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Better oversight needed for agencies caring for severely disabled youth

As statewide leaders in advocating for the health and well-being of children involved with the child welfare system, members of the Coalition to Protect Maryland's Children (CPMC) were dismayed to hear about the death of Damaud Martin in a licensed group home. While his death was ultimately determined to have been caused by the severe abuse he suffered years ago, investigative reporting by The Baltimore Sun has raised a number of questions about the care that the state's most vulnerable children are receiving. Deficiencies at the now closed Lifeline group homes and the still open Second Family have included inadequate financial management and lack of documentation of training in health and behavior management.

A recent Review of Services for Medically Fragile Foster Care Youth conducted by the Office of Health Care Quality (OHCQ) at the Department of Health and Mental Hygiene (DHMH) made a number of recommendations to address these deficiencies and improve care for these children.

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The recommendations include:

•Clarifying and documenting the roles and responsibilities within and between agencies that provide oversight to these providers;

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•Improving systems of data collection, analysis and sharing within and between agencies;

•Improving the initial licensure process to include review of the program's business model;

•Better coordinating with other agencies to ensure that investigations of complaints and self-reported incidents are done in a timely and consistent manner;

•And hiring a coordinator at OHCQ with responsibility for planning, policy review and revision, and interagency coordination.

CPMC members appreciate the efforts by DHMH to identify shortcomings in the oversight of group homes and to identify ways to rectify these shortcomings. Unfortunately, this is not the first time that recommendations have been made. Several years ago, the Interagency Licensing Committee developed policies and procedures for coordinated monitoring of these programs. OHCQ and the Department of Human Resources (DHR) are supposed to be visiting group homes together, so that each agency could benefit from the expertise of the other and both would have firsthand knowledge of any problems. The DHMH report suggests that these policies and procedures are not being fully followed.

There is also a provision in the licensing regulations that requires each agency that licenses children's residential programs to submit their report to the Governor's Office for Children (GOC), which is then supposed to share the reports with other agencies that place children in the program. Unfortunately, GOC has little power to compel that these reports are submitted. The governor and legislature should use their power to ensure that agencies are following reporting requirements and to ensure that adequate resources are available for oversight activities and rectification of identified problems.

We appreciate that OHCQ has made an effort to review the oversight deficiencies and to make recommendations. However, as the OHCQ report notes, they work in tandem with DHR to ensure appropriate care for children. Unfortunately, DHR has provided no public response to the problems identified at group homes. Although DHR has implemented new financial reporting requirements for all of their contracted providers, a similar review of procedures and recommendations for improvement should be conducted by DHR. In addition, public release of periodic progress reviews by both DHMH and DHR would help allay concerns about lack of transparency and lack of attention to the needs of our most vulnerable children.

All five of the OHCQ recommendations identify the need for better coordination between the Department of Health and Mental Hygiene and the Department of Human Resources. We strongly agree that there is a need for improved coordination between these two agencies and believe that such coordination is badly needed for all programs where child health and child welfare intersect. In addition to group homes for developmentally disabled foster youth, enhanced coordination is also needed for the oversight of health care for children in group and home-based foster care and for medical services for children being investigated as victims of suspected abuse and neglect. As long as our state agencies work in silos, providing quality care to our most vulnerable children will be more difficult and more costly than it should be.

Dr. Wendy G. Lane is a member of CPMC and Chair of the Child Maltreatment and Foster Care Committee of the Maryland Chapter of the American Academy of Pediatrics. Her email is wlane@epi.umaryland.edu. CPMC members signing on to this op-ed include: Advocates for Children and Youth; Baltimore Child Abuse Center; Child Justice, Inc.; Citizens Review Board for Children; Jackie Donowitz; The Family Tree; FreeState Legal Clinic; the Maryland Association of Resources for Families and Youth; the Maryland Chapter of the American Academy of Pediatrics; the Maryland Children's Alliance; the Maryland Chapter of the National Association of Social Workers; the Maryland Coalition Against Sexual Assault; Sabrena McAllister; Ellen Mugmon; Pat Ranney; and the State Council on Child Abuse and Neglect.

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