Disabled kids head back home
Craig Schneider - Staff
Sunday, May 28, 2006

Georgia is spending millions of dollars to move potentially thousands of
emotionally disturbed or disabled children out of mental health facilities
and back into their family homes.


State officials acknowledge there are not enough community and home
services to handle the children, however, so the state is creating more of
them.


Child advocates applaud the guiding premise: With the proper support of
professionals, children will do better with their parents instead of being
housed in treatment facilities. Several agencies in other states have
adopted similar programs in recent years.


Some advocates, however, fear the state is making the move simply to cut
costs, and that parents and schools are unprepared for these
sometimes-hard-to-handle children.


Some parents are fearful their children will return to the behaviors that
placed them in treatment, advocates say.


"They're concerned whether it will start all over again --- Will they hurt
my other children? Will they try to hurt me? Will they hurt themselves?"
said Pam McCollum of the Cobb and Douglas Community Service Boards, a
quasi-governmental agency that provides community services.


Department of Human Resources officials made it clear they don't aim to
shut down all facilities, and that potentially dangerous children with
severe problems may stay in treatment facilities. But officials will try to
move them closer to home.


The first phase of the Bring the Children Home program is assessing 264
children to see if they can go home. Eventually all of the 5,800 children
in facilities across the state will be assessed, officials said. About 90
have already been discharged, the majority sent home to their families,
with some sent to facilities closer to home.


State child welfare officials say they are taking care to ensure the
released children will be safe and have enough services. Before deciding to
release a child, they say, they are assessing each child's abilities and
needs, speaking with the parents, and reviewing the availability of support
services. Those services range from therapists who come to the home, to day
treatment centers, to respite care that allows the parents and children to
take a break from one another.


"This is not akin to opening up the doors to the institutions and letting
everyone out," said Gwen Skinner, director of the state Division of Mental
Health, Developmental Disabilities and Addictive Diseases. "It is child by
child by child."


In fact, state child welfare officials say the approximately 90 children
sent home or moved since January are doing well in their new environments.
None who were sent home have been returned to a facility, said Mary Dean
Harvey, director of the state Division of Family and Children Services.


Concern for other children


As long as that level of attention continues, Douglas County juvenile court
Judge Peggy Walker will be satisfied.


"Of course we want children served in the community, when they can be," she
said. But without enough support, she said, "We're setting these kids up to
fail. We're setting up these kids to go into the Department of Juvenile
Justice for their behaviors. And we will do further harm to them."


She said she is particularly concerned about sending home children who act
out sexually with other children. "They put other children at risk," she
said.


State school officials say they fear for the safety of school children.
Several of the children in the program have already arrived in schools
without any personal records, said state education department spokesman
Matt Cardoza.


"Some of these kids may be offenders," he said. "Without records it's
difficult to know their history."


Bring the Children Home targets young children to teenagers, with a variety
of problems. The majority have mental health issues, such as depression,
suicidal thoughts, anxiety issues, hyperactivity and problems with
authority figures. Others have developmental disabilities such as mental
retardation, cerebral palsy or autism.


The children reside in a range of facilities, from small group homes to
large state hospitals. Some reside in privately operated therapeutic
facilities, such as Inner Harbor in Douglas County and Deveraux in
Kennesaw, where they receive counseling and behavior medicine.


State officials acknowledge these programs can be expensive, and that the
state budget for therapeutic care has operated with a multimillion deficit
for years.


For now, the state is investing several million dollars to help bring these
children home, creating community services such as crisis units that help
children and their families get through rough periods.


'I'm afraid he'll hurt somebody'


Not all parents embrace the program.


Linda McCoy, whose 16-year-old son was moved earlier this month out of the
state hospital in Rome into a facility closer to home, thinks he was better
off before.


Her son Joseph, who has severe manic depression and hyperactivity, was
finally making progress at the Rome hospital after years of living at a
dozen other facilities, she said.


The move, she fears, will reverse her son's progress.


"I'm afraid he'll hurt somebody or himself," she said.


She added, "I didn't ask for this."


But the state is closing the Rome hospital unit in June and moving out the
14 youngsters, some to their homes and others to facilities closer to their
homes. Joseph was moved to an Atlanta facility closer to his mother's home
in Barrow County.


In other cases, the state's efforts are creating happy homecomings.


Laurie Faulk's 13-year-old son, Donald, returned home after spending six
years in a nursing home. Donald has cerebral palsy and suffered brain
damage at birth.


"I'm so glad to have him home with me," said Faulk, who lives in
Hawkinsville, about an hour's drive south of Macon.


Faulk, a single mother who cleans and maintains rental homes for a living,
said she was never comfortable with her son living in a nursing home. She
recalled he had to be hospitalized a half-dozen times because his feeding
tube had been pushed too far inside his stomach, which made him vomit and
become dehydrated.


Faulk got her son back in February with the help of a program called the
Children's Freedom Initiative, a joint venture of the Georgia Advocacy
Office, the Governor's Council on Developmental Disabilities, and the
Institute on Human Development and Disability at the University of Georgia.


The program aims to bring home virtually all the children with mental
retardation and other developmental disabilities. This year, state
lawmakers set aside 45 Medicaid waivers for developmentally disabled
children, which help provide them community services. These waivers allow
Medicaid money intended for institutional care to be redirected to
community and home services.


Faulk did not need a waiver, but program officials helped her son obtain
at-home physical therapy, an aide who comes daily, a hospital-style bed and
a machine that helps her suction her son's mouth.


"Now he wakes up to friendly voices, giggling," said the 44-year-old
mother.


Major change for families


Child welfare advocates say this is the biggest push in memory to remove
children from Georgia institutions. The effort marks a quantum leap from a
few generations ago when such children were warehoused in large, sprawling
mental institutions.


The state still relies heavily on institutions, nursing homes and
therapeutic group homes for children, officials said, because in the past
the state did not provide the services needed to care for children at home.


Georgia lags behind the national average on providing community-based
mental health services for children, according to a 2005 study by the
National Association of State Mental Health Program Directors Research
Institute.


Like Georgia, though, most other states rely more on treatment facilities
than at-home care for these children, experts say. Efforts to move children
out of state institutions often face strong opposition from private mental
health facilities worried about losing business, and a public perception
that the children will be a threat.


While treatment facilities can provide intense services for children with
serious and persistent problems, critics say many of them do not prepare
children for the outside world, and that many children fail once
discharged.


In Georgia, the push reflects a variety of initiatives put in place since
DHR Commissioner B.J. Walker took the helm in 2004. She has stressed that
the state should assist parents with their children, not replace the
parents by taking the children into state care.


Bring the Children Home requires major changes in the way mental health
professionals provide services for these children. Many providers will have
to shift toward more mobile services, where they visit the child's home to
provide counseling, family crisis intervention and parent training to deal
with the children.


Also, more mental health services are needed in rural areas, where they are
in short supply, officials say.


State officials say the children will thrive with their families, or in
facilities closer to home.


"It's not good for a child to grow up in an institution," Walker said.
"Families will take care of their most vulnerable folks far better than we
can, if we give them a shot and an opportunity to have services and
programs."


State expects to cut costs


State officials and experts say it's cheaper in the long run to care for
these children at home, as it relieves the state of facility and staffing
costs. But Georgia mental health officials said they do not have a detailed
analysis on the potential savings.


National experts pointed to several studies that showed significant
savings. It is not uncommon to reduce the cost for a child from $75,000 to
$30,000 a year, said Eric Bruns, an assistant professor at the University
of Washington in Seattle, who has studied several programs across the
country.


"With the right kinds of support, you can see tremendous recovery," said
Bruns, who is also a psychologist. "It's a change in their life course."


State officials acknowledge they're under pressure to reduce spending on
therapeutic care for children, which has been running a $50 million deficit
for several years. The daily costs range from about $100 for a child in
therapeutic group home to more than $300 for a child in a state hospital.


"We don't want the children to get lost in these dollar considerations,"
said Normer Adams, executive director of the Georgia Association of Homes
and Services for Children.


Walker said the program is not driven by dollar concerns, but by what's
right for the children.


"We're not doing anything that the families don't want," she said.


To improve at-home and community services, the state has allocated $2
million for more Medicaid waiver slots, which will allow more children to
receive home treatment.


Another $3.7 million is slated to create crisis stabilization units, where
children in distress can go to settle down for a few days, rather than be
hospitalized. Mobile crisis teams, which will visit children suffering
emotional setbacks at home and offer them counseling and medication, are
starting up around the state.


At the Cobb-Douglas Community Service Boards, officials worry they're
having to provide more services for children, while they are still in talks
with the state for more money. The boards are working with about a
half-dozen children recently sent home and expect about 20 in the first
wave of the program.


"These children generally need more services than we are funded for," said
McCollum, the boards' director of child and adult services. "We're looking
to supply what we can."


For example, the program is moving one boy home in stages. He spends one
day a week in a regular school and weekends at home with his parents, so
his caseworker can see how things are working out.


"It may not be as quick as the state wants it to be, but we're trying to do
this in a thoughtful way," McCollum said.


BY THE NUMBERS


5,800: Number of emotionally disturbed or disabled children in state
institutions


$100-$300: Amount it costs per day to care for them


$50 million: Amount the state has been over budget for several years