Best practices research over the past 20 years has made it clear that children with special needs—be they mental health issues, developmental disabilities, physical disabilities or behavioral issues—flourish best in settings that are as unrestrictive as possible, given their specific needs. Keeping children whenever possible with their families, in their communities of origin, and in their familiar schools and surroundings, has been shown to result in the best overall outcomes: the individual children have the best chances for recovery and successful lives, and the costs to society of community-based preventive care and treatment are much lower than the costs of in-patient care.
North Carolina has, over the past 15 years, begun constructing a system that places fragile children in the least restrictive settings possible in order to achieve the best possible outcomes. Massive budget cuts to state services for children currently being proposed in the House, however, would hit all the pressure points of this delicate system, destabilizing the cross-agency continuum of care that the state has managed to cobble together.
House-proposed budget cuts would decimate children’s protective services.Currently, when children are identified as at-risk by child welfare services, schools, physicians or others, there are protective services available to stabilize them. Community-based mental health services, family support services, parent education, mentoring for children, after-school programs, school-based health services and more all work to give children and families the supports they need to overcome difficult circumstances.
House-proposed cuts to Support Our Students, Boys and Girls Clubs, mentoring programs, Communities in Schools, adolescent pregnancy prevention programs, school nurses, family resource centers, and more would greatly weaken the state’s system of preventive services. Without these protective community- and school-based services in place, more children and families will begin to disintegrate.
House-proposed budget cuts would decimate children’s mental health treatment services. Currently, when children must leave their homes because of serious mental health issues, or because of abuse or neglect, they are placed in a range of settings, from basic foster care homes (for children with few special needs) to more intensive foster care homes (where children with more needs can receive appropriate therapy) to in-patient psychiatric settings (where children with the most severe needs can be treated).
House-proposed cuts to community-based mental health services will mean that families providing therapeutic foster care will no longer have the community treatment services that are the basis of the therapy their foster-children receive. Children that need these more intensive placements, therefore, will no longer receive the necessary therapies and will have to move into basic foster care homes. However, House-proposed cuts in payment rates to families who foster and adopt children mean that fewer families will be able to serve as therapeutic or basic foster care families. North Carolina, like states across the nation, already has a dearth of foster care families.
In addition, children who are placed in therapeutic foster care settings are there for a reason—their needs are too intensive for basic foster care. When placed in basic foster care, then, these children will likely begin bouncing from foster home to foster home before they eventually end up either in a group home, in in-patient psychiatric care, or, because adolescents living with unaddressed mental health or other special needs may act out in inappropriate ways, in the juvenile justice system.
House-proposed budget cuts would decimate juvenile justice treatment services. House-proposed cuts to Juvenile Crime Prevention Councils mean that fewer preventive services (mentoring, after-school programs, community programs) for all at-risk children (mental health needs or no) and community-based rehabilitative services for children involved in the juvenile justice system will be available. Without these services in the community, more children will have to be placed in youth development centers (residential treatment and rehabilitation centers).
House-proposed budget cuts mean a return to institutional care.The proposed House budget would erase 15 years of work during which fragile children were intentionally shifted into the least restrictive settings possible in order to give them the best shot at recovery and successful lives. Group homes (the child welfare system placement of last resort), in-patient psychiatric beds (the mental health system placement of last resort) and youth development centers (the juvenile justice system placement of last resort) would once again become the dumping ground for children with mental health and other special needs. Warehousing children in institutional settings is detrimental to their development, recovery and life success, and costs society more in the long-term than do effective prevention and treatment services.
House-proposed budget cuts would decimate even last-resort placements for children.The coda to this story is just as troubling. The House-proposed budget cuts would also eliminate many of the settings of last resort. Cuts to group homes that provide intensive therapy for children with mental health needs would limit placements further, cuts to Medicaid provider rates would decrease the number of available psychiatric in-patient beds for children (North Carolina already has too few), and the shuttering of two youth development centers would cut needed juvenile justice beds as well.
Where will you stand?It is past time to start asking legislators—and ourselves—the difficult questions. Will we not prioritize prevention, given the established connection between effective preventive services and long-term positive outcomes for children and society? Are we willing to allow children to live with serious, untreated mental illness or other special needs? Where will our children go after the last resort is eliminated?