Will pulling children from institutions work?
By Lauren Sausser
COLUMBIA — Stephanie Trevitz adopted one child, then another, and finally four more from the South Carolina foster care system.
“I was afraid that if we didn’t adopt them they would go to a group home,” she said.
But when her son Jake developed a sexual obsession with his sister two years ago, she and her husband found themselves turning to a group home as a last resort for help.
Jake poked a hole in his sister’s bedroom wall. He stole a pair of her underwear. He searched the Internet for sibling pornography and wrote pages and pages of stories about having sex with her before his parents decided they couldn’t manage him anymore.
“We couldn’t punish him for it. He’s mentally ill,” Trevitz said. “We had to watch him 24/7. It was 10 months. It was horrible … I was screaming for help.”
Trevitz’s story illustrates the dilemma South Carolina parents face as they try to care for a troubled child they can’t control, a child who could pose a danger to others.
There aren’t enough resources in the community to treat children like these, so Trevitz and other parents say they had no other option but to check their sons and daughters into psychiatric residential treatment facilities — decisions that left them dispirited and conflicted.
Some state leaders say South Carolina should offer families a better, at-home alternative for their troubled children. But even supporters of the idea question whether it could actually work.
A fledgling project called the Palmetto Coordinated System of Care would keep children with severe behavioral health problems out of group homes and institutions and offer them the same services at home, or at church and school.
The state Medicaid agency hired Gywnne Goodlett to set up the Palmetto Coordinated System of Care last year. She said the program — still just an idea — is based on the premise that medical professionals and therapists can treat these children in the community, allowing them to live at home rather than locked up inside expensive group facilities.
If you do this right, you save money,” Goodlett said.
It costs the state Medicaid agency approximately $100,000 a year to house one child like Jake in psychiatric residential treatment.
“How much can you do for a family with $100,000? A ton! You can probably serve two families or three families,” Goodlett said.
The Palmetto Coordinated System of Care would also provide parents with relief workers to give them time away from home and “crisis stabilization” experts who are better trained than police to handle mental health emergencies — like a meltdown in the supermarket or a fistfight between siblings.
Group homes occasionally are necessary, Goodlett acknowledged, but this doesn’t explain why South Carolina spends millions of dollars on some children who languish for years in these institutions.
“The month of their 19th birthday, they leave the facility and go to a homeless shelter,” she said. “And what did we create? Someone who knows how to live in an institution and does not know how to live on their own.”
Federal law demands that children, even the most difficult ones to raise, live in the “least restrictive” setting possible. But some child advocates argue that the Palmetto Coordinated System of Care won’t work. They say it’s unrealistic, that some children just can’t function in a normal family setting.
“It sounds good on paper. It looks good on paper. I helped create it and it still doesn’t meet the needs of my own family member,” said Kelly Troyer, whose adult son lives in a group home in West Ashley.
Troyer participated in a flurry of meetings last year to develop the Palmetto Coordinated System of Care. She now doubts it will succeed. Troyer also had to send her son away from home when she couldn’t control his outbursts. He is diagnosed with autism, a mild intellectual disability and bipolar disorder.
Paula Fendley, executive director of the Palmetto Association for Children and Families, attended some of those meetings, too, and expressed serious doubts about the Palmetto Coordinated System of Care. Fendley’s association represents many group homes in South Carolina.
“At some point, we have to critically think through whether the ‘least restrictive level of care doctrine’ makes sense for South Carolina,” Fendley said. “We shouldn’t just go to the lowest possible level of care first, and allow children to fail their way up to the higher levels of care. That makes no sense.”
The state wants to reduce the amount of money it spends on costly residential treatment facilities, Fendley said, but some children with severe behavioral health problems will always be safer in group homes that offer intense, on-site services. The Palmetto Coordinated System of Care doesn’t acknowledge this reality, she said.
“To me, it’s just a cost avoidance model, really,” she said. “It’s not about ‘What does this child and family need?’
Children prone to starting fires, those who have been sexually abused or have threatened to hurt themselves can’t be treated in the community, some experts say. They’re too dangerous.
Trevitz, for example, and her husband couldn’t deal with Jake on their own. Now he lives at Palmetto Summerville Behavioral Health, a residential treatment facility that offers around-the-clock services for children and adolescents with severe emotional needs.
“We had tried everything else. We knew with Jake that this was beyond our ability to handle in the house,” Trevitz said. “I’m exhausted. I’m tired.”
Other states have tried to implement similar “coordinated systems of care” with varying success. The Palmetto Coordinated System of Care is based on a Louisiana model that’s already saddled with problems, said Sara Godchaux, a New Orleans attorney for the Southern Poverty Law Center.
“I think that really it hasn’t lived up to what it’s supposed to be on paper, for a multitude of reasons,” she said.
There aren’t enough relief workers, crisis stabilization experts and other health care providers in Louisiana who offer this kind of in-home treatment, Godchaux explained. And the state doesn’t pay them enough to participate.
“The kids are enrolled in this program but there are no services,” she said.
The Southern Poverty Law Center sent the federal government a letter last year outlining its concerns with the Louisiana model.
South Carolina might face some of the same problems, Goodlett said. The state is trying to roll out the Palmetto Coordinated System of Care slowly and thoughtfully, but Goodlett doesn’t know how many children will qualify to participate or when their families can start signing up for services. That likely won’t happen this year.
“I think it’s going to take longer than that,” she said. “I’m frustrated. I’m a very impatient person by nature, and I wanted it yesterday.”