the two House districts in the Pender County case are not the only ones in North Carolina that don't meet the standard of the Voting Rights Act. The suit does not spell out the specific legislative districts it is challenging. Instead, it lists several counties that it says include districts that do not meet the federal standard.

"If the legislature were to comply with the North Carolina Supreme Court's order, ... then nearly three-quarters of the House of Representatives 2003 redistricting scheme would have to be redrawn because it grossly fails to properly group counties," the suit says.

Orange, Chatham, Caswell and Moore are among the counties that have been wrongly combined to help form districts, the suit says. Incorrect census data were used to create the districts that cover those counties, the suit says.

Hunter could not be reached for comment Friday. Officials at the state Attorney General's office, which would defend the state in the suit, did not return phone calls Friday.

But Hunter accused the legislature in the lawsuit of deliberately using incorrect census data.

"The General Assembly withheld corrected census data in order to produce a more politically advantageous redistricting scheme and knowingly diluted the votes of specific citizens," Hunter said in the suit.

One of the eight plaintiffs in the lawsuit is Frank Mitchell, a former House member from Iredell County.

Mitchell lost a re-election bid in 2004 to Julia Howard in the Republican primary and believes that the redistricting contributed to his loss.

But he said his concerns went beyond what happened in his district.

"There was a dorm at Chapel Hill that got counted twice, and the Census Bureau notified the leaders of the legislature, but they never told us about it, and they drew the districts using those bogus figures," Mitchell said in an interview.

The Supreme Court said in the Pender ruling said that the legislature did not have to revise the election map until 2010.

But Mitchell says waiting until 2010 would mean an election carried out under unconstitutional districts.

"They have enough time to redraw those districts," Mitchell said. or (919) 829-4802

Redirected Funds (from N&O)

REDIRECTED FUNDS:Money that legislators approved for treating mentally ill people is instead being redirected to cover administrative costs at local mental health offices. State administrators have rerouted $20 million to pay administrative bills, reducing the state budget for services by about 5 percent, to $369.7 million. Legislators knew the state division of mental health didn't have enough set aside to pay the entire administrative bill, said Mike Mosely, director of the agency. "We were going to have to take those dollars from within the budget," he said. "The only other place was from the services side." The local offices are getting $128.5 million for administration -- $75.4 million in state money and $53.1 million in Medicaid funds. Even with the money transfer, no local office will get less than it did last year for patient treatment. Frank Edwards, president of the Wake County Chapter of the National Alliance on Mental Illness, said the move frustrates him, especially because leaders at the state Department of Health and Human Services are emphasizing a need for efficiencies. The focus should be on consolidating the 25 regional mental health offices rather than giving them more money, Edwards said.

County and regional offices, which operate somewhat independently of the state mental health division, have pushed legislators to give them more oversight of patient treatment. More local responsibilities resulted in higher administrative costs. Rep. Verla Insko, an Orange County Democrat who helps lead a legislative mental health oversight committee, said the budget changes are the outgrowth of the yearly problem of local offices ending up short of cash, while some money budgeted to treat mentally ill people in or near their hometowns goes unspent. Last year, the division had to find $18 million in its budget to cover local administrative expenses. "It's hard to get new appropriations for administration," she said. (Lynn Bonner, THE NEWS & OBSERVER, 11/22/07).

Broughton Hospital News

Hospital shrinks to qualify for funds
Staff shortages, training at issue
Lynn Bonner, Staff Writer
From the 24 November News & Observer

Broughton Hospital in Morganton, one of four state mental hospitals, has made itself smaller in an effort to restore federal money lost because of problems with patient care.

Officials have shut down parts of the hospital where short-term patients stay -- keeping vacant 38 beds in what has been a heavily used unit -- to concentrate staff in fewer areas.

Broughton lost its ability in August to collect about $1.3 million a month in federal insurance money after investigations into patient treatment found problems with hospital staffing and training. The hospital also no longer qualified for money from a related federal program that brought millions of dollars to the state last year.

The federal government cut insurance payments to Broughton after one patient died and another was seriously injured. In February, a 27-year-old man suffocated after staff members held him to the floor, with one person reportedly lying across his chest. Months later, a patient who was supposed to be closely supervised suffered a serious head injury in a fall.

The state sent in a team to try to fix problems at Broughton. Whittling away at the number of patients was a way to deal with a shortage of psychiatrists.

"We're doing this as a stopgap measure to get us ready for our recertification," said Mike Moseley, director of the state mental health division. "That's our only intent. We want to be recertified just as quickly as we can."

Moseley said patient space has decreased only temporarily, until the hospital can hire more psychiatrists.

In the meantime, he said, patients get better care.

"Psychiatrists have to run from building to building when you have major vacancies," he said.

Broughton is short six psychiatrists. The hospital Web site also posted jobs this week for 13 registered nurses and two staff psychologists.

Some patients are checking into local hospitals rather than going to Broughton, or traveling to state mental hospitals in Granville County, Raleigh or Goldsboro.

Under pressure

Liz Smith, a past president of the Western North Carolina chapter of the National Alliance on Mental Illness, said it is "horrible when people are diverted" to hospitals hundreds of miles from their homes. It's hard enough for people from some western counties to get to Morganton to visit relatives at Broughton, she said, never mind driving to Raleigh or Goldsboro.

The hospital has a longstanding shortage of psychiatrists, Smith said, one that's not likely to be solved in a few months. What's more likely to happen, she said, is that after inspectors come through, the hospital will start using those 38 beds again, whether or not they have enough psychiatrists to treat the patients.

"The pressure is on the hospital to accept people, because there's no place for them in their communities," she said.

Short-term admissions to the state mental hospitals have jumped in recent years, so much that this year the state division of mental health decided to stop new people from coming in when the admissions areas are at 110 percent of capacity.

Broughton was able to stop using 38 short-term beds because admissions dropped over the past month, said Dr. Michael Lancaster, a top administrator in the state mental health division. He is directing the hospital's reorganization.

The hospital is concentrating on filling key job vacancies, he said. But Lancaster said the need for fewer admissions beds could be long-lasting if communities have to cut back on their use of state hospitals to show the hoped-for results.

Depending on the outcome of the division's mock inspection next week, state administrators may ask federal inspectors to come back as soon as possible.
In the best case, Lancaster said, federal inspectors will return in mid-January and decide that the hospital can once again qualify for federal money. or (919) 829-4821

Listen now!

To hear any of these stories, please visit:


North Carolina members of Congress are raising more money than ever before, mostly due to the increasing prevalence of donations from political action committees or PACs. The North Carolina Congressional delegation received over $17 million during the 2006 election, with 40 percent of the funds coming from PACs. In addition, fundraising efforts are bringing in about four times as much as in 1980, even when adjusted for inflation. Josh Ellis has more.

A survey from the N.C. Office of the Commissioner of Banks asserts that three-quarters of low and middle-income familes surveyed were unaffected by the essential ban on payday lenders in North Carolina since 2005.'s Scott Carr looks into what benefits the loans - which can carry an A.P.R. as high as around 400-percent - may have held for those 12-percent of respondents who said they do miss the service.

Tom Vitaglione, a senior fellow at the non-profit Action for Children is Barlow Herget's guest. Vitaglione helped establish the Health Choice program in North Carolina and points out there are 250,000 children who have no medical insurance whatsoever, including Medicaid or Health Choice program benefits. He argues uninsured children are the ones who often suffer the consequences from a lack of political consensus in Washington and Raleigh on issuse concerning healthcare for the poor.

Hate-crimes provision puts defense bill on skids

Hate-crimes provision puts defense bill on skids
Contributed by Roxana Tiron
November 16, 2007

An imbroglio between the Senate and the House over a provision that protects gays from hate crimes is pushing
conference negotiations of the 2008 defense authorization bill into December.
The Senate language would extend federal hate-crimes law to violence against gays. But conferees from both sides of
the aisle and both chambers are warning that the Senate provision would jeopardize the passage of the entire defense
authorization bill, which includes policies designed to help wounded soldiers and increase military pay.
What was a tactical victory in the Senate - the provision was adopted by voice vote - is now becoming a quandary in the
House, where Armed Services Committee leaders worry they do not have enough votes to pass the defense
authorization bill with the hate-crimes provision attached. The chairmen of the two chambers' armed services panels are
still working out the issue. The report was supposed to be done by Wednesday in hopes that Congress could vote on the
bill by the end of this week.
Rep. Neil Abercrombie (D-Hawaii), a senior authorizer and one of the conferees, said that there could be a middle
"This is a strategic question, not a tactical question. The middle ground is to recognize that and realize to put the defense
bill out as is, as opposed to changing it," he said. "It does no harm to the principle involved in the hate crimes bill."
Abercrombie warned that a failure to find middle ground could have the "devastating consequence possibly of killing both
Losing the defense bill as well as the hate crimes legislation would be an outcome "that would leave a lot of people
bitter," said Abercrombie. He added that the defense bill should not get bogged down by subordinate issues.
He also pointed out that the House already passed a stand-alone hate crimes bill earlier this year. For that reason,
defense conferees will not be diluting the principle behind the hate crimes provision if they drop the language from the
authorization measure, he said.

Is anybody watching?

Editorial from the 20 November Charlotte Observer
Posted on Tue, Nov. 20, 2007

Is anybody watching?

If this doesn't make your blood boil, it ought to: Vague state guidelines
and poor oversight of private mental health contractors in North Carolina
left taxpayers overcharged and mentally ill clients served by
poorly-qualified workers.

The cost? Perhaps as much as $45 million. The result? Scarce public dollars
earmarked for the state's vulnerable citizens were wasted.

When will North Carolina admit that its experiment with mental health reform
(a.k.a. pushing services back to the community level and cutting costs by
privatizing) is failing? Either the state Department of Health and Human
Services is incapable of responsibly instituting reforms or this is an
impractical idea -- or both.

A state HHS audit found that 185 companies have been paid tens of millions
of dollars for providing mental health services that were not medically
necessary. People who didn't need services got them. Others who did need
them got too much service. What a mess.

At issue is an important program called community-support services, which
helps about 31,000 people each month. It provides personal aides and
professional counselors to teach people with mental illness and substance
abusers life skills, such as shopping for groceries or finding a place to
live. It's paid for mainly through state and federal Medicaid dollars and is
intended as a short-term service to help people move toward independent

The program might have worked well if anyone had been watching to make sure
a private company paid to give the go-ahead and charges for services did its
job -- or if state guidelines for the program were tough enough.

This is more evidence that the state is not paying attention to details --
or to the best interests of sick citizens, many of them poor
-- as it has de-centralized its mental health services. Consider what else
has happened:

. North Carolina began closing down state mental hospital beds before
adequate funding was in place for community-based facilities. Meanwhile
psychiatric admissions were on the rise.

. In 2001, a critical leadership failure at HHS put emotionally ill children
in group homes at risk. Slack rules, lucrative reimbursements to private
contractors and scant state oversight surfaced after a girl in a Charlotte
group home suffocated while a worker without proper training restrained her.

The intent behind the state's movement toward community-based services is
good: To serve people in their own surroundings and help them live
independently rather than institutionalizing them.

The concept behind contracting services to private providers also has merit.
More efficient delivery can make limited dollars go further and help more

But somebody has to make sure reforms are well thought-out, the right amount
of funding is in place and that contractors provide the right services at
the right levels to the right people. That's not happening in North

Amicus Briefs filed

Please note that two new amicus curiae briefs have been filed by NASW in the U.S. Supreme Court.

Sprint/United Management Co. v. Mendelsohn is an employment discrimination case that originated in Kansas. The case focuses on age discrimination, but the legal issues are more widely applicable to various forms of employment discrimination. The brief that NASW joined seeks the inclusion of “other supervisor” evidence by employee-plaintiffs as proof of discrimination in the workplace. It was filed October 19, 2007 by a legal team from Fried, Frank, Harris, Shriver & Jacobson LLP in New York, and the Lawyers’ Committee for Civil Rights Under Law.

A brief was filed in Kennedy v. Louisiana on November 14, 2007 by NASW, the NASW Louisiana Chapter, and other organizations (NASW was the lead organization) by an excellent pro bono legal team from Mayer Brown LLP. The brief was filed in support of a petition for certiorari to the U.S. Supreme Court in a case addressing the imposition of the death penalty for child rape in Louisiana. NASW, and other victim advocate organizations, argue that the death penalty in child rape cases is actually detrimental to victims and increases the incentive for perpetrators to kill their victims.

Both briefs are available on the NASW LDF Amicus Brief Database by visiting

Response to Medicaid overbilling story

Two Letters to the Editor of the News & Observer on Medicaid overbilling:

Involve providers

Regarding your Nov. 16 story "Overbilling found in mental health

Community support services include everything from emergency services to skills-based services to individual therapy. When the Community Mental Health Centers morphed into Local Management Entities, they stopped working directly with clients. They became administrators -- not clinicians. To say that providers have overcharged the government about $45 million for a basic, widely used service, which a state official said, is to completely ignore what took place when the community mental health centers essentially shut down.

More troubling than this, providers have no way to impact N.C. mental health reform. There is no complaint procedure and no way to address issues other than to badger LME administrations, which simply ignore providers because they can.

The Joint Legislative Committee co-chairs might want to consider asking the providers what they believe the problems are. There is no formal way to do this at this time. It needs to be put into the law associated with mental health reform.

Marsha Hammond, Ph.D.
Clinical licensed psychologist

Mental health results

Regarding your Nov. 16 story "Overbilling found in mental health

You reported that one-third of recipients of community support services were not eligible for the services. As a result, the mental health division has blocked the licensing of new (perhaps more ethical) providers and is withholding 10 percent of payments to providers until all overpayments are recovered.

This story seems to suggest that the providers are the barbarians while North Carolina's mental health bureaucracy stands at the gates to defend the taxpayer. That same human services and mental health organization championed the outsourcing of mental health services billing. That same organization championed the outsourcing of oversight from the case managers who were also outsourced.

The result of these failures is that those needing services can't secure the protection they need. The result is that North Carolina's ability to bill Medicaid and Medicare is limited. The result is that better mental health providers cannot or will not replace the incompetent and unethical providers who overbill. The result is that our court system is choked with cases that could be avoided with treatment and care-giving.

Dempsey Benton is eminently qualified as the new leader for the Department of Health and Human Services. Now all we need to do is replace most of the bureaucrats who report to him.

Don Ward

Monday, November 19, 2007

Daily News

Can we shut off the afterburners?
Wilmington StarNews
The argument over whether to build a Navy landing field in North Carolina has escalated into a noisy political battle between Democratic Gov. Mike Easley and Republican U.S. Sens. Richard Burr and Elizabeth Dole.

Plenty of criminals
Raleigh News & Observer
When I first heard we were getting our own state prison back home in Columbus County, I thought it was a bad idea. We had all that public money but no way to use it for anything positive. You know, to encourage people to plant things or make things with their hands or recycle things somebody else made.

Dole disputes criticism of stand on Navy field
Winston-Salem Journal
Republican Sen. Elizabeth Dole responded yesterday to criticism from Democratic Gov. Mike Easley, saying she met with local residents to discuss the Navy’s proposal to build a practice-landing field for jets in Eastern North Carolina.

Daily Radio Commentary

11.16.07 The racial and economic divide

11.16.07 Special interests winning again

Friday Follies

by Chris Fitzsimon

It has been a fairly busy news week in Raleigh for the middle of November, much of it dominated by more revelations about the reign of former House Speaker Jim Black and his Co-Speaker for the 2003-2004 legislative session, Rep. Richard Morgan.
The News and Observer reported Sunday that Black’s son was awarded state contracts for pest control services at three prisons, despite submitting bids for the work that were much higher than quotes from other companies.
The story is complicated but includes allegations by a subcontractor of the company building the prisons that he was pressured to hire Black’s son to make sure the construction company would get the prison business.
The sordid tale also involves special provisions snuck into the state budget that allowed the construction company to bypass low bidders when awarding subcontracts. Virtually every story about corruption in the General Assembly at some point comes back to special provisions, changes in state law snuck into the 300 page budget document at the request of a powerful legislator, almost always without any public debate or even notice.
Banning special provisions from the budget has long been on the agenda of good government groups and House Speaker Joe Hackney said before the 2007 session that he didn’t like them either. But Senate President Pro Tem Marc Basnight openly defends the practice, saying it makes it possible to pass important programs like Smart Start.
It also makes it much easier for corrupt politicians to have their way without anybody noticing. Pretty amazing that we are still arguing about whether or not it is better for the public’s business to be conducted in public or in secret, behind closed doors.
How many more scandals will it take to end the undemocratic practice of using special budget provisions to change state law?

Speaking of Basnight, the story about Black’s son getting state contracts also included a quote that must have caused more than one state government insider to laugh out loud.
The story mentions that the Senate wanted three new prisons included in the 2003 budget bill. Some House leaders wanted to build only two prisons but were told that the Senate leadership would hold up the entire budget if it didn’t call for three.
The News & Observer reports that Basnight says “he has never threatened to hold up a budget if he doesn’t get something he wants.” Right. Actually some advocates can probably confirm Basnight’s claim that he doesn’t threaten to hold up the budget. He does hold it up.

North Carolina received mixed reviews in a new report that grades the states on how well they provide public online information about business subsidies, state contracts and lobbying activities.
The national group Good Jobs First released the report, called The State of State Disclosure, which gives North Carolina an overall grade of C for online access to the information, but a D+ for the way the state makes details of economic development subsidies available.
It points out again how slow some state agencies are in making public information available to citizens via the internet. The State Board of Elections has been struggling for years to make campaign finance data available online, but remains handicapped by the lack of a requirement for campaigns to file reports electronically and by a lack of staff to process the information.

Here are some numbers to consider as the Thanksgiving holiday approaches. A new report from the U.S. Department of Agriculture says that more than 35 million people in the United States went hungry in 2006, with children and single mothers the most vulnerable.
That figure includes 12.9 percent of households in North Carolina that are designated as food insecure. That means that at some point during the year, those households had problems providing enough food for everybody in their family.
The market fundamentalists who keep telling us that poverty is a choice and is vastly overstated should note that this information is not from a progressive, anti-poverty advocacy group. It is from the Bush Administration.
People are poor and hungry in North Carolina this holiday season, thousands of them.

NC Policy Watch

Radical Right Reality Check

Lawmaker’s anti-immigrant “statistics” traced to fringe groups and websites
By Rob Schofield
On Friday November 9, State Representative George Cleveland of Onslow County sent a document to all “exchange users” of the North Carolina General Assembly email system (i.e. all legislators and legislative staff) entitled “Interesting Statistics.” Cleveland, you may recall, was the person who uttered this statement in support of his proposal to tax international money transfers by undocumented persons:
"Anyone working in a Western Union I would hope has enough common sense to be able to discern who they should question and who they shouldn't… If a fella comes in with a pair of shaggy boots on, and jeans and a t-shirt, and he's got a straw hat on? I mean, come on! Give me a break!
Cleveland’s email offers up 13 numbered sentences (or sentence fragments) – each of which purports to offer a damning statistic on how much “illegal aliens” are costing the United States. His estimated total cost: “a WHOPPING $338.3 BILLION DOLLARS A YEAR!!!” (more...)

NC Policy Watch

Carolina Journal Weekly Update

Reaction of the Week
RALEIGH — The state’s second highest court rejected attempts by the N.C. Department of Environmental and Natural Resources and the Environmental Management Commission to fine a Nash County property owner $7,500 for failure to submit a comprehensive site assessment for a property he had inherited, reports Michael Lowrey for Carolina Journal.In reaching its decision, the N.C. Court of Appeals found the landowner was not responsible for the contamination on the property and questioned the department’s handling of the matter.A.J. Lancaster Sr. owned and operated a convenience store in Nash County. As part of his business, he sold gasoline, which was kept, as is customary, in underground storage tanks. Groundwater contamination at nearby well sites was detected in tests conducted by Nash County and DENR officials in 1989 and 1991. DENR officials suspected the leak was coming from Lancaster’s tanks and in early 1991 demanded that Lancaster immediately correct the situation. He did not respond to the agency before he died in November 1991.A.J. Lancaster Jr. inherited the property and continued to use the tanks. In 1993, he was informed of new technical requirements for underground storage tanks. After studying the cost of upgrading the tanks, he decided it made more financial sense to have them removed. This was done in late December 1993. Contamination was discovered at that time and 225 cubic yards of soil near the tanks was removed and properly disposed of. He was not alerted by DENR to the possibility of groundwater contamination at the time.

News Features
CJ: State agency, university deny records requests
RALEIGH — The North Carolina Climate Action Plan Advisory Group proclaims its commitment to “transparency,” but when asked by Carolina Journal to provide data and analysis by its consultant, the state-appointed panel had little information to offer.

CJ: Water is emotional, especially when scarceGREENSBORO — Water is a very emotional subject for a lot of people,” N.C. Department of Environment and Natural Resources section chief Tom Fransen said in July. A battle brewing in Guilford County over water, land, and suburban development confirms Fransen’s words.

CJ: Court rules for widow in tax caseRALEIGH — The N.C. Court of Appeals rejected an attempt by Henderson County officials to collect back taxes, penalties, and interest from a widow after they failed to assess property taxes on her house for a decade. The decision by the state’s second highest court might not be the last word in the matter, however, because the N.C. Supreme Court must take the case if the county appeals the ruling.

Black’s son bid high but got jobsRALEIGH — A company owned by the son of former House Speaker Jim Black won contracts to provide pest control at the state’s newest three prisons, although competing bidders offered to do the work at less than half of Black’s price. Black Pest Control was paid $124,000 for prison construction projects in Bertie and Greene counties, although a business in Stafford, Va., bid $42,000 on the same work.

Charter school loophole urgedRALEIGH — Facing flak from parents who want more charter schools and public school supporters who hate the idea, a blue-ribbon commission is borrowing a page from the playbook that agents and general managers use to skirt the salary limits in professional sports.

Upcoming Events
Monday, November 19, 2007 at 12:00 NoonA meeting of the Shaftesbury Societywith our special guest Dr. Michael SaneraReflections on Environmental Journalism based on attending the Society for Environmental Journalists National Convention

Wednesday, November 28, 2007 at NoonSpecial Wednesday Shaftesburywith our special guest Dr. Richard BrakeFailing Our Students, Failing America: Holding Colleges Accountable for Teaching America’s History and Institutions

Thursday, December 13, 2007 at 7:00 p.m.4th Annual Evening of Holiday Cheerwith Our Very Special Musical GuestsA Little Night Music

For full stories, please click on the provided links or visit


Yesterday, the House tried to over-ride the President’s veto of the FY 2008 L-HHS-ED bill and it FAILED. The vote was 277-141. 226 Democrats and 51 Republicans voted for the over-ride. On the other hand, 141 Republicans voted against the over-ride. The final vote could have been closer because there were 15 members who did not vote! Roll call vote information below.

The word now is that the Democrats are backing down and planning on splitting the difference with the President’s budget request. This puts funding of domestic programs – health, education, disability – in a “worst case scenario”.

The network needs to send the message that our programs cannot maintain the high rate of advocacy on behalf of children and adults with disabilities and their families without an increase in funding. The increases in the bill are EXTREMELY MODEST – but would make a big difference for the programs that were destined to receive them.

During the Thanksgiving Recess, we strongly urge you to:

1. Call and thank your Representatives that voted for the veto override by explaining how the additional funds would have made a huge difference in the lives of their constituents with disabilities.

2. Call and express disappointment in those Representatives that voted to support the President’s veto by explaining how their constituents with disabilities are negatively impacted by the rejection of these desperately needed additional funds.

3. Call Representatives and Senators from your home state that sit on the Appropriations Committee and explain the need for the important appropriations increases for the P&A programs in the Labor, HHS, Education Appropriations bill to be maintained. As much as possible use state specific facts on the impact these additional funds would have, or the negative impact not receiving these increases would have.

To figure out if you have a Representative or Senator on the Appropriations Committee, you can follow the following links:

House -

Senate -

When making the calls, you can always call the Capitol Operator (202-224-3121) and ask to be transferred to a specific office.

Representatives and Senators need to hear from you on the impact these funds will have as these decisions are being made over the Thanksgiving Recess and very shortly afterwards. Others will be calling to help their programs, and if the appropriators don’t hear from the P&A system, we may not be able to save the great increases we received. So, take a little time and call.

SFY08 1st Quarter Performance Contract Report

We are pleased to send you by electronic mail the following Performance Contract quarterly report documents:
Cover memo from the Division Director
SFY08 1st Quarter Performance Contract Report
Within the next few days, a copy of the quarterly report may be found on the Division of MH/DD/SAS website at:

If you have questions please do not hesitate to contact us by email or by phone at (919) 733-0696.

Overbilling found in Mental Health Program

Private mental health providers have overcharged the government about
$45 million for a basic, widely used service, a state official said
Until the companies pay the money back, the state is withholding 10 percent
of what they earn as they continue to treat patients.
The state discovered the overcharges when mental health officials reviewed
records of patients who were getting a service called community support.
The reviewers reported thousands of cases of misuse. More than a third of
the clients getting the service did not need it, and companies were spending
too much time on more than 80 percent of the people who needed help. The
state is trying to get money back from 185 providers. It withheld about
$900,000 from a recent round of payments.
Tara Larson, an assistant director in the state Medicaid office, told a
legislative commission Thursday that the overcharge figures were based on
"preliminary work," and that the final numbers aren't in.
Companies started offering community support to children and adults in March
2006. Company workers are supposed to teach skills such as anger control to
people who are mentally ill or are substance abusers, and find patients
other help they might need so they can live at home, stay in school, or find
and keep jobs.
The bills for community support started rolling in, to the tune of
$842 million last year -- hundreds of millions more than the state expected.
As costs ballooned, state officials and startled legislators tried to clamp
down on the companies. The legislature passed a law trying to regulate the
service, and the state Department of Health and Human Services recently
announced new controls.
Costs continue to rise. Over the past four months, the state spent $88
million more for community support than expected. The rate of spending would
exceed this year's $805 million budget for the service.
"This thing's out of control, and for the life of me, I don't see it getting
any better," said Sen. Martin Nesbitt, an Asheville Democrat who helps run a
legislative committee overseeing the mental health system.
Last week, the state said no new companies seeking to be paid with
government money would be allowed to sign up to offer the service.
While new sign-ups are on hold, state officials said they would tighten
rules for worker training and and company qualifications.
The state also wants to rewrite rules to make it easier to take away
permission for companies to bill the government.

From the News and Observer, Lynn Bonner, November 16, 2007