State's fragmented system failing troubled youths

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The children, most of whom have been abused or neglected by family members, are often moved from home to home, forced to undergo therapeutic evaluations more than once and work with myriad case managers, according to a review of state records by The Greenville News.

Children often get sicker the longer they are in the system, according to state records and an attorney who works to protect troubled children.

"They get further behind at school. They become more violent, and then they either wind up really getting very sick and in a very expensive group home or residential treatment facility or they end up in the Department of Juvenile Justice system," said Rochelle McKim, a child advocate attorney.

Compounding the problem of fragmented services is a lack of care for the children in their home communities, documents say.

State taxpayers spend $140 million a year to care for troubled children, whose problems range from behavioral disorders to mental illnesses. Included in the state's system is an office to oversee disputes between the various agencies.

The system is so flawed agencies don't agree on the definition of a troubled child.

Only seriously disturbed children get the care they need, according to state records and officials who work with the children.

"It needs fixing bad," said state Sen. Verne Smith, a Greer Republican who chairs a Senate budget committee that oversees children's services.

The trouble in the system recently came to the attention of courts and law enforcement.

An Oconee County girl who spent seven months in two Upstate group homes has sued the state Department of Social Services and operators of the homes, alleging state officials failed to protect her from sexual predators in the homes. She reported she and other female teens were sexually abused, the lawsuit says.

Two months ago, three workers at a group home near Summerville were charged with homicide by child abuse after a 10-year-old boy died while being restrained.

The News reported last month that complaints to DSS of abuse and neglect in the homes increased more than 200 percent last year, and substantiated allegations also have increased.

The Children's Services Study Committee, established by the Legislature last year, found a lack of central oversight, too many agencies involved and no consistent quality control.

"Children must become seriously disturbed before adequate care is available," committee documents say. "Along the way, as their condition deteriorates, families report delays, restrictions, and duplications in getting care."

McKim, who was a member of the committee, said the services of the multiple agencies are often uncoordinated.

The job of monitoring the children's care is generally split between two agencies: DSS and the Continuum of Care, which is part of the Governor's Office.

Many other agencies have a role in watching the children and the facilities in which they stay or provide some service to the juveniles. They include the Department of Juvenile Justice, the Department of Health and Human Services, the Department of Health and Environmental Control, the Department of Mental Health, the Department of Disabilities and Special Needs and even the state fire marshal.

The Continuum was created in 1983 to coordinate services for emotionally disturbed children. In 1994, the Legislature decided DSS could retain legal custody of such children, but Continuum and the Mental Health Department would direct their treatment.

But two years later, then-Gov. David Beasley directed that DSS assume more control. Continuum could continue to coordinate services for children but not those in state custody, he said.

Last year, when then-Gov. Jim Hodges transferred some of Continuum's funds to be used by his office, Republican lawmakers vowed to move the agency out of the governor's control. Lawmakers have fought ever since over where to send the tiny agency and how to reorganize treatment of troubled children.

House Majority Leader Rick Quinn said one problem with having so many agencies involved is children are moved more, which can prove disastrous for emotionally disturbed youth.

He recalled one child who was sent to four different facilities in an 18-month period.

Advocates say that's not unusual, nor is the system's failure to detect problems in their care.

The Oconee County girl alleged she had been moved three times in a year, encountering repeated sexual abuse, inadequate security and poor management at each group home.

Her suit says officials ignored multiple warning signs. There were "massive" escapes at the homes by children, some of whom remain unaccounted for, according to the suit. The girl's regular blood tests indicated sexually transmitted diseases and tuberculosis, yet she was not removed from the home or treated, and flagrant socializing and sexual fondling of girls were conducted in open and public areas, the lawsuit says.

The abuse ended when juveniles at one facility snapped photos of one worker touching the girls and the photos came to the attention of a judge, according to court records.

ù One major problem with the system, critics say, is that the same agency that places many of the children — DSS — is responsible for monitoring their care and catching violations.

Candy Waites, who directed the Division of Children's Services under Hodges, said separating state workers who monitor the homes from the agencies that send children for treatment is critical.

"If you're going to have a clean ship, you don't have the fox guarding the hen house," she said. "The risk is if you have a lot of children that need to be placed, they could just look the other way if there are some problems in the way the facility is being run."

DSS Director Kim Aydlette said while she understands Waites' conflict concerns, her agency always watches over the children in its custody.

"I would never allow the agency to license or renew a license of a facility that we thought was unsafe because they were providing placements for our children," she said. "I don't think anyone in the agency would allow that to happen."

But, she said, "it would not hurt my feelings for someone else to pick up the job of licensing and monitoring."

Aydlette, who was appointed in January by Gov. Mark Sanford, said she thinks the system can be improved. But she said some of the problems being talked about are driven by budget needs.

DSS faces cuts of about $10 million in the budget starting in July, which when multiplied by loss of federal matching funds, could force the layoff of as many as 500 workers statewide.

"Everybody sort of agrees on what kinds of services these kids need," she said. "But the question is, do all those agencies have what they need to be able to provide it? To me, that's the bigger issue."

Lawmakers, long aware of the problems, have struggled for a solution in the last year.

"I think if we could centralize this, it would cut down on the problems that have existed in the past," said Rep. David Weeks, a Sumter Democrat who sits on a House panel that examines spending on children's services. "One of the problems we have in this state is that there are so many agencies and many of the functions of those agencies overlap."

Such duplication, studies have found, include monitoring services as well as assessments.

"Families report their children undergo multiple assessments, which is a burden to the child and family and incurs excessive cost," the Children's Services committee found. "Children sometimes have multiple case managers but no or few services that are direct, core therapeutic services to address their problems."

Waites served on the Licensing System for Child Treatment Facilities Committee, which included 16 state officials and representatives from children's homes. The committee, established by the Legislature, was to review the licensing, monitoring and streamlining the process for all facilities that treat children.

The committee issued a report in January that recommended the system be streamlined and only one agency do the licensing, monitoring and enforcement of regulations. The report did not specify which agency.

McKim's panel, meanwhile, recommended Continuum be moved to Mental Health. A minority of committee members said DSS would be a better choice.

House lawmakers two months ago approved a plan putting state offices that deal with the children in the state Department of Health and Human Services.

"What I'm hoping to do is by making these (agencies) come under a uniform approach where there's one group of people, one staff and one approach, we can stop this ping-ponging where kids get bounced between different providers," Quinn said.

Vicki Rinere, who visits children and adult homes for the state Department of Mental Health and who helped write the panel's final report, said having one agency to license and monitor all the facilities seems a common-sense idea, one she said has worked well with adult homes.

Family members interested in adult homes, she said, can call DHEC and find out the licensing history of any home and know where to go with complaints. The same approach should work with children's homes, she said.

Waites said one agency also would prevent the problem of agencies not monitoring a home adequately because each thought the other was watching.

"If you have one agency, then there is no way to pass the buck," she said. "There wouldn't be this risk of things occurring that shouldn't, or the treatment being not as it should."

Rep. Jackie Hayes, a Dillon Democrat who chairs a House committee on children's services, agrees with the panel's recommendation.

"There are a lot of duplication of services and things that get overlooked because one agency thinks another is doing it," he said.

Smith helped produce a plan in 1994 to better coordinate services, but he said a change in agency directors and governors kept the plan from working.

"We worked on that before and it certainly needs to be done," he said. "Because everybody's business is nobody's business."