The shift from state to local behavioral and mental-health support begins today for nearly 100 at-risk youths.
Local agencies and support groups are now providing expanded behavioral and mental-health services to replace those reduced by state agencies as part of state budget cuts.
In August, the General Assembly voted to eliminate $38.4 million in support over two years for Level III and IV youth group homes. Medicaid typically pays for two-thirds of the cost, which averages $260 a day, according to the N.C. Department of Health and Human Services.
Youths staying in those homes typically are being treated for moderate to severe behavioral and emotional issues that may involve issues at home.
The state decided to keep in place the option of sending at-risk youths to those group homes.
However, a 120-day limit was set for new admissions, and those youths evaluated as needing more help would be limited to 90 days for each new extended stay approved.
Admissions also are based on more rigorous standards involving a "team" representing the youth and family and the local management entity, such as CenterPoint Human Services. Insurance requirements are being tightened, according to CenterPoint officials.
The state wants to reduce North Carolina's dependency on out-of-home placements, which is high compared with other states. Officials say that studies have shown that the current strategy has not been as effective as projected.
About 10 percent of at-risk youths statewide are projected to be placed in a psychiatric residential treatment facility -- the most intensive level of care.
"These youth group homes should be used on the order of last resort rather than first resort," said Leza Wainwright, the divisional director of mental health for the state.
State officials say that some group homes are likely to close as they lose residents. The department did warn that the "closure of these group homes across the state has the potential to create placement crises for mentally ill children if discharge planning is not conducted in a systematic, coordinated manner."
Laurie Coker, a board member of several local mental-health advocacy groups, said she supports the requirement of a child and family team -- something already in place, but not significantly used.
She also supports the requirement that the team review "a current comprehensive clinical assessment that includes a discussion of all life domains -- emotional, social, safety, housing, medical and health, educational, vocational and legal."
"There has not been required accountability for planning during or following a child's placement," Coker said.
The new policy also requires that the child and family team develop a discharge plan.
Joe Raymond, the director of the Forsyth County Department of Social Services, said he has concerns about how many youths will be placed in Level III and Level IV settings with the new policy. "I am unsure whether there are enough multisystemic therapy providers across the state," he said.
Multisystemic therapy specifically targets factors in a youth's social network that are contributing to his or her antisocial behavior. Services are delivered at home, school and within the community in a family-directed strategy rather than therapist-directed.
Ken Simington, the assistant superintendent of student services for Winston-Salem/Forsyth County Schools, said that the system is obligated to accept youths under 16 unless there are extenuating circumstances. Students ages 16 and older can request readmission to a school.
The state Department of Juvenile Justice and Delinquency Prevention has more than 600 youths placed in group homes, spokesman William Lassiter said. Almost 100 are linked to violent crimes.
The department also is scrambling to figure out where to place youths returned to its care, particularly since its budget also has been reduced.
rcraver@wsjournal.com | 727-7376
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