By Paul Hammel
WORLD-HERALD BUREAU
A year after Nebraska made national headlines because a stream of “safe haven” kids were dropped off at local hospitals, advocates say the state still isn’t providing adequate services for its troubled children.
Kris Jenkins of Lincoln said her adopted 10-year-old son has been hospitalized six or seven times after uncontrollable violent outbursts. No baby sitters can control him, the family locks away knives for protection and psychiatrists who treat him, she said, have vigorously recommended that he be admitted to a residential care facility such as Boys Town.
Yet, she said, a managed care company hired by the state, Magellan Health Services, has denied that coverage, and one of its case managers told her that her son needs more violent episodes before he might qualify.
“I am just flabbergasted at what parents have to go through to get help,” Jenkins told a group of state lawmakers.
She was among a handful of witnesses testifying Monday before a special Children’s Behavioral Health Oversight Committee set up by the Legislature last November after its special session on the safe haven issue.
The session was prompted by the dropping off of 36 troubled children, mostly teenagers and pre-teens, at hospitals and other facilities under the state’s old safe haven law, which set no age limit for such drop-offs.
Safe haven parents frequently complained that Nebraska lacked sufficient mental and behavioral health services for troubled youths, leaving families with no choice but to abandon their troubled children to the state to get them help.
The drop-offs ended when the state, during the special session, set a 30-day age limit — like 42 other states have — to drop off a child under the safe haven law.
Last spring, state lawmakers and Gov. Dave Heineman took several steps, setting aside an extra $16 million to establish a help hot line for families and to provide more youth services.
But judging by the sometimes tearful testimony to lawmakers Monday, there’s still plenty to be done.
“We still have gaps in services,” said State Sen. Kathy Campbell of Lincoln, who heads the oversight committee. “We’re just at the beginning of answering the questions.”
Officials from Magellan and the Nebraska Department of Health and Human Services told the committee Monday that very few children who request services are denied.
Vivianne Chaumont, director of Medicaid and long-term care services for HHS, said Magellan has no financial incentive to deny services.
Chaumont said that there are many misconceptions about the role of Medicaid and Magellan and that any Medicaid savings realized by the managed care firm choosing the least costly option for “medically necessary” services are used to provide other mental health services.
However, Magellan Vice Presidents Deb Happ and Matt Miller agreed that the company needs to make additional communication and education efforts, particularly to clarify expectations of mental health providers. They said more meetings with providers are planned, a “provider advisory group” will be established, and a survey of provider needs is planned.
“I’m going to hold you to that,” said Lincoln Sen. Colby Coash.
Happ said it was a “myth” that Magellan forces children to fail at less costly services before they’ll OK more expensive residential help. She said research shows that at-home help usually has a better outcome.
But advocates for children said that the progress on paper hasn’t translated into wholly improved services for children and that some deeply troubled kids need more than in-home counseling.
Carol Stitt, director of the State Foster Care Review Board, said her agency surveyed the cases of 554 children placed in foster care and found that 45 percent were not getting needed mental health services.
Angie Thiel of Lincoln said she has had to fight the state-hired managed care company at every step to get services for her 13-year-old son. Thiel said her son didn’t get the necessary help until she told her story to reporters.
Jenkins said that after Magellan denied residential services for her 10-year-old, her family undertook in-home counseling, which she described as a “joke” in which the counselor was more interested in what was for supper and in playing a Wii video game.
“It was six months totally wasted,” the mother said.
Her husband, Ken, said he was bothered that Magellan officials “at the end of a phone” could deny services that were recommended by professionals who directly work with his son.
Happ, the Magellan official, said she did not know the details of the Thiel and Jenkins cases but said she planned to look into the complaints. She disputed the Foster Care Review Board findings, saying not everyone applies for care.
Campbell, the state senator, said the cases illustrate that the state is still struggling with services for those who are profoundly troubled.
