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			Friday, February 20, 2009 News Clipping Archives *Maryland / Regional* Baltimore health officials declare influenza alert (Baltimore Sun) Government Cutbacks Leave Faith-Based Services Hurting (Washington Post) Compromise Weighed on Domestic Violence Bills (Washington Post) Smoking Ban Passes In Va. (Washington Post) Taking the pain out of prescriptions (Salisbury Daily Times) *National / International* Costs for individual health plans soar (USA Today) Report: 4 million Americans lost health insurance since recession began (Baltimore Business Journal) Women account for largest increase of users at city's cold weather shelter (Frederick County Gazette) Young adults' health is static or even declining (USA Today) *Opinion* Data update for health reform (Washington Times) Children in the Mental Health Void (New York Times) *Maryland / Regional* Baltimore health officials declare influenza alert By Frank D. Roylance Baltimore Sun Friday, February 20, 2009 With the number of positive influenza tests rising sharply in the city, Baltimore health officials declared a flu alert yesterday. "We're really seeing sustained transmission of flu in Baltimore. Now is the time to protect yourself," said the city's health commissioner, Dr. Joshua M. Sharfstein. Sentinel hospitals reported that 12 percent of flu tests last week came back positive, more than twice the rate for the previous week. There have been no deaths, but the Johns Hopkins Children's Center is treating a teenager who is critically ill with flu. "This is not just the sniffles. It can be very serious," Sharfstein said. Residents are urged to get flu shots, to wash their hands frequently, cough into a tissue or sleeve and stay home if they're sick. For more: www.baltimorehealth.org/flu Copyright 2009 Baltimore Sun. Government Cutbacks Leave Faith-Based Services Hurting By Jacqueline L. Salmon Washington Post Friday, February 20, 2009; A01 Faith-based charities, which provide an enormous array of private social services to the nation's sick, elderly and poor, are facing unprecedented cutbacks from one of their biggest funders: the government. The nation's economic woes have led local and state government agencies across the country to reduce contracts and grants or delay payments to the groups, which have been forced to eliminate programs, lay off staff or try to borrow money in a tight lending market. In the Washington region, where the Maryland, Virginia and District budgets are being developed, faith-based charities from Catholic Charities of the Archdiocese of Washington to the Salvation Army's National Capital Area Command are freezing job vacancies, postponing initiatives and rallying their religious congregations to dig deeper into their pockets. Government leaders are also urging the organizations to increase their fundraising, but political leaders and the groups say that the economy is causing deep cuts in private giving. Ken Kozloff, chief executive of the Jewish Social Service Agency, with offices in Montgomery and Fairfax counties, has seen its private donations fall almost 10 percent, but its client roster has grown 35 percent. It gets half of its revenue from federal, state and local governments. Without government funding, "where are the resources going to come from?" asked Kozloff. "How do we serve people? How do we keep people's lives whole?" Faith groups elsewhere in the country are feeling the strain. California is soon expected to make its payments to faith groups, and other organizations, as IOUs instead of cash. In Illinois, a local Lutheran social services agency is owed $4 million. A Lutheran social services agency in Minnesota closed four residential facilities for troubled adolescents after the state slashed its funding. And in Newark, New Jersey cut a $1 million contract to the local Catholic Charities, which provided job training and other assistance to 400 mentally ill welfare recipients, forcing it to shut down the program and lay off about a dozen people. "It's only going to continue to get worse," warned Larry Snyder, chief executive of Catholic Charities USA, one of the country's largest nonprofit organizations, which gets about 65 percent of its revenue from government contracts. "Our folks out in the field are feeling a little overwhelmed because they can't see the end, and all they see are more and more people coming and fewer resources coming their way. And yet we don't have the luxury to say, 'You know what? We're going to close our doors for a while.' " Faith-based charities' services run the gamut of social programs: They own hospitals and nursing homes, run substance-abuse and foster-care programs, operate homeless shelters and mental health clinics, build affordable housing and distribute food to the needy. Researchers say it is impossible to calculate what percentage of total social service assistance comes from faith-based organizations, although they agree it is large. One San Jose State University study estimates the value of the social services provided by faith-based charities and other religious organizations across the country at $50 billion a year. In the Washington area, at least one-third of faith-based charities and congregations get government money, according to a survey by Scott W. Allard, a professor in the School of Social Service Administration at the University of Chicago. Allard said that estimate is probably low because it misses many smaller congregations and social service organizations that also receive contracts. But across the country, caring for the poor is growing more and more difficult, faith organization leaders said. The passage of the economic stimulus package is expected to do little to reverse the trend. In Virginia, for example, even with the funds expected from the stimulus package, the budget shortfall is anticipated to be at least $2.7 billion, with cuts for faith-based services all but certain. In a survey of 50 Catholic Charities affiliates nationwide, about half have experienced cutbacks or unpaid state contracts. The problem appears slightly better locally, but not by much, because state and local governments are finalizing budgets. A survey by the Maryland Association of Nonprofit Organizations found that at least one-third of its members experienced a reduction in state funding or anticipate a reduction. Not long ago, Montgomery County Executive Isiah Leggett (D) met with local nonprofit social service agencies, including a number of faith-based organizations, to warn them to expect significant cuts. "Government's ability and the ability of nonprofits [to respond] becomes more challenging when there is a greater need," Leggett said. "And that's the real irony of what we face." In normal times, nonprofits can tap into bank credit lines to cover lags in payment. But faced with swelling late payments, many organizations have hit their maximum or struggling banks have cut their lines of credit. Independent Sector, a coalition of charitable groups that represents nonprofits, estimates that at least $15 billion -- 18 percent of all government funding to nonprofit human service providers -- is delayed or will be delayed if the problem is not addressed. Nonprofits unsuccessfully lobbied for a $15 billion bridge loan package for human services nonprofits, administered by the federal government, to be included in the fiscal stimulus package. The charities say the cutbacks will only boomerang on the states. When California slashed more than $300,000 from a contract with Jewish Family Service of Los Angeles, it had to cut 70 slots from a program that kept poor elderly people out of nursing homes by providing them with services in their homes. "Unless their families had some alternative," said Chief Executive Paul Castro, "they undoubtedly ended up in a nursing home," potentially costing California taxpayers even more money. Copyright 2009 Washington Post. Compromise Weighed on Domestic Violence Bills By Lisa Rein Washington Post Friday, February 20, 2009; B06 Maryland Gov. Martin O'Malley's administration is considering changes sought by law enforcement officers and defense lawyers in its domestic violence proposals to improve the legislation's chances for passage in a key General Assembly committee. The Maryland Fraternal Order of Police is seeking an exemption to two bills proposed by O'Malley (D) that would give judges more authority to remove firearms from domestic abuse suspects. The group contends that law enforcement officers need their weapons to do their jobs. And defense lawyers on the House Judiciary Committee are seeking language that would require victims to show a judge that alleged abusers have used or threatened violence before they must surrender their guns. "We are open to working with the General Assembly on any necessary changes, provided that at the end of the day, the bills provide meaningful protections for victims," Lt. Gov. Anthony G. Brown (D) said in an interview. Brown and other advocates pressed their case for tightening the law yesterday at a hearing of the Judiciary Committee, which in the past has resisted the firearms bills and other domestic violence legislation because of concern for the rights of suspects and gun owners. "My child is dead," Kate Wood, a retired Baltimore police officer, said after recounting how her daughter unsuccessfully asked a judge to remove her estranged boyfriend's handgun, two days before he shot her in the throat. "Pass the bills, please." The panel was scheduled to hear 18 bills, including legislation to require convicted abusers to wear Global Positioning System devices while on probation and a measure to establish a state database of protective orders that police could call up from their cruisers. Of 500 homicides in Maryland last year, 75 resulted from domestic violence, victim advocates said. Guns were used in half the domestic violence slayings. One of the governor's bills would allow judges to order suspects to give up their guns when served with a seven-day protective order; the courts now have no authority to remove firearms during that period. The other bill would require that guns be removed after a court hearing in which a final protective order is issued; the current law does not require it. "This is about removing lethal weapons from people with a propensity to violence," said Stacy Mayer, O'Malley's deputy legislative officer, calling the bills "narrowly tailored." Opposition from the Fraternal Order of Police has helped doom firearms bills in the past, despite support from many police chiefs. But Brown sought the group's support this year. FOP lobbyist Percel O. Alston Jr. said law enforcement officers are at a disadvantage because they can be fired if they are subject to a protective order, even if the allegation is false. "Unlike any other professional, with us the removal of a firearm after an allegation results in the loss of a job," Alston said. One lawmaker said an exemption for police would amount to special treatment for one group. "How are they different than somebody who has a security clearance? A politician?" asked Del. Michael D. Smigiel Sr. (R-Cecil) "We're allowing some abusers to keep their guns and others to lose them." Alston said that his group generally supports the bills but wants judges to find that suspects used violence or threatened violence before taking their guns away. Many committee members said such a standard should apply to everyone, not just law enforcement officers. "The definition of abuse is expansive," said Del. Luiz R.S. Simmons (D-Montgomery), ranging from violence to a disagreement that later gets worked out. Victim advocates said the gun laws would not stop all domestic violence-related killings. But they said that when a suspect has a gun, violence is more likely. "I'm saying give me the chance to take that weapon away," Howard County Police Chief William McMahon said. Copyright 2009 Washington Post. Smoking Ban Passes In Va. Measure Represents A Rare Compromise By Anita Kumar Washington Post Friday, February 20, 2009; B01 RICHMOND, Feb. 19 -- The Virginia General Assembly gave final approval Thursday to a plan that prohibits smoking in most of the state's bars and restaurants, handing Gov. Timothy M. Kaine one of his first significant legislative victories. Kaine and others have pushed for a prohibition for years. But its passage never seemed likely given that Virginia is home to the world's largest cigarette manufacturer and tobacco is so intertwined with state history that images of tobacco leaves are painted on the ceiling of the Capitol Rotunda. "I think it . . . demonstrates persistence can be a virtue," Kaine said at a news conference. "I learned early on you've got to stick with something you believe in and maybe you can make it happen." Starting Dec. 1, smoking will be banned in most restaurants and bars, although it would be permitted in private clubs, on some outdoor patios and in separate ventilated rooms. "It's just a big step in the right direction for the health of Virginians," said Sen. Ralph S. Northam (D-Norfolk), a pediatric neurologist. With no debate, the Democrat-controlled Senate voted 27 to 13 for the proposal. Hours later, the Republican-controlled House approved it 60 to 39. The bill will be sent to Kaine, who said he will sign it into law. Tobacco was once the foundation of Virginia's economy. The state is still home to thousands of tobacco farms. The proposal was strongly opposed by the powerful tobacco and business communities and by some anti-smoking activists who did not think it was comprehensive enough. "You're going to have some people happy with the compromise and some people that aren't," Del. S. Chris Jones (R-Suffolk) said. "Some might think we didn't go far enough. Some people think we went too far." The state has repeatedly resisted efforts to curtail smoking in public places, even as health concerns over secondhand smoke prompted 23 other states and the District to enact prohibitions. Virginia will become the first state in the South to ban smoking in both restaurants and bars. "It's going to save a lot of lives," said Keith Hare of the Medical Society of Virginia. "Our hope is that one day all indoor spaces in the commonwealth will be smoke-free." Kaine and House Speaker William J. Howell (R-Stafford) spent weeks behind closed doors negotiating the unexpected compromise. The deal represented a rare moment of bipartisan cooperation between the state's two most powerful leaders. Many legislators from rural, tobacco-growing areas in the southern part of the state joined with the most conservative members to oppose the bill. They objected to what they said was an assault on individual freedom. Currently, bars and restaurants impose their own smoking rules. "I believe very strongly in the power of the free market to resolve the collective wishes of our society," Del. C. Todd Gilbert (R-Shenandoah) said. In Virginia and across the nation, public sentiment in recent years has shifted rapidly in favor of such bans. A 2006 Gallup poll found that even most smokers believed that restrictions in public places were justified. Copyright 2009 Washington Post. Taking the pain out of prescriptions Pill costs leave you feeling ill? Discount cards help lessen the sting for the uninsured By Mary Daisey Shockley Salisbury Daily Times Friday, February 20, 2009 BETHANY BEACH -- Despite rising prescription costs, Margaret Young is happy with her trips to the drug store. "(Costs) are high for people who don't have insurance, but I do and I just have to pay the co-pay," she said, noting that her pharmacist is knowledgeable and attempts to reduce out-of-pocket costs. "Unless you specify that you don't want generic, they try to help you save money." In times when money is tight and folks are pinching pennies, many organizations are trying to find ways to offer financial assistance to those in need. Bill Harbester, a pharmacist at Walgreens in Bethany Beach, said he encourages all of his uninsured clients to apply for a Walgreens Prescription Savings Club card, which helps them save on prescription drugs. "Once we tell them about that, they usually sign up," he said. "They can use the card (at any age). We even have people sign their pets up for it." The card is available for $20 per person or $35 for a family. It doesn't matter if the customer is insured, and there is no age requirement, Harbester said. The only stipulation is that the customer can't be receiving government aid. Buying prescriptions in large quantities can also help, Harbester said, as many insurance companies offer discounts for bulk purchases. Carol Coulter, an administrator at Ocean View Family Medicine in Millville, said she and her co-workers try to help however possible, sometimes offering payment plans for low-income patients. "There are so many programs available to seniors," she said. "If we can't help them, we try to point them in the right direction." Area residents can also take advantage of a discount prescription drug program, offered by the Sussex County government and the National Association of Counties. Cards, which offer a 20 percent discount, are available to community members regardless of income, age and existing health coverage. Applications are unnecessary, and the cards are accepted at every major pharmacy chain. "Sometimes there's not an awareness out about how easy it is to enroll," said Andrew Goldschmidt, NACo director of membership marketing, in a previous interview. "It's a turn-the-key program. We provide everything." Cards are available at all 14 public libraries, the county Bookmobile and county administrative offices. mdaisey@dmg.gannett.com 302-537-1881, 207 Additional Facts To get the cards WHAT. NACo Prescription Drug Discount Cards WHERE. Any 14 Sussex County libraries, County Administrative Offices and the Bookmobile CALL. 1-877-321-2652 COST. Free VISIT. www.caremark.com/naco WHAT. Walgreens Prescription Savings Club WHERE. Any Walgreens pharmacy CALL. 1-866-922-7312 COST. $20 single person, $35 family a year VISIT. www.walgreens.com. Copyright 2009 Salisbury Daily Times. *National / International* Costs for individual health plans soar By Julie Appleby USA Today Friday, February 20, 2009 At a time when more people are forced to buy their own health insurance because of job losses, costs for many individual policies are soaring. Advocates say the 17 million Americans who buy their own coverage can't negotiate lower rates the way employers or other large group plans can. COBRA SUBSIDY NEARS: Employers fear rising health costs "These folks have their back against the wall," says Jerry Flanagan, a health advocate with Consumer Watchdog, a California-based group. More people are shopping for coverage: The Golden Rule Insurance Company, a part of UnitedHealth Group, says sales of individual policies are up 24% in the past two months. A website that links people with insurers, eHealthInsurance, says applications are up 18% in the fourth quarter, compared with a year ago. Copyright 2009 USA Today. Report: 4 million Americans lost health insurance since recession began By Mary Beth Lehman Baltimore Business Journal Thursday, February 19, 2009 An estimated 4 million Americans have lost their health insurance since the recession began, and as many as 14,000 people could be losing their health coverage every day, according to a report by liberal think tank Center for American Progress' Action Fund. The report also claims at least half of the 4 million who lost their insurance coverage still are uninsured. Before the recession started there were an estimated 46 million Americans without health insurance. The center reported the new estimates Thursday in a conference call. The recent rocky economic climate, however, has likely increased the number of uninsured at the rate of 14,000 a day, according to the center. The report uses estimates from Urban Institute researchers that a one percentage point rise in the national unemployment rate causes 2.4 million people to lose employer-sponsored health coverage. Of those people, 1 million rely on Medicaid or the Children’s Health Insurance Program and 1.1 million end up uninsured. Since data was last collected in the spring 2007, the unemployment rate has grown from 4.4 percent to 7.6 percent, and as a result, an estimated 3.5 million people have lost their health insurance and are now uninsured. Copyright 2009 Baltimore Business Journal. Women account for largest increase of users at city's cold weather shelter By Katherine Mullen Frederick County Gazette Thursday, February 19, 2009 The number of homeless men and women seeking refuge nightly at the Cold Weather Shelter on Frederick's DeGrange Street increased 8 percent from November and December 2007 when compared to the same months in 2008, according to statistics from The Religious Coalition for Emergency Human Needs. The Cold Weather Shelter opened Nov. 17 when the nighttime temperature consistently dipped below 32 degrees Fahrenheit. The shelter will stay open until March. It is the largest shelter and the only emergency shelter for the homeless in Frederick County, with 80 beds for men and women, shower facilities, instant soup, clothing and hygiene supplies inside the Alan P. Linton Jr. Emergency Shelter. Guests must be at least 18 years old to stay. There is no limit to how many nights a person can stay. The Rev. Brian Scott, executive director of The Religious Coalition, said this week that a total of 147 guests stayed at the shelter in December, compared to 136 during the same month in 2007. Scott said the stretch of cold temperatures and the economic recession has created "the perfect storm" in bringing more residents to the shelter. "Most of the folks we are seeing are people who have lived here for a significant amount of time in Frederick County," he said. He said that the shelter is not running out of space, though there have been some nights that it housed 74 people, almost reaching capacity. The number of women using the shelter has also increased significantly, up 29 percent from last year. In December 2007, 25 women stayed at the Cold Weather Shelter, compared to 36 women one year later. This increase can partly be explained by the fact that an extra shower stall and six beds were added to the women's section in the summer. But Scott believes that the economy has become a factor in the higher number of women seeking help. Scott pointed to unequal pay for women as a contributing factor. On average, full-time working women earn 77 cents for every $1 a full-time working man is paid, according to the WAGE Project Inc., a nonprofit dedicated to ending discrimination against women in the American workplace. Many families seeking help from the Religious Coalition are headed by single women, he added. According to a report compiled by the Frederick County Coalition for the Homeless in April, women made up 46 percent of adults sheltered in emergency and transitional shelters and motels in Frederick County in 2007, and 58 percent of households sheltered. The coalition cited several reasons for guests' homelessness in its 2007-08 statistics, including lack of affordable housing and income, domestic violence, family disputes, mental health issues and alcohol and substance abuse. The Religious Coalition for Emergency Human Needs, a nonprofit organization that provides emergency humanitarian and utility assistance to Frederick County residents, has operated the cold weather shelter, first in church basements and halls, since 1990. E-mail Katherine Mullen at kmullen@gazette.net. Copyright 2009 The Gazette. Young adults' health is static or even declining By Sharon Jayson USA Today Friday, February 20, 2009 Young adults today aren't any healthier than 10 to 15 years ago, and in some cases — obesity, for one — they are significantly less so, says a federal report on the nation's health released Wednesday. The annual report, from the National Center for Health Statistics, is based on the most recent data available from a variety of health sources. It covers health issues across ages and includes for the first time a section on 50 million young adults ages 18-29, a group that is "understudied," says lead author Amy Bernstein. The data show that: • About one-third are obese, and one-third are overweight. • About 30% do not have health insurance. • Among men, almost one-third smoke cigarettes and a quarter binge-drink (five or more drinks on at least 12 days in the past year). "Saying they're all basically healthy now doesn't take into account ... the long-term effects of health habits formed during this time," she says. Obesity has tripled in three decades, to 24% in 2005-06. Smoking among women declined nearly 20% from 1997 to 2006, but no significant decline was reported among men. Findings are similar to those in the annual Monitoring the Future survey by the University of Michigan, says co-principal investigator John Schulenberg. "Any gains we've been getting over the years with better adolescent health, we're not realizing in the 18-29 group." Schulenberg suggests many behaviors, such as smoking and drinking, may be low in high school but pick up after young people leave home. Bernstein says bad health behaviors haven't seemed to slow among that age group. "They're still smoking, still drinking, still taking illicit drugs and not exercising," she says. "Whatever we're doing, we're not getting through to this particular age group." Copyright 2009 USA Today. *Opinion* Data update for health reform By Sam Nussbaum and Charles Kennedy Washington Times Editorial Friday, February 20, 2009 OP-ED: What if your airline pilot announced he would forgo the designated flight plan in favor of a route plotted on fold-out maps? Would you feel safe knowing the integrated information, navigation, weather and communication systems that successfully coordinate thousands of flights each day had been turned off? If the suggestions seem preposterous, ask yourself why we accept this approach in health care. The majority of care delivered today is coordinated via handwritten paper medical records sent amongst physician offices and hospitals. And far too often, physicians rely on a medical history recalled from the patient's own memory to design an appropriate treatment "flight plan." With chronic conditions affecting nearly half of Americans, medical errors resulting in thousands of unnecessary deaths and excess costs, and our system's failure to provide the best available care nearly 50 percent of the time, this patchwork system of health information exchange cannot, and will not support the required transformation of U.S. health care. Our country must invest in a health information system that delivers a patient's complete health record at the point-of-care to guide better-informed decision-making by physicians and patients. The Obama administration and Congress have acknowledged a health information technology gap through the HITECH Act, a $20 billion health information technology investment included in the economic recovery package. Yet much of the dialogue in Washington surrounding how to spend these dollars has centered on digitizing physician office records to create electronic medical records. Revitalizing our economy through health information technology, however, will take more than converting paper file cabinets to electronic ones. Simply, an electronic medical record in the absence of connectivity and sharing of clinical knowledge, is a bridge to nowhere. With an aging population and rapidly increasing shortage of primary care physicians, electronic medical records and other efforts that improve the office efficiency of solo or small group physician practices should certainly be applauded. These practices typically cannot afford to make the investments in health information technology made by larger integrated medical groups. Yet, while research has demonstrated electronic medical record use can result in administrative efficiency, greater billing accuracy, and a reduced risk of malpractice claims, other studies found stand-alone electronic medical records do not improve the quality of care for chronic conditions, and may actually perpetuate medical errors and increase costs. To realize the true health-care quality, safety and efficiency benefits of health information technology, the HITECH Act investment must reach beyond individual physicians' offices. Investments must require combining a patient's medical, pharmacy and laboratory information and deploying this integrated health record to the patient, her physicians, hospitals, and the entire care team. Research has projected this type of "informed" health information technology system could save more than $160 billion annually. In Dayton, Ohio, WellPoint members have experienced the benefits of integrated health information technology firsthand. Patients can view their combined medical claims, pharmacy, laboratory and physician chart records online. A primary care physician treating a patient with heart disease is able to view examination notes and lab results from her patient's cardiologist. An emergency room physician can access a patient's prescription drug history in real-time, avoiding the dangerous guesswork based on his patient's description of the color and shape of pills. Patients with diabetes and asthma can receive actionable messages and reminders to obtain recommended care. These, and additional successful models advanced by integrated health-care delivery systems such as Kaiser and Geisinger, all share a common theme: integrated data-sharing and connectivity promote health-care quality and safety. While digitizing physician offices can provide some efficiencies, electronic medical records represent only a first step toward improving health-care quality and reducing health care costs. The HITECH Act investment must connect physicians, patients and health information to better inform health care decisions - at the hospital, in the emergency room and in physician offices across the country. Fueled by clinical knowledge, this investment can prevent adverse drug events and unnecessary medical services, promote improved chronic illness care, support improved prevention, and achieve billions in health-care savings. Sam Nussbaum, M.D., is executive vice president for clinical health policy and chief medical officer at WellPoint Inc. Charles Kennedy, M.D., is vice president for health information technology at WellPoint. Copyright 2009 Washington Times. Children in the Mental Health Void New York Times Editorial Friday, February 20, 2009 Remember the Nebraska law meant to keep desperate new mothers from abandoning their babies in dumpsters by offering them the possibility of legal drop-off points at “safe havens” like hospitals? As was widely reported last year, the law neglected to set an age limit for dropped-off children, and eventually led to 36 children – mostly between the ages of 13 and 17 – being left with state authorities. Most of these children had serious mental health issues. Some were handed over to the state by relatives who had no other way of securing for them the heavy-duty psychiatric care they needed. Seven of the children came from out of state, including one who’d been driven 1,000 miles to Lincoln, Neb., from Smyrna, Ga. Recently, The Omaha World-Herald acquired 10,000 pages of case files concerning these children from the state’s Department of Health and Human Services. They paint a portrait of desperation – of out-of-control kids, overtaxed parents and guardians, and an overstretched health care system – that really deserves more widespread national notice. Because even though the mentally ill “safe haven” children had extreme needs, and some of their parents and guardians had extremely limited capabilities (one grandmother said her charge had “demons inside of him”; a mother who dumped her two teenagers in an emergency room said they were “mouthy,” “too much work” and “need to be voted off the island”), what their stories have to say about children’s mental illness, parental limitations and the paucity of care available in our country is altogether typical. They illustrate how a lack of good care early on can create much bigger problems, for families and for society, in the long run. Their example also serves as a necessary corrective to the popular view that children being labeled mentally ill today are just spirited “Tom Sawyers” who don’t fit our society’s cookie-cutter norms, with parents who are desperate to drug them into conformity. The children abandoned in Nebraska had big-deal problems. An 11-year-old boy, hearing voices since the third grade, had punched his fist through a glass door and smeared another child with his feces; other children had started fires, tortured pets, sexually abused younger children and made murder and suicide threats. Some of the adults charged with their care had problems, too, mental health issues that made them incapable of properly seeking help. Some parents and guardians had blocked earlier efforts by the state to provide care for their children, by not taking their children to Medicaid-funded therapy sessions or not picking up free psychiatric medications. Others had tried hard to get help for their children; Matthew Hansen and Karyn Spencer, reporters for The World-Herald, noted that the 29 Nebraska “safe-haven” children alone had received nearly $1.1 million in state-financed mental health services. But these services “were not provided in a coordinated and cohesive way,” Kathy Bigsby Moore, executive director for the advocacy group Voices for Children in Nebraska, told me. She reviewed the state case records and found that some children received too little care too late and some, in desperate straits, were spending months on waiting lists for spots to open in residential treatment programs. One Oklahoma woman who had been frustratedly trying to get her adopted son into a residential treatment program phoned a Nebraska official and threatened to bring the boy to his state unless she received help. The boy was admitted to a psychiatric program almost immediately. “Why on God’s green earth does it take all that to get help?” she asked The World-Herald. This problem of lack of access to care – and lack of access to truly good care – is the real mental health “epidemic” affecting children in our time. Insurance companies will no longer pay for long-term inpatient care for mentally ill children; as a result, psychiatric hospitals have been steadily closing, and residential treatment programs for the most difficult children, whose tuition is most often paid with public funds, are packed. And yet the care available for children at home with their parents is severely lacking. Outside of big cities, where even under the best of circumstances there can be a two- to three-month wait to see a child psychiatrist, there is a severe shortage of children’s mental health specialists. In 1990, the Council on Graduate Medical Education estimated that by 2000, the United States would need 30,000 child psychiatrists; there are now 7,000. Many rural areas have no child psychiatrists or psychologists at all. Often, pediatricians end up providing mental health care, but they aren’t trained for it and often aren’t reimbursed for it by health insurance. The American Academy of Child and Adolescent Psychiatry is currently working with the American Academy of Pediatrics to try to formalize ways to collaborate on caring for children with mental health needs, but models for such joint care are scarce. And doctors have no financial incentives to talk to one another on the phone. Programs that could help support mentally ill children and their families – therapeutic after-school care, community-based outpatient services, transitional care for children with chronic mental illness who sometimes suffer dramatic flare-ups of symptoms that send them to emergency rooms or to adult psych wards unequipped to help them – are also very poorly developed around the country, and generally not reimbursed by health insurance. The result of all this fractured, fragmented, chaotic or non-existent care, said Christopher Bellonci, a psychiatrist who is the medical director of the Walker School, a nonprofit residential treatment program in Needham, Mass., is that children with psychiatric problems get steadily worse, and eventually “fail up” through repeated trials of medication and short-term hospitalizations until they can no longer be kept at home. Getting these children into good treatment programs requires “significant advocacy on the part of parents who have to be extremely sophisticated,” he said. And the cost of those programs is so great that, as was the case in Nebraska, some parents are actually forced to make their children wards of the state in order to get the child welfare system to pay for their care. “Parents who have not been abusive or neglectful are put in the untenable situation of having to surrender custody,” Bellonci told me. “It’s criminal, frankly.” In Nebraska, where access to child mental health services is particularly poor, child advocates had hoped that last year’s headline-making child abandonments would shock lawmakers into spending more money to develop better child mental health services. But that isn’t happening. So far, Moore says, the only legislation likely to win passage would create a uniform state hotline and provide “navigators” to help parents find mental health services for their children. There isn’t, however, any increased funding for actual care. And without access to services, she said, “We fear it’ll be a hotline and navigators to nowhere.” “Navigation to nowhere” perfectly sums up the experience of many parents I have interviewed about their attempts to secure mental health services for their children. As a country, it’s really in our interest to provide them with a compass. Copyright 2009 New York Times. BACK TO TOP


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