Greensboro News Record - Greensboro, NC, USA
Cuts likely for at-risk youth homes
Sunday, July 19, 2009
By Gerald Witt
GREENSBORO — Children who are suicidal, violent or severely mentally and emotionally unstable might have no place to go if the Senate version of the state budget passes.
And by most accounts, it looks like a cut to the therapeutic facilities serving those children is likely.
“There will be casualties along the way,” Robert Williams , director of the Guilford County Department of Social Services, said of the potential state cuts. “The question is, 'How do we minimize those?’”
If not for those facilities, Williams said, those children — about 130 in Guilford County — would otherwise end up in jail, juvenile detention, state substance-abuse programs or in mental health programs.
Instead they are at facilities offering more security and therapy than a group home or are in locked facilities that are less expensive but on par with a psychiatric hospital.
The suggested cuts to those centers total $15.9 million in 2009-10 and $22.6 million the next year , according to figures from the N.C. Providers Council, which advocates in the legislature on behalf of children’s homes, among other things.
The state Department of Juvenile Justice expects the change and is preparing for about 600 children in therapeutic homes statewide that will likely need to go elsewhere.
“There are about 100 that we would be really concerned about, that would need some kind of 24-hour placement,” said William Lassiter, a department spokesman. “These are serious or violent offenders.”
Juvenile detention centers don’t have room for those children. As of Friday, more than 400 of the state’s 425 juvenile beds were occupied.
“We understand that it’s pretty likely that this is going to happen,” Lassiter said. Juvenile justice has sent letters to local court coordinators and began working with the state’s human services department to prepare for the change.
The cuts are partly a reaction to a system that’s long been thought to hemorrhage money, a system in which a child could stay for years without much therapy while the provider collected tax money.
Some work was even being falsely called therapy.
“They had people doing things like taking (children) to the fast-food restaurant,” Williams said, “And that’s what we paid for.”
When an overhaul of the mental health system, which is tied to how those therapeutic homes worked, began in 2001, an abundance of private care providers appeared that has since thinned itself out.
Advocates say that the remaining facilities generally work well.
“It’s working again, and it’s about to be turned upside down,” said Michael McGuire , clinical director of The Children’s Home in Winston-Salem, one of the best-known homes in the state offering residential child therapy.
He advocates simply raising taxes to keep facilities open.
“We have a responsibility to help folks,” he said. “And maybe it’s short-term, maybe it’s until the economy does recover.”
If the cuts happen, it wouldn’t automatically lead to those most at-risk children being turned out on the streets.
“We convinced many of the legislators to slow it down,” said Bob Hedrick, director of the N.C. Providers Council.
Overall, Hedrick said that the state is poised to cut $541 million in 2009-10 from the N.C. Department of Health and Human Services and eliminate another $753 million in 2010-11.
For those most extreme child cases — called level III and level IV clients by insiders — a complex and strong set of alternatives must be ready, advocates say.
As the system stands, here are the options for those children:
-- Group homes: Some would lose money under the cuts and might not be staffed appropriately to handle the specific needs of those most at-risk.
-- Therapeutic foster homes: Like a higher-level traditional foster home, these offer therapy as they raise children. But foster homes are traditionally intended to take those children living in abusive or dangerous home environments, not children who are a danger to themselves or others.
-- Psychiatric hospitals: This option is one of the most expensive ways to treat a child.
Williams and others have said that the system needs tweaking. Studies have shown that other, more nuanced methods of treatment for the most difficult cases can work better than residential therapeutic facilities.
“We need to change it,” Williams said, “but we need to do it in a very planned way.”
He sees much of the burden shifting to therapeutic foster homes.
“Do you have the manpower, the professional manpower, to man these programs that they should?” he said.
Otherwise, the burden would shift elsewhere.
“The system is going to pay for it either way,” he said. “We either pay for it and let them be in a productive system or we let them go into the mental heath, juvenile justice, substance abuse or criminal justice systems.”
Contact Gerald Witt at 373-7008 or firstname.lastname@example.org