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More troubled group homes

This summer Maryland closed an Anne Arundel County group home for severely disabled foster children operated by Lifeline Inc. after a 10-year-old boy died there and The Sun reported long-standing financial and other problems at the company. Most of the children were transferred to Second Family, a Prince George's County nonprofit that is Maryland's largest contractor for specialized foster care and one of only three remaining firms in the state that provide such services. But another Sun investigation revealed that Second Family has had serious problems of its own caring for vulnerable youngsters and that the state's system for monitoring conditions at its facilities may not be adequate to protect them from neglect and abuse.

As The Sun's Doug Donovan reported on Sunday, two Second Family staffers were captured on video slapping, kicking and pushing an autistic child in January, and in July another employee was fired for neglect that resulted in a child's injury. The Sun investigation also found that half of Second Family's group homes had been owned by top executives, contrary to state regulations, and that the state approved fat salary increases for those managers at the same time it was authorizing decreased spending on food, clothing and other expenses for the children under their care.

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The report raised a number of questions that state officials have struggled to answer, including why there aren't more firms in Maryland to care for severely disabled foster children and how it is that Second Family's top three executives earned a total of more than $400,000 in salary but couldn't afford to hire workers who don't slap kids around or neglect them. With only three such providers left in the state after the closure of Lifeline, is it too much to ask of the state agencies that oversee such operations to keep track of what's happening to the children they're supposed to serve?

Child advocates say it's expensive to care for severely disabled youth because it's hard to find qualified staff and pay them enough to provide the kind of high-quality care these children need. The Sun investigation suggests the lion's share of the salary increases at Second Family went to the firm's top managers rather that to those who worked directly with children and that scrimping on lower-level staffers' pay may have played a big role in the company's difficulties finding people truly dedicated to their work.

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Yet it also appears there was also a lack of coordination among the state agencies responsible for monitoring care providers. Group homes for medically fragile children in Maryland are licensed by the Department of Health and Mental Hygiene, but the caseworkers who are actually responsible for the welfare safety of individual children work for the Department of Human Resources and local social services departments. Child advocates say the overlapping jurisdictions of different agencies often lead to confusion over which one is responsible for which aspect of oversight to ensure a provider is doing what it's supposed to.

For example, case workers from DHR and DDS regularly visit children in group homes, but their reports focus only on particular children, not on general conditions such as staffing levels, the physical infrastructure or the overall quality of care at the facility. Moreover, in cases of child abuse or neglect by a staff person, information about an incident is placed in that child's folder but there's no way for a DHR or DSS caseworker to get more general data regarding how many similar incidents have occurred at the facility or which staffers were involved.

The lack of transparency makes it difficult for even the most dedicated caseworkers to monitor the overall effectiveness of care providers — or to sound an alarm when things go wrong. On the other hand, DHMH, which licenses such facilities, has its own monitoring unit which operates more or less independently of the caseworkers and doesn't always benefit from their first-hand knowledge and observations, and it doesn't always follow up sufficiently. If there were more transparency in the system and information were more available to the public, the families of children under the providers' care and the lawyers representing those children might be able to hold the state more accountable for the facilities it licenses.

What is certain is that state officials need to improve the oversight of such facilities by instituting more frequent inspections — including unannounced visits — to make sure all state regulations and best practices are being followed and to develop plans for facilities that are in violation to bring them back into compliance within a specified time frame. The state also needs to develop clear guidelines for sharing the results of inspections more widely among the different agencies.

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State officials acknowledged many of these shortcomings in a report released on Sunday and have promised to work on remedies. Now they need to follow through. There may be no easy solutions to the problems at Maryland's group homes, but it's clear what the state needs is not only more choices among providers but a more robust, better coordinated system in general for caring for some of the state's most vulnerable children.

To respond to this editorial, send an email to talkback@baltimoresun.com. Please include your name and contact information.

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