A 7-year-old girl left unsupervised with a 17-year-old boy at a Department of Social Services office was sexually abused.
A teenage girl spent nine months in an emergency room, essentially in isolation.
A 14-year-old Lumbee boy spent at least three years in a psychiatric residential treatment facility where he said he was bullied and felt unsafe.
These cases and others make for some difficult reading in lawsuits filed as recently as last month against individual counties and the state of North Carolina alleging that the state is failing children, especially those with disabilities, who wind up in the child welfare system.
Not only is the state failing these children, the lawsuits argue that by allowing these conditions to continue and fester, North Carolina is in violation of the federal Americans with Disabilities Act, which outlaws discrimination against people with disabilities, including kids with mental health issues.
Beyond that, the state is in violation of the 1999 U.S. Supreme Court Olmstead decision, which affirmed the Americans with Disabilities Act and went further, saying that people with disabilities have a right to be fully integrated into society, into their communities.
Despite lawsuits and legislation, problems with the system persist.
“It is a well-studied problem. It is a well-documented problem,” said Corye Dunn, director of public policy for Disability Rights North Carolina, which filed lawsuits against the state in 2017 and 2022. “It is a problem that many policymakers have expressed concern over, and yet kids are still suffering.”
‘No easy fix’
State officials, lawmakers and advocates all say that North Carolina has been working on improving the system. In an emailed statement to NC Health News on Friday, staff with the state Department of Health and Human Services noted that those efforts range from increasing foster care spaces so children won’t end up in emergency rooms or the offices of county Departments of Social Services, to improving training for new workers.
There’s no easy fix, said Karen McLeod, who runs Benchmarks, an umbrella nonprofit organization that advocates for groups that provide care for children and families.
“It is a combination of things that are going to need to be lifted and looked at holistically to be able to move this system to a different place where we don't have the crisis that you currently see,” she said.
North Carolina landed in this quandary in part because it is one of only nine states in the country with a child welfare system that’s state-supervised, but where the activities of child welfare get performed by agencies in the state’s 100 counties. She noted that of those nine states, North Carolina’s funding is at the very bottom of the heap.
“There is — and will continue to be — tremendous challenges in our foster care system because it is very underfunded,” McLeod said.
And there are wide disparities between what wealthy counties and their poorer neighboring counties can offer.
“If, for instance, as a poor county, you have trained up a social worker, but you can't pay them near as much as the county next to you that is a wealthier county, then basically you are a ground to train and lift up workers who then go somewhere else as soon as they gain some level of skills,” she explained. “You just have this constant turnover.”
McLeod said the county social service workers who get left behind end up overburdened and burned out.
“It's very stressful for those workers, because now they have all these cases, and they know how important this work is, but their ability to be able to have the time and to address all of the components that are in that case, it's just not feasible,” she said.
Regionalization as an answer
After the neglect death in Moore County of 23-month-old Rylan Ott in early 2016, the 2017 General Assembly passed a child welfare reform bill that included a directive to create a regional supervisory system to offer more support to counties.
The idea behind Rylan’s Law is that regional advisers could provide training, technical assistance and — importantly — more oversight of the smaller number of counties under their purview.
But seven years later, that regional system is still being put into place. A lead regional director began work in January this year, and all but one of seven regional director positions has been filled, according to information DHHS shared Friday in an emailed statement.
“County partners are already benefiting from the wealth of knowledge our regional directors bring to these critical positions,” DHHS said in the statement.
Other efforts to continue making changes to the child welfare system have struggled to make headway in the General Assembly.
“With the political will, the General Assembly could fix this,” said Dunn of Disability Rights NC. “There have been very high-quality proposals in recent years, in the Senate in particular, that could dramatically improve the administration of child welfare services.”
The two legislative chambers have not been able to come together on a plan. Case in point: Senate Bill 625, which received unanimous support in the Senate before getting a complete overhaul in a House committee. The new version sits in the House’s rules committee.
DHHS said in the statement to NC Health News that it supported the version that was passed by the Senate in April 2023 as an “important opportunity to further improve the system by granting NCDHHS additional authority in child welfare cases.”
That extra authority was stripped from the current version crafted by the House, where lawmakers are often under greater pressure from county boards of commissioners and social service directors who resist the loss of local control.
“Anytime you have a shift in authority, there's always going to be some level of pushback. And you know, we've heard that there are counties that have a lot of concerns about (SB) 625, shifting some of that authority over to the state and … that has led to some of the concerns on the House side,” McLeod said.
The latest version of the bill does include a recommendation to study the creation of a foster ombudsman program, similar to what states like Texas and Maryland are using to investigate complaints from children in the foster care system.
Adding an ombudsman, along with regionalizing services and creating greater oversight and investigatory authority, are steps Dunn suggested North Carolina should take.
“All of those things would improve the state's insight into county-level functions,” she said.
DHHS efforts to improve child welfare system
In an emailed statement to NC Health News, staff with the state Department of Health and Human Services listed the following efforts to improve the child welfare system:
- The regional support model, created under Rylan’s Law, is being implemented. Under this model, DHHS “will deploy continuous quality improvement and technical assistance in safety, permanence, and using the agency data to drive effective services that protect children, promote our value of health and well-being for all North Carolina.”
- Six out of seven regional director positions have been filled.
- The General Assembly approved $80 million “to strengthen specialized behavioral health treatment options in local communities and increase residential and inpatient settings for children to divert them from emergency rooms and local DSS offices.” These include treatment programs to safely stabilize children who are experiencing a behavioral health crisis with emergency department diversion, mobile outreach response crisis teams, specialty treatment programs for children with complex behavioral health needs, and intensive supports in the community.
- The new Medicaid Children and Families Specialty Plan will support children, youth and families served by the child welfare system in receiving coordinated health care even if they move across county lines from where their Medicaid services originate.
- A new Emergency Placement Fund will ensure children are not languishing in inappropriate settings like DSS offices.
- A trauma-informed, standardized assessment is being developed to address the trauma experienced by children and youth served by the child welfare system.
- A statewide foster family awareness campaign was launched. The number of licensed foster homes in the state increased from 5,825 in December to 6,081 in June.
- A new kinship program was instituted to provide financial supports to unlicensed kinship providers to increase the number of foster-care involved youth who are placed in kinship care. As of June, there were over 1,600 unlicensed kinship families eligible to receive financial support, with nearly $600,000 going to families in that month alone. Over 2,500 children are with their families as a result of this work.
- Worker training improvements include a redesigned Child Welfare Pre-Service Training curriculum that will provide new workers opportunities to practice knowledge, skills, abilities and behaviors grounded in realistic on-the-job experiences.
Funding concerns
Even with recent huge investments by the legislature, there are still funding gaps, DHHS said.
The department shared information from a 2018 survey conducted by Child Trends, a research organization focused on children and youth, that showed how North Carolina ranked last in total annual spending per child compared to other states that have state-supervised/county-administered child welfare systems (the organization has not replicated this survey).
North Carolina also ranked last when comparing state funding per child among seven states in the Southeast.
That information did not take into account last year’s historic $835 million public investment in behavioral health and home- and community-based supports. The General Assembly directed that $80 million of that funding go toward strengthening specialized behavioral health treatment options in local communities and increasing residential and inpatient settings for children to divert them from emergency rooms and local DSS offices.
In addition, the state last year increased monthly foster care and adoption assistance rates and began kinship payments to support family members who foster the children of relatives.
Even so, funding gaps remain. DHHS said several positions in each of the seven regions under the new regional support system remain unfunded. And counties continue to struggle with inequities in funding to hire staff, continuing the flow of workers from poorer counties to wealthier ones.
“There are fundamental challenges within the North Carolina child welfare system —– including its decentralized structure, staffing shortages, and a long history of underfunding from the state —– which cause inherent inequities between counties and directly impact outcomes for children and families,” DHHS told NC Health News.
The state stopped providing money to county social service offices in fiscal year 2009, according to DHHS.
“Legislative action is needed to better serve children and families, alleviate the child welfare staffing crisis, provide aid to counties and increase capacity of courts to expedite permanency,” DHHS said in the statement.
Lawsuits drive change
Along with legislation, court action has helped move the needle in improving care for children in foster care.
This spring, the state agreed to a series of improvements as part of settling the 2017 case brought by Disability Rights NC and the families or guardians of five children. That lawsuit, more commonly known as the Samantha R. case, alleged that North Carolina unnecessarily institutionalized, or placed at risk for institutionalization, people with intellectual and developmental disabilities, something that violates both the Americans with Disabilities Act and the Olmstead decision.
Another lawsuit filed in 2022 by Disability Rights NC and the North Carolina State Conference of the NAACP against Kody Kinsley, secretary of NCDHHS, sought to prevent what they described as the continued “warehousing” of children of color in locked psychiatric facilities that can be dangerous.
In their lawsuit — known as the Timothy B case — filed in the Middle District of North Carolina, the groups allege that children they represent withstood “sexual and physical abuse, bullying, and hate speech by both youth and staff; and face mental health deterioration and cocktails of strong psychotropic medications.”
That case remains pending after the court earlier this year rejected the state’s attempt to dismiss the lawsuit.
Two more lawsuits were filed last month.
DHHS declined to comment on the cases, noting that they don’t comment on pending litigation.
‘Windowless cubicle’
A Moore County mother sued her local Department of Social Services on Aug. 8, alleging the agency institutionalized her two children with disabilities while she was in the hospital and refused to return them for months after she recovered.
The lawsuit, filed by Disability Rights North Carolina, alleges that Moore County Department of Social Services took custody of two children with disabilities when their mother, Rumina Slazas, was temporarily hospitalized for cancer treatment. The suit alleges the Moore County DSS unnecessarily placed the children in the emergency department and locked psychiatric facilities.
Federal courts have ruled that state-operated services for people with disabilities should be based in the community — instead of locked facilities — as much as possible. The lawsuit claims that Slazas’ son was sent to a locked facility for a year and a half. Meanwhile, Slazas’ daughter became eligible for special community services through the state funded Innovations Waiver, but the lawsuit claims that she was instead left in the emergency department at UNC Hospital in Chapel Hill for nine months before being moved to a psychiatric residential treatment facility out of state, a model being scrutinized nationally for harming children more than they help.
The children's physical and mental states deteriorated during their time in foster care, according to the lawsuit.
Slazas spent about six weeks in the hospital before returning home and after a few months of recovery was ready to reassume custody of her children, but DSS refused to give the children back, her attorney alleges in the lawsuit. Moore County DSS used "unwarranted assumptions and stereotypes" that contradicted the medical opinion of her doctors about the mother's ability to parent due to her disability, violating the Americans with Disabilities Act, Slazas’ attorney wrote.
While in Moore County DSS’ custody, Slazas’ now 15-year-old daughter lived in the DSS office building, two emergency departments, and a residential psychiatric treatment facility before being returned to her mother. While at the hospital, the teen “lived alone in a windowless cubicle with a curtain for a ‘door,’” according to the lawsuit. Her daughter has intellectual and developmental disabilities and is considered nonverbal, but had functioned well before being removed from her home. The lawsuit claims that DSS didn’t provide communication aids or services for the child while she was in their custody.
Since her time in DSS custody, the girl is cautious about leaving home and fears time when separated from her mother, according to the lawsuit. Slazas claims her daughter regressed from using the toilet independently to wearing diapers and having frequent accidents since her time in DSS custody. She has also required extensive dental work since her time in DSS custody, according to the mother who has always helped her daughter brush and care for her teeth.
Meanwhile, her now 16-year-old son spent some time living in the Moore County DSS office before being placed in a locked facility as well. He was separated from his mother and sister for 16 months, the lawsuit alleges. His mother claims that her son didn’t receive the physical and mental health services he requires for his intellectual and developmental disability during his time in the facility. Since his time in DSS custody, he required reassurance that he won't be removed from his home again and that his belongings won’t be taken from him.
His mother alleges that her son harms himself when he’s stressed, something he did not do before going into the custody of Moore County.
Mary Craven Adams, an attorney representing Moore County, did not comment on the lawsuit itself, but answered questions regarding current placement data and existing policies.
She wrote in a statement to NC Health News that community-based settings, which “include kinship (family) and fictive kinship (friends of the family) placements are MCDSS' first priority for all children in out of home placement. In the majority of cases these are not licensed family foster homes, they are named placements suggested by the parents of the children.”
Class action lawsuit
In the most recent child welfare case, nine children and their families or guardians filed a class action lawsuit in federal court on Aug. 27 over what they called the state’s “continuous and systematic failure to protect and provide for North Carolina’s foster children.”
“Children are placed into institutions at twice the national average, are shuttled between placements with disturbing frequency, and do not receive adequate services or necessary medical treatment or education,” attorneys wrote.
State officials are aware of these issues, acknowledging in the 2020-2024 Final Annual Progress and Services Report that the state needs to improve stability and reduce the number of placements for children in its care, for example.
Attorneys also allege that caseworkers don’t receive adequate training or support and can’t manage caseloads, and said turnover is outpacing recruitment.
In the Annual Progress and Services Report, DHHS also acknowledges the issues with turnover leading to inexperienced staff.
Attorneys argue that the state system is violating the First, Ninth and 14th Amendment rights of foster children, as well as their rights under the Child Welfare Act of 1980. Furthermore, the rights of some children in the welfare system are also being violated under the Americans with Disabilities and federal Rehabilitation acts.
They’re asking that the court require the state to fix the many issues raised in the lawsuit, from improving caseloads and staffing levels to enforcing mandatory performance metrics and ensuring there are community-based therapeutic services available to children with disabilities. They also asked the court to stop the state from putting kids in a congregate care setting when there are no foster homes available.
“There's widespread agreement that we have a lot of room for improvement,” Dunn said. “We owe our kids better than this.”
This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.
