By Stephen Smoot
Many of the recent discussions and changes in state public education have centered more around the behavior of children. State Senate Education Committee chair Amy Grady, a fourth grade teacher in Mason County, recently told West Virginia Metro News that “we’re talking about threatening teachers, throwing things at other students, throwing things across the room, slamming things, hitting things.”
And she was including the youngest of students in that.
The rise of severe and dangerous behavior problems in school points to bigger problems at home. For the past three years, the former Department of Health and Human Resources, now the Department of Health Services, has relied on a Medicaid waiver program to help parents and other caregivers contend with their children’s serious emotional and behavioral disorders.
The point of the program, according to Cindy Beane, commissioner of the West Virginia Bureau of Medical Services, lies in “trying to keep West Virginia kids home and with their parents.”
According to a state website, the Children With Serious Emotional Disorders Waiver (or CSEDW) “provides additional Medicaid support to children ages three to 21 with serious mental, behavioral, or emotional health needs.”
In many cases, especially when the children show the potential to harm themselves or others, residential treatment programs have traditionally served as one of the first options for care. Some of these treatment resources take the children hundreds of miles away to other states, far from their comfort zone of family and place.
Other children have ended up in West Virginia’s critically overburdened foster care system.
As Beane explained, separation from the home environment is “traumatic for the child.” She added that “we don’t want them to have disruption in their home life” if services can provide sufficient in home services.”
The waiver program relies on a network of providers that serve every county in the state. Damon Cater of Charleston’s Home Base Inc. serves clients all over the state. He said that prior to the waiver program “there was a severe lack of meaningful and effective community based services to work with this population in the child’s home and community.”
Beane shared that the program started when the State of West Virginia asked the federal Centers for Medicare and Medicaid Services “if we could have an in-home program to provide services.” The goal lay in bringing treatment to the child and keeping him or her in the environment in which they felt most comfortable.
This obviously assumes that their current home is safe and secure.
The CSEDW program brings more benefits than providing supportive services. “It’s actually going to be cost efficient,” Beane says, over residential treatment or foster care that “takes the child out of the home, away from family.”
Similar to the CSEDW model, in home services for senior care have proven more beneficial to the client and also less costly for taxpayer supported medical payment programs.
Additionally, the program also helps the parents or other caregivers. Beane explained that is “why the program is so well received. Parents don’t know what to do.” Services include engaging with caregivers to give them better strategies and tactics for helping the children in their care.
Cater shared an example of what a CSEDW can do for a family. “In one case,” he said, “a sibling group was on the verge of losing an opportunity to be adopted due to the behavioral and emotional dynamics being displayed in the home.” A CSED waiver paid for eight months of in home treatment and “the adoption was able to proceed successfully and the family is intact today.”
“Had it not been for CSED,” Cater said, “these kids would probably be placed in foster care and probably would have had to endure a multitude of placements and separation over the past few years.”
Cater added that services covered can include respite, supportive counseling, wrap around facilitation, independent living skills, job development, and more. The more resilient such services can make a family, the better off the children will be in their care.
Programs such as CSEDW, Communities in Schools, and other resources have arisen to fill the gaps once covered by the traditional family. As two parent households become more rare, children and those who care for them enjoy less support and more burdens. Add to this the scourge of drug abuse and addiction that has ripped apart family units and exposed children to, at best, neglect and at worst serious abuse, and the need becomes clear.
Many of the children in the worst need do not live with their parents at all. “West Virginia is one of those states with a lot of kinship care programs,” Beane said. Many children live with grandparents, others with aunts or uncles, family friends, or even siblings.
The breakdown of the traditional family has also deprived many parents and caregivers of solid role models for parenting.
“Our goal,” Beane stated, “is that West Virginia children need to stay in West Virginia and be raised by their families.