Hard Climb Ahead

More questions than answers regarding Nebraska’s child care privatization

Get comfortable before you ask state Sen. Kathy Campbell what concerns and questions she has about Nebraska's child welfare privatization program. You're likely to be there for a while. “Is the program as we've set it up sustainable, both financially, as well as service contracts or sub-contracts with other agencies?” she says. “I think the financial questions and its future of sustainability — that's a whole cluster of questions. And how the system is working on behalf of children or families is the other large area of questions.” “Another set is how is the foster care system working within this new framework?” “You want me to go on and on and on?” she asks, laughing. “The point here is that there's just a great number of questions about what has happened.” Fourteen months into the process, answers are hard to come by. What is clear about Nebraska’s early effort to outsource its child welfare responsibilities is that it's floundered. Three of the five lead agencies hired in the revision process have dropped out or declared bankruptcy, leaving just two service providers to oversee thousands of Nebraska's most vulnerable children and families. The state has actually resumed its responsibilities in the entire western part of the state, but is working with fewer resources due to the failed work from private contractors. Each of the more than 6,200 child wards of the state has been given a new case worker — many have had multiple agents. For children and families who often struggle with mental health diagnoses and addictions, these changes are especially difficult. They delay the ultimate goal: establishing permanent, safe environments for the kids. A report by a governor-appointed board shows the process has been wrought with confusion: including unclear work responsibilities and lack of training for case workers; case workers who lack knowledge about families they represent and, in some cases, the experience to deal with complex child abuse and neglect cases; and lack of documentation and records that leaves government agencies and advocacy groups unsure of how they can help. Where we've been In 2008, Nebraska's child welfare system gained national attention. Lawmakers had passed a Safe-Haven law, signed by Gov. Dave Heineman, intended to protect newborns from being killed or unsafely abandoned by distraught mothers. But unlike the other 49 states that enacted similar laws, Nebraska law allowed parents to drop off any child — up to age 18 — at state agencies and other places. More than two-dozen kids — including a 17-year-old boy and a 15-year-old girl — were dropped off at state agencies by parents or guardians. One woman drove from Georgia to leave her 12-year-old son with the state. In November 2008, lawmakers held a special session to amend the law to apply only to children under age 1. But the incident shed light on the state's already failing child welfare system. “That was a huge nightmare where Nebraska sort of gained national prominence for not taking good care of its most vulnerable kids. And a lot of those kids had been in the child welfare system,” says Sarah Forrest, policy and research associate for children's advocacy group Voices for Children. Nebraska already had one of the worst child-welfare records in the country, including one of the highest rates of children removed from their homes. The Federal Department of Health and Human Services reviewed Nebraska's child welfare system in 2002 and found it failing in all of its indicators of child safety, permanency and well-being. It also had problems with data collection and licensing procedures. It didn't fair much better in a 2008 review. Like other states, Nebraska turned to the private sector to right its ship. In November 2009, the state contracted with five private agencies to provide all services for children and families in its child welfare and juvenile justice systems. But that system didn't last long. CEDARS Youth Services withdrew from its contract and Visinet, Inc. declared bankruptcy in April 2010; and Boys and Girls of Nebraska, Inc. terminated its contract in October 2010, sending about 1,700 child welfare cases in western Nebraska back to the Department of Health and Human Services. These families often deal with issues of mental health, drug and alcohol addictions and domestic violence, says Georgie Scurfield, executive director of Sarpy County's CASA program. Many struggle with restrictions related to poverty, lack of transportation and access to services. “So they rely on services provided by these agencies to be able to prove that they're doing better, to get their children home and to help their children out,” she says. When contractors quit, it meant personnel changes in every case. From January-October 2010, more than half of the children in the state's care had two or more service providers, according to a December report by the governor-appointed Foster Care Review Board. “Families and children were having to deal with strangers coming into homes to set up plans or to provide services,” Scurfield says. “Those things are very difficult to deal with for families who had perhaps just learned to trust one person, for that person to be gone and somebody else to come in.” She says personnel changes, accompanying problems with documentation, can significantly impact children's wellbeing. It also delays the end goal: moving cases to a swift and sensible conclusion. After Visinet and Boys and Girls Home pulled out of their contracts, shelters in North Platte and Kearney closed, forcing kids to be shipped as far as Columbus to have a place to stay overnight. “It's really bad in western Nebraska,” Forrest says, where services have been largely depleted. These problems, Scurfield says, were accelerated by the state's decision in October to hand over even more responsibilities to contractors. Starting in January, the state transferred case management duties to the two remaining contractors, KVC Behavioral Healthcare Nebraska and the Nebraska Families Cooperative. Activists and child welfare organizations loudly protested the decision, demanding the department slow down an already troubled reform process. Voices for Children in Nebraska said in a press release that it was “deeply troubled by this sudden move by DHHS, made without significant stakeholder input.” Where we're at In December, the Foster Care Review Board released a scathing assessment of the situation. There had been no significant reduction in the number of children in out-of-home care; it had not helped move more cases toward resolution or altered the rate of children returning to foster care. The report showed a deteriorating child welfare infrastructure. It found licensed foster homes decreased by 13 percent in the state from October 2009-October 2010, as well as anecdotal evidence that therapists and other service providers were ceasing work with foster care or going out of business because of payment issues or other problems with lead agencies. While the federal assessment found the state's $725 per-month payment for non-relative foster parents was too low in 2008, the board reported that non-relative foster parents were receiving only $600 per month in 2010. The report found 30 percent of cases reviewed lacked documentation — a troubling, 11-percent increase from 2008. “Service coordinators do not have sufficient training or background to keep children safe and obtain needed documentation/evidence,” the report said. It found service coordinators' workloads already “preclude their ability to be proactive for children and families.” The state DHHS disputed the assessment. “We are working to create better outcomes for children by making necessary changes,” said Todd Reckling, director of the Division of Children and Family Services, in a press release. The report … focuses on the policies of the past and seems to advocate a return to practices of the past.” Word came after the report's release that Gov. Dave Heineman had decided not to reappoint two review board members, including chair Alfredo Ramirez. The governor's spokeswoman, Jen Rae Hein, said the letters had been sent to the board members before the report had been released. Voices for Children in Nebraska Executive Director Kathy Bigsby Moore told The Reader in January that the members' dismissal removes knowledgeable people at a critical time. “You know, there are times for fresh, new approaches, and then there are other times where you need people who already have that ground knowledge. And this strikes me as a time where continuity would outweigh change,” she said. Where we're going Georgie Scurfield has worked in the child welfare field for 30 years — across two continents. She began volunteering for the Sarpy County's CASA program in 1990, and has directed the program for the last 14 years. She's a member of — and formerly chaired — the Foster Care Review Board. Looking back, she says, Nebraska's reform could have been more effective with better planning. She says when Florida privatized its child welfare services in 1996, “there was extensive and detailed legislation put in place to address the problems that were likely to arise as they moved through the privatization process. “And that hasn't happened in Nebraska.” The Foster Care Review Board recommends the state rebuild its child welfare infrastructure and build a system of preventative services, in addition to dozens of other suggestions to help fix what's broken. “There are a lot of really good people both in the department and the contractors who are trying to do good work,” Scurfield says, “but this needs to be a concerted effort and we're in a difficult time economically to be making this scale of change. Campbell says, right now, no one knows the answers to the state's reform questions. But she hopes her resolution, LR 37, will help. It allows the legislature's Health and Human Services Committee, which she chairs, to consult with the state's Health and Human Services department, Foster Care Review Board, the courts, lead agencies and other stakeholders to use studies, reports and other information to improve the child welfare system. The committee could hold public hearings, subpoena and take depositions of witnesses to consider the goals of the system overhaul, measurable outcomes, coordination and long-term planning. And it could request a fiscal and performance audit. After a “rocky” year, Sarah Helvey, staff attorney and director of Nebraska Appleseed's child welfare program, says the fiscal and performance audits are critical. “We think it's really important to understand what went wrong and what went right over the course of the last year,” she says. “It can inform our steps moving forward.” The committee has until the end of the 2011 legislative session to get its questions answered. Campbell expects the committee to begin interviewing stakeholders this summer. “I think it's going to work, I don't think there's a doubt about it,” she says about privatization. Scurfield says for that to happen, it's going to take help from the community. She says volunteers are needed to review paperwork for the Foster Care Review Board, and to become Court Appointed Special Advocates — screened and trained volunteers appointed by a judge to advocate for one family of children at a time. These volunteers then report to the judges and work with case managers and service providers to ensure the children and families' needs are met. “We need the community to step up and help out, because things are not looking good,” she says. Forrest says Nebraskans should care about this issue because it affects taxpayers as well as the state’s most vulnerable children and families. “If we don't have a system that's secure and stable, we're going to end up putting a lot of money into something that's not serving our families well, not providing efficient and good services,” she says. “Potentially, we're going to lose a lot of money if we don't establish something that really works.” Money underlies every question about revising the system. But child welfare is not like retail, Scurfield says. “We don't have a Black Friday. Even if things are all right by next November, it isn't good enough, because we're doing the damage right now to the families who maybe could have been reunified, or the children who are not safe at home, or the families who could have had their children home safely.” Learn how you can help by visiting NebraskaCASA.org and FCRB.Nebraska.gov. Hilary Stohs-Krause contributed reporting to this story.

posted at 07:53 pm
on Wednesday, March 09th, 2011

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