The Maine Department of Health and Human Services has a new motto: Really Sorry About All Those Dead Kids.
If that sentence makes you cringe, that was intended. Get used to it, because there’s more cringe-worthy stuff coming up.
According to data that reporters pried out of the department, in the past two years, 26 children between 20 days old and 10 years old died after DHHS was notified those kids might have been abused or neglected. In some cases, the department seems to have done nothing about those complaints. In others, it didn’t do nearly enough. In all of them, nobody at DHHS was held responsible for failing to protect those children.
The reason for that is both simple and complicated. Let’s do simple first.
Department caseworkers are overworked. There are far too few of them handling far too many cases. Some reports are bound to fall through the cracks, and some of those are going to result in deaths. That’s the inevitable result of not taking a serious problem seriously.
The complicated part is that simply hiring more caseworkers isn’t the whole answer. Those new employees have to be trained, they have to be monitored, they have to be valued, and they have to have access to a network of services for kids, parents and foster parents. Without all that, more children are going to die for no good reason.
Why can’t all that be accomplished? Because DHHS is a monstrosity. The department sprawls across the bureaucratic landscape like a pulsing blob of mutated alien ooze. Since 2004, when DHHS was created by combining the Department of Human Services and the Department of Behavioral and Developmental Services, it has grown into a behemoth requiring a commissioner, three deputy commissioners, 12 directors, two superintendents, one coordinator and more than 3,200 underlings charged with doing impossible tasks. That’s more people than live in a 30-mile radius of my house.
Besides child abuse cases, the department is charged with dealing (or not) with people with mental illnesses, people with disabilities, old people, people with addictions, disease prevention, and all manner of welfare from food stamps to Medicaid. There are plenty of horror stories about how it’s botched those responsibilities.
Incompetence costs money. In fiscal years 2018 and 2019, DHHS will spend something north of $3.8 billion. That’s more than the combined municipal budgets of every city and town in Greater Portland, with enough left over to fund a large swath of York County.
By any measure, this department is unmanageable.
Under former Gov. Paul LePage and ex-Commissioner Mary Mayhew, the priority was to cut spending. Welfare rolls were reduced, sometimes reasonably, sometimes not. Positions of frontline workers were left vacant, always without regard to how that would affect vulnerable populations. Follow-up was nonexistent. Problems were ignored. Kids died.
Democratic Gov. Janet Mills and new Commissioner Jeanne Lambrew have promised change, with Lambrew telling a legislative committee she is “aggressively assessing” what’s possible. Here’s hoping that aggression extends to doing some serious deconstruction.
The only way DHHS can be made functional is to tear it apart and replace it with several smaller departments that could be adequately overseen. Start with a Department of Child and Family Services. Add a Department of Welfare. A Department of Health. A Department of Other Stuff That Maybe Needs Doing But Possibly Not.
Cut the creature down to a size that’s manageable.
And less cringe-worthy.
Cutting comments can be emailed to aldiamon@herniahill.net.
There is a a lot of negative attitude/ politics in Maine regarding the DHHS and the programs they facilitate. I feel it’s important to point out- in the case of children, they didn’t ask to be here. The children are dependent on whoever they are living with.
Kendall Chick provides a case study of common issues:
1.) parents with drug addiction that isn’t going to just go away.
2.) grandparents with drug addiction relying on Suboxone to maintain sobriety and traveling to Portland to receive it.
3.) zero oversight/ follow up/ healthcare follow up/ medical work up or communication on Kendall from the DHHS to the grandparents other than everyone knows she is a so called “drug baby”.
4.) couple years go by with murky details and then Kendall tragically dies/ the apparent victim of severe abuse.
5. Kendall never received regular medical care/ eval by MD’s and when she was placed with the grandparents they were unable to get any information from DHHS regarding Kendall’s health/ medical status.
Kendall’s step grandmother was recently convicted of killing her via abuse. However, it’s not a clear cut case of “xyz beat up the kid and killed it”. Many things appear to have gone terribly wrong culminating in Kendall’s death. First and foremost: Kendall is never regularly seen by anyone at all besides family. She is never taken to regular MD check ups. Family members state she seemed to have health problems consistent with drug exposure in the womb, but she never receives any medical evaluations. Family members state she is unusually clumsy, she has bathroom accidents on the floor and in her pants, she runs head first into things. She is always bruising and they do not know why. They are afraid to take her to the MD because they are afraid they will be charged with child abuse.
These are all things that one does see in abused children. Signs of abuse. However, there are also medical complications, often connected to drug users, and drug exposure in utero. Crystal Meth causes birth defects in the CNS and abdominal organs. Fetal alcohol syndrome causes well known birth defects. It’s unclear the long term effects of opioids on infants, but they certainly struggle with withdrawl and developmental delays. IV drug users often have HIV and Hepatitis. Reye Syndrome occurs in children recovering from virus and/ or taking aspirin. Certain STD’s, such as Syphilis, passed to infants can causes serious CNS and systemic issues (not to be harsh bu reality is drug addicted parents are often resorting to flesh trade to support themselves, exposing babies in utero and in the home to many things) . Measles, mumps, rubella all can cause massive systemic illness/ issues in infants/ very young children especially s already “stressed” by unhealthy home environment.
Kendall Chick’s family is certainly guilty of making poor choices regarding whatever issues she was having. Her grandmother maintains she is innocent and did not render fatal traumatic injury on the child. It’s possible she’s telling the truth. If Kendall had undiagnosed/ untreated medical conditions causing bleeding disorder/ CNS disorder/ infections of her internal organs….In theory Kendall Chick could have suffered seizures violent enough to crack her head on things, fallen off and into things, bruised unusually, bled unusually, organ rupture via abscessation, been unable to control her bladder and bowels, vomited etc. etc. In which case she needed to be seen by a MD, she needed thorough medical intervention.
I’m not at all saying it’s OK, or that I have sympathy for a family that let Kendall Chick’s health situation get so extremely out of control she died…because they feared being accused of abuse if they took her to a MD. It’s also quite possible her issues were aggravating the grandmother and she did lose her temper—that is not excused either. HOWEVER, what I really want to drive home is how common the scenario is!!!!! People are not taking children to healthcare providers for a variety of reasons/ fears/ superstitions etc. that cause bad situations to become out of control. In school aged children we have the buffer that, perhaps school employees will notice something is wrong and alert authorities. But, for kids not in school for a variety of reasons, the risks go way up. There is also this fear in the community about reporting suspected abuse/neglect: “I don’t want to get anyone in trouble” “they seem like nice people” “What if I am wrong” “I don’t want them to know it was me who reported” etc etc.
DHHS needs a strategy that keeps children like Kendall Chick eyes on by the right professionals. A required timeline/ check list of routine appointments with pediatricians, DHHS case workers, mental health therapists could spread the load of having eyes on these kids while attending to their health and well being needs. 9x out of 10 for these kids to grow up well, the whole family is going to need some structure/ support to keep things moving in a healthy direction. It does take a village. I think we can find effective ways to do this without creating huge, expensive, unwieldy DHHS. I think it will come down to identifying and implementing effective strategies as opposed to more bodies on the payroll. Bodies on the payroll is fine if it’s going to be effective, solve problems… however,we’ve seen many times it does not. It’s the organization, structure, systems put in place to make things run effectively that move the needle.
The state is poised, in the name of public health, to require vaccinations of children, since some parents cannot be trusted to do this. This policy will be implemented by DHHS and the DOE. It will undoubtedly lead to a more efficient and trusted bureaucracy.
Mary Poppins makes good points. The choice of on-line identity is interesting. The nanny state will be OK if our nanny is Mary Poppins….but I rather suspect it’s more likely to be Nurse Ratched.
JR I think your “nanny state” click bait rhetoric is …click bait. When you have X% of population of children born into homes that can not safely care for them—someone(s) going to have to step up to attempt to get these children’s needs met. Emotion and humanity aside, if we want to look at it from hard core economic angle: it’s cost effective to get x% of at risk children some form of a nanny to help them reach adulthood with healthy life skills and a road map to a sustainable life/ work. Leaving such children without some “nanny” support assures greater % of wash, rinse, repeat: unhealthy life skills, unhealthy future…that ultimately costs the state more $ in aid, medical care, crime, drugs…and more children born to individuals unable to care for them. Round and round.
It’s never going to work perfectly as a utopia at home or in state intervention. However, we can shift a certain % healthfully and effectively. AND, very importantly, continue to track what works and what doesn’t work. Focus on what can be implemented to succeed in getting the greatest % of these kids to adulthood with a healthy “kit” of life skills and education so they can take it from there into their future, and their family/ children in the future.
The alternative is …let them live abused and neglected creating terrible patterns of unhealthy homes, kids, lifestyles? What do you want to do JR? Take them out behind the barn and put a 22 to their forehead? Let them live on streets begging/ hustling like the 3rd world? That’s not good for business or drawing industry and tourism… neglected and trafficked kids laying about the sidewalks sassing passerbys tends to kill curb appeal.
As Oliver Wendell Holmes said “Taxes are the price of civilized society.” I agree. I mean, I’ve been in the 3rd world…watching someone sell their kid into human bondage is hard to stomach. Watching babies die from diarrhea in a sewage ditch is hard to take. Watching 10yo street kid use drugs and sell their body for sex is hard to take. Personally, I don’t need the xtra money for 2 cars, big house, giant fridge and freezer, meat every meal @ $4per lb, garage, boat, ATV’s, snow machines, camps, 25 firearms etc. I don’t mind at all paying that xtra money as tax or charitable donation to stop our American and Maine streets from looking like 3rd world slums.
Finally I’ll point out a distinction in Mary Poppin’s style nannying : she came when they needed her and left (to help another family) once they were back on their feet.
Mary Poppins- I’ve got no problems with Mary as our nanny- I know several child protective workers and am a mandated reporter myself.
State power is necessary, but hard to control. Child abuse is now being defined as opposing gender dysphoria sterilization/surgery.
Mary Poppins, DHHS was at least functional, before dems got their meat hooks into it. Under McKernan, DHHS had snags but it worked, then King and Baldacci who brought the ACLU with them. A judge ruled that it was wrong to not place a child with family, no matter how dysfunctional that family may be. Pre-1997 DHHS would have taken the kid, placed them in a foster home and then let the parents petition the court for visitation rights. The dems however decided to focus on the family, they limited the number of foster homes, cut funding for existing homes in favor of a stipend to the family members who are supposed to provide care. By the time LePage got there the system was so broken his ONLY option was to seek out of state help.
As was stated not enough workers. But the problem also goes to the courts and lawyers. Having done foster care for a long time lets state some facts. This state does not have enough foster parents. The burden of proof for child endangerment falls on the DHHS. Another words they have to prove to the court that the child is endangered and because there are not enough foster parents or the children have to be split up (all children have to stay together now). They may be forced to depend on family members. But don’t forget the abusers I mean parents rights. If the state cant get into court in a timely fashion (they have 90 days) then the abusers (parents ) can come up with a safety plan to get the kids back. Oh and lets not forget the poor case workers living in hotels with children because there is no foster home. Remember what you think is endangerment may be that families life standard So before blaming the DHHS this is a huge problem no one including myself can have or can come up with a simple fix. From the first foster parenting class I took until the day my wife and I adopted our last child I have never understood why the parents/abusers have so many rights but the innocent children don’t. I have had children in my home want to eat from the garbage can, defacate themselves so that no one will sexually abuse them. So before anyone else states this a problem look into foster care and walk in the shoes of those that try to help these children out instead of saying what the problem is without any understanding of how difficult it is or sat with a case worker (who is close to tears) because she has to return a child to a horrible situation by court order knowing that they will have to remove that child again and again.