In recent years Nebraska has received two major wake-up calls to improve its mental health and substance abuse treatment for young people.
Wake-up call No. 1: the Von Maur shooting in December 2007.
In that incident, a 19-year-old former state ward, who had received psychiatric treatment, killed eight people and then himself.
There was much talk at the time that the shooting should prompt the state to make major improvements in the mental health and substance abuse services it provides young people in its custody.
But in the five years since, the state has dropped the ball.
A legislative hearing this month examined this failure. The lack of adequate treatment resources has meant, among other problems, that the state has to place nonviolent juveniles in with violent ones at Nebraska’s centers for state wards who have been taken out of their homes for juvenile delinquency.
It’s encouraging that Thomas Pristow, children and family services director for the Department of Health and Human Services, is working with private providers to shift existing funds toward preventive services as much as he can. But Nebraska has far to go. Strengthening those services needs to be a priority for the Legislature and the Governor’s Office for the 2013 legislative session, with more funding, better state and private coordination and stepped-up strategic planning.
A key need is providing transitional care to help wards move into independence once they turn 19 and age-out of state custody. The lack of this care was highlighted as a key deficiency in Nebraska in the wake of the Von Maur shooting. Yet the problem remains unaddressed.
Funding at appropriate levels, laws that are well crafted, departmental policies that are sensibly structured — those are all important in seeing that state wards receive needed help. But as World-Herald reporting explained in the case of the Von Maur killer, there is one additional, vital factor: Sound judgment must be exercised throughout the process by various actors — judges, state agencies such as Health and Human Services, and Magellan, the company hired by the state to oversee Medicaid mental health services for the needy.
Wake-up call No. 2: the safe-haven crisis of 2008.
When people even from out of state were dropping off their minor children to state care in Nebraska, it was rightly said that the state needed to make big changes to improve its services for families in crisis.
Since then, Nebraska has achieved commendable progress in helping families. But major challenges remain.
First, the progress. In 2008, Gov. Dave Heineman responded to the safe-haven crisis by saying he was making child behavioral health a priority. The Legislature created a task force that developed a set of sensible, affordable proposals.
Since then, Nebraska’s six regional behavioral health authorities have worked well with nonprofit providers to provide services more efficiently and effectively, often in a multidisciplinary team approach. Once families call the state helpline at 1-888-866-8660, they can be directed toward a wide variety of services. The Nebraska Federation of Families has worked hard to coordinate activities among nonprofits providing services.
An online resource in Nebraska is the Nebraska Network of Care at http://nebraska.networkofcare.org.
As part of this reform, each year a consultant reviews the services for the families in crisis. This year’s report, recently issued, said that current programs “satisfy the needs of 80 to 90 percent of the families” who have called the helpline. An expansion of services might be needed, the consultant said, to meet the needs of the remaining families, with a child or children with especially intensive needs.
The consultant spoke positively about an ongoing series of improvements the nonprofits have made and in particular praised the work being done by Boys Town and Right Turn, a program by Lutheran Family Services and the Nebraska Children’s Home Society that helps families with an adopted child having major behavioral challenges.
State Sen. Amanda McGill of Lincoln chaired the Legislature’s safe-haven task force. She agrees that Nebraska has made significant improvements in some ways, but she adds that much work remains to be done. “To me we haven’t followed through on our promises on safe haven,” she says.
Among the challenges she cites: Many parents who could be helped don’t know about the state helpline; the state needs to step up its promotion of it. Nebraska lacks treatment programs for elementary-age children. Medicaid fails to cover therapy for that age group. A lot of private service providers went out of business because they weren’t adequately compensated. “How do you encourage nonprofits to start back up again,” McGill says, “when there is so little trust for reimbursing their services?”
Nebraska has had enough wake-up calls. It’s time for the state to take strong measures to help state wards and families in crisis.