Palmetto Childrens Law Blog

HEALTHCARE FOR ALL CHILDREN--THE MORAL THING TO DO?

methridge@carlockcopeland.com (Mike Ethridge) — Mon, 09 Apr 2007 21:22:28 -0500

Kanmani is 10 years old. She lives in a small village in Tamil Nadiu, India. From 8:00 in the morning until 6:00 at night she sits on the same concrete floor, making cigarettes. Her job is to close the ends with a little knife. She has to complete 2000 cigarettes a day. If she doesn’t, she’s beaten. During her 10 hour work day she gets a single break of 30 minutes for lunch. At the end of her 6 day work week she is paid her weekly wages---75 cents. And she has done this since she was five years old.

When her older brother got sick, Kanmani’s family had to borrow fifty dollars to pay the medical bills. To secure the loan, her parents sent Kanmani to work for the money lender. The agreement with the money lender requires that the money be repaid in a lump sum. Kanmani’s family needs the 75 cents she earns every week. So, after five years, Kanmani’s family is no closer to paying off the debt than when she started. Kanmani will spend the rest of her childhood on that concrete floor, closing the ends of cigarettes with a pen knife 10 hours a day.

Hard to believe something like that could happen on this planet in the 21^st century. Unfortunately, Kanmani’s story is not particularly unique. These stories repeat themselves millions of times over in India, where destitute families are forced to sell their children into indefinite servitude to pay for basic services to keep other members of their family alive.

Aren’t we glad we live in the United States? Thank God, nothing like that could ever happen here. We pride ourselves in taking care of those who cannot care for themselves…protecting the rights of the most vulnerable in our population---our children.

Really?

Last week I met Jim and Carol from Boston. They had to put their children in the foster care system just so the children could have access to health care. 3 days later I met Linda and Robert, whose son has cerebral palsy. Their family declared bankruptcy when Robert’s insurance stopped providing coverage for their son’s medical services

Today, in this country, there are 9 million children under the age of 19 who have no health insurance. Every 46 seconds another child is born uninsured in America. And there are millions of other children who are at risk of losing coverage if their parents change jobs or their employers drop family coverage. It’s not that these children belong to parents who aren’t trying. 90% of the 9 million children without insurance live in households with working parents.

What happens when these children get sick? What kind of choices do the parents of these 9 million children have to make when it comes to seeking medical care for their children?

Let’s bring these statistics a little closer to home. There are roughly 1,000,000 children in South Carolina.

A staggering 10% of those children (103,000) have been uninsured throughout 2003-2006.
South Carolina's infant mortality rate is higher than some 3rd world countries with roughly 463 babies dying each year in South Carolina before their 1^st birthday.
Almost 25% of two year olds in this state are not fully immunized.
32% of the babies born in this state are born to mothers who do not receive early and regular prenatal care.
Over 10% of the babies born in this state are born with low birth weights.
A family of 4 earning $21,000 a year in this state is not eligible for public assistance to help with payment of doctors’ bills.

Now, maybe it’s a little melodramatic to compare failure to provide medical insurance to bonded slavery. Some suggest that health care is not a right it is a privilege. Access to a doctor when your child is sick is not a fundamental liberty. Besides, the United States is not a developing country, and at least we have systems like foster care and bankruptcy so that parents don’t have to sell their children into slavery.

In the healthcare debate, I think I understand these arguments when they are directed at adults (I don’t agree with them, but I understand them). When we are talking about a portion of the population totally unable to protect itself, the logic of such an argument evaporates. Is that the best we can offer to justify the absence of any kind of program to provide universal health coverage for the single most vulnerable segment of our population?

Since the industrial revolution our economy had developed into a financial juggernaut. We are the architects of the most thriving and robust economy this planet has ever seen. In the last 100 years our technological advancements have exceeded those of any other culture in history.

We can build space ships that can take us to Mars. We can push a button and in an instant be talking to someone on the other side of the world. We can build computers that run our lives. But we can’t build a health care system that will ensure that every sick child has access to a doctor. We can’t build a program that guarantees that all children in all 50 states receive the same necessary medical and mental health services.

What is currently in place fails our children miserably. The size of the problem and the complexity of the issues have resulted in a kind of political paralysis. And year after year political gamesmanship and ideology result in inaction.

Is it an easy problem to solve? Of course not. I recognize that such coverage is expensive, and that such costs will impact small businesses and possibly result in higher taxes. I recognize that Americans feel strongly about wildly divergent methods of addressing this problem. Some call for a single-payer national health-care plan and others recommend a series of incremental reforms to the existing system. There is no easy solution. But there was no easy solution for going to the moon either.

The good news is that the problem is not without a solution. The Children’s Defense Fund is working hard this year to advocate for universal health care for all of the children in this country. Check out their website for more information on their proposed legislation. Write a letter. Educate yourselves. Talk to people. Engage in debate. Our children deserve it.

The Holocaust, Darfur, and the Superbowl

methridge@carlockcopeland.com (Mike Ethridge) — Sun, 04 Feb 2007 15:53:05 -0500

On Saturday, I visited the United States Holocaust Memorial Museum in Washington, D.C. It is a must-see for everyone living in this country. I will return with my 14 year old daughter, Anna Margaret. I plan to spend the entire day there, and I am not going to let her leave until she has seen every exhibit, watched every film clip and listened to every account of the horrors of that dark time.

It is sobering to think of the moral failure that allowed the holocaust to happen. And it is even more sobering to see how slowly we as a nation moved to address that systematic execution of a people. To be sure, the world has done a lot to minimize such moral failure in the future. (See Continuing Impact of the Holocaust). But genocide continues to plague the world. The horrors of Cambodia, the Balkans, Rwanda and the Sudan are all too familiar.

It is Superbowl Sunday, and as a nation we gather in the warmth and comfort of our homes, with coffee tables piled high with food, to watch an event which can command millions of dollars for only a few seconds of air time. It is a bit insane when you think about it.

Maybe it seems insane because having visited the Holocaust Museum yesterday, I know that for all my good fortune there are millions today who are experiencing horrors not unlike what was visited on the Jews in the 1940s. For all my good fortune, I know that there are millions scattered across refugee camps in Darfur who have no homes, no beds, no medicine and precious little food--victims of the genocide that has racked the Sudan. Untold millions in Sudan have been beaten, raped, displaced or killed. The genocidal assault by the government continues. And as a country (as a world) we don't quite know what to do. Maybe a little football can distract us.

What does the future hold for the Darfurian people? How can they be protected? How can their safety be assured? How can the genocide be stopped? How can the millions of women and children living in stick built huts with only a sheet of plastic for a roof, return home to reclaim and rebuild their lives? The answer to those questions will be decided by how the world responds. How well have we learned the lessons of the holocaust?

Maybe the folks who run the Superbowl should give the Holocaust Museum a free 60 second half-time spot.

What does this have to do with South Carolina children? A lot. The time has long since passed when we could pretend that something going on in a country on the other side of the world does not affect us. We are all in this together. Just because it's not in our backyard doesn't mean it does not warrent our immediate attention. We will never be truly secure as a country until we can address problems like the wholesale slaughter or men, women and children in Darfur. Confronting the problems of global poverty and unstable governement is more than charity, it is the heart of national security.

That's why it matters to our children. Because unless we have the courage and imagination to engage the problem of genocide, our children will never be safe. They will live in a world threatened by instability and strife. They will live in a nation threatened by moral bankruptcy. The holocaust and Darfur matter to our children, because they need to know that we are all one. They need the courage and the moral values necessary to confront problems like genocide. If our children can develop and sustain that courage, they can do more than any generation who has come before.

That's why I want my daughter to visit the Museum. But I will have to make our travel plans later. Right now it's time for the game.

January 12th Deadline for Applying for Services Under PDD Pilot Project

methridge@carlockcopeland.com (Mike Ethridge) — Tue, 09 Jan 2007 10:36:30 -0500

Through legislation passed last year, the South Carolina Department of Disabilities and Special Needs (DDSN) appropriated $3 million to develop a new Medicaid Pilot Project to treat children ages 3 through 10 years old who have been diagnosed by age 8 with a Pervasive Developmental Disorder (PDD). [See September 29th blog article]. Children participating in the pilot project will be selected based upon an application process. The deadline for applying for services under this Project is Friday, January 12th. On January 17th the applications will be randomly selected one at a time and given a number in the order they are drawn.

For more information, or to apply for services under this waiver go immediately to the DDSN website. Your service coordinator or early interventionist may also be able to provide you with some information regarding the waiver. DDSN has set up a helpline at 1-888-576-4658 (but several parents have reported that they have not been able to get through).

We're Back!

methridge@carlockcopeland.com (Mike Ethridge) — Tue, 09 Jan 2007 10:11:02 -0500

We have returned! After a month away due to trial schedules and holidays, we are glad to be back. Sorry for the lapse in posts, but we are looking forward to an active 2007 with lots of issues affecting children and the law.

It's Time to Try an "Upstream" Solution--Funding for School Readiness Programs

methridge@carlockcopeland.com (Mike Ethridge) — Sat, 25 Nov 2006 15:24:35 -0500

Last week, Diette Courrege, in a article in the the Post & Courier, reported that the Charleston County School District recently measured the progress of the children in the district's 4 year old pre-kindergarten program. The results were amazing. At the beginning of the year, the children were 38% below the national average (or in the bottom 22 percentile). After completing the district's pre-K program these same children scored in the 82nd percentile (or in the top 25% in the nation). Stunning.

Stunning, maybe, but not surprising. Ms. Courrege points out that the effectiveness of child readiness programs is undeniable and well documented. If we know something works this well, why is it that this kind of program is available to less than half of the children in Charleston County? (Ms. Courrege points out that Charleston County could double the number of Pre-K 4 year old programs and still only accommodate 80% of the county's 4 year olds. And this says nothing about the services needed for 2 and 3 year olds. She also quotes school district officials who point out that given current budget restraints, the only way to fund additional school readiness programs is to take money away from programs for older students.)

Why do we struggle so to find the money to pay for programs which are so undeniably effective?

We find it difficult to answer this question because programs such as school readiness and pre-K represent an upstream solution to the problems faced by at risk children, and this runs contrary to most of our public policy which focuses downstream. Think about it, we build strong courts, corrections, and law enforcement systems to be able to confront crime. While that system may operate well, our system “shines” only after the crime is on the books, only after the criminal acts. That means that society and neighborhoods suffer before the “system” can operate. In this example, the crime is the long-delayed visible result of a lengthy process of failure on the part of the criminal.

We all know that it is more cost effective to deal with the problem upstream, ahead of social dysfunction. But most of our effort currently goes downstream, once a problem manifests. There are a number of reasons for this: 1) We often need to “see” a crisis before we act. When a child has committed a crime, we see the problem and can move to address it. It is tough to see someone going sour when he or she is just entering kindergarten. 2) With constant funding uncertainties, local governments have a tough time just providing basic services. In the face of budget crunches, it can be a political liability to advocate for providing support services for youth when it is impossible to determine or measure outcomes.

But it's time for a change. It's time to try an upstream solution.

An upstream approach will have to be multi-faceted and involve a continuum of services and programs--one of the most critical of which will be school readiness programs such as the one described in Ms. Couregge's article. It is well documented that the 1st 5 years of a child’s life are critical to brain development, social development and feelings of self worth. Research indicates that from birth to age 5, 85% of a child's intellect, personality, and social skills is formed. Basic emotional and social responses are learned, including that all-important characteristic, trust. By the age of 3 most of a child's working vocabulary is in place. Certainly, we should channel our human, monetary, and capital resources to provide services to children during these first few years of life.

Assume every waking hour of a child's life represents an opportunity for some developmental potential. In this state a child will have lived 60 months before he or she is eligible for kindergarten (1825 days or roughly 25,000 waking hours). Even a pre-K 4 year old program will provide only 180 days of service at 6.5 hours---less than 5% of the 25,000 hours of developmental opportunity for children before they enter kindergarten.

So here's the question---what can we do to enhance the developmental experiences of at risk children during their entire first 60 months of life?

For one thing our communities and neighborhoods need to become as organized as possible in refocusing their efforts ahead of problems—when the causes of the problems are relatively easy to address. While state and local government must be held accountable, the real solution is going to come from the communities and neighborhoods themselves. The solution is going to require local partnerships and local collaborative effort as a defense against the built-in political nature of government funding, which is short term at best and whimsical at worst.

And the solution offered by these local partnerships will have to include the development of performance-based child readiness services which target at-risk children. Only then can those children begin school armed with the tools they need to succeed.

It's not a matter of not knowing what to do. We know what to do. It is a matter of when, and especially how, we go about doing the things that we know make a difference.

Gang Violence--It's Tougher to Care

methridge@carlockcopeland.com (Mike Ethridge) — Sat, 18 Nov 2006 08:05:12 -0500

Last week an anti-gang summit was held in Columbia. This was the 2nd in as many months. Communities in our state, like those across the country, are growing increasingly concerned about gang violence and the number of youth who are becoming involved in gang activity. The concern is legitimate. There is a lot to be afraid of, and it seems we really don't know what to do.

The fear and confusion are, to politicians, what blood is to sharks. To build campaign coffers and raise political ratings, there is a lot of rhetoric about "get tough" legislation...legislation that will ensure those who participate in gangs are punished swiftly and severely, and put away quickly. These same politicians reduce the complex issues involving youth and the poor to soundbites and quick fix solutions. "It's not about rich or poor, but about right and wrong." So as we prepare for a new legislative season, we can be assured that there will be an ample supply of this "get tough" legislation on the table in Columbia. As the issues become more complicated and the problems remain unsolved, then the repressive responses are the easiest: more laws, more police, more prisons.

But let's not allow this important debate to be controlled by those who seek to demonize youth and put them away. As Michael Meade reminds us, the problem is not the gang; the problem is the lack of interest in the gang. As we enter this debate, maybe it would be helpful if we reminded ourselves that all our youth (even the most heavily tattooed and the most "homeboy" braided) have something meaningful to contribute to our communities. If we begin our discussion there, the perspective is quite different, and the proposed solutions will be quite different as well. It matters when a community works on the premise that every life has value. It matters when social policy is based on the premise that with proper support a young person can find the self-caring and self-discipline necessary to live full and productive lives.

And maybe it would also be helpful to ask whether we, as a society, have really done all we can for our youth. The answer to that question is very important. As a society, we can hardly fail to properly care for our young people and then blame them for their short comings.

Any society that does not take care of the material, spiritual and educational needs of its children has failed. A community out of balance turns out unbalanced people. When we see more and more violent responses to problems---whether from gangs or politicians---we know society has lost its vision. It's time to regain our vision.

So as we seek to recover our vision and talk meaningfully about the youth in our communities, maybe the conversation needs to include questions such as these:

Where are the centers and the schools where young people can be creative, respected and safe?
Where are the empowering, socially charged community improvement projects?
Where are the sanctuaries and sacred spaces where young people's spiritual quests are attended to and their psychological and social concerns met?
Where are the safe places where the law, which often works against young people, can be made accessible and understandable so it can work for them?
Where are the elders and mentors who can inspire all youth to contribute to social change, to work at bettering their homes and community, and who can affirm that their contributions are essential?

Too many churches, recreation centers and employers have closed their doors. Too many people have given up. Too many politicans have gone for the quick and easy "fix." Our communities are, at best, fragmented in our response to the troubled youth in our neighborhoods and on our streets. Our violent and fractured communities are producing violent and lost children.

So let's re-frame the debate.

Do we need policymakers and law enforcement? Of course. But as a part of a much bigger package. Let's remember that all children have intrinsic attributes that can allow them to succeed. Let's remember that all youth have a natural instinct to re-create their world. Let's start to try to imagine how we might develop policy and action around the assets of a community instead of the perceived deficits. Let's recapture our vision. Let's remember that as a society we are bigger than punitive responses to the problems of our troubled youth. Let's find the courage and will to use all our advanced resources to heal and protect the lives of our children.

It doesn't take guts to put money into inhumane, punishment-driven institutions. It's tougher to walk the streets, to listen to the young people, to respect them and fight for their well-being. It's tougher to care.

SC Loses Medicaid Funding for Autistic Children

methridge@carlockcopeland.com (Mike Ethridge) — Tue, 14 Nov 2006 10:01:37 -0500

On December 31, 2006 South Carolina will loose $1.4 million in federal Medicaid funding used to teach autistic children. The loss of Medicaid funding will mean that school districts will have to find other ways of paying for expensive Applied Behavioral Analysis (ABA) therapy.

ABA therapy is a research based therapy that has proved to be very effective in treating children with autism. The earlier the intervention the better the results. Studies have shown that half of the children who receive ABA therapy to treat an Autism Spectrum Disorder become socially and academically indistinguishable form their peers, and all children receiving ABA therapy make some progress.

While critical to an autistic child's education, this therapy doesn't come cheap. Up to now school districts have relied on Medicaid funding to help pay for these services. With the evaporation of that funding there are some huge questions as to how schools will find the money to provide these children with what they need.

And if the school districts don't find the money, what then? Will the parents of autistic children find that they are being asked to sign new IEPs at the end of the school year---IEPs that don't include ABA therapy?

For more read the letter from Cheryl Bauerle.

Special Needs Children Arrested for School Behavior Problems

methridge@carlockcopeland.com (Mike Ethridge) — Tue, 14 Nov 2006 09:24:23 -0500

It is no secret that children with special needs are much more likely to be arrested for school behavior problems. Some studies suggest that as many as 75% of the children in detention centers throughout South Carolina are special needs children.

Unfortunately, this is nothing new. For decades schools who have been unable to deal with children with disabilities have found ways to send those children to court. South Carolina's Disturbing Schools statute makes it particularly easy. Underfunded and under-staffed, schools in this state conveniently discover opportunities to have disabled children arrested or referred to the juvenile justice system and family court.

Ironically, family court can prove to be a vehicle through which much needed services can be provided to the child at the school district's expense. The following article by Peter Wright explains how.

New Laws Affecting Children

methridge@carlockcopeland.com (Mike Ethridge) — Mon, 16 Oct 2006 21:37:12 -0500

During the 2005-2006 South Carolina General Assembly several laws were passed relating to children. One of these new statutes relates to juvenile justice and another to education. To access the full text of each Act, and to get more information on other statutes affecting children, visit the Children's Law Office website.

Juvenile Justice

POSSESSION OF TOBACCO BY MINORS (Effective Date: August 21, 2006)

Act 231 added several provisions to Section 16-7-500, regarding sales and possession of tobacco by minors. Most notably, effective August 21, 2006, it is unlawful for a minor under eighteen to purchase, possess, attempt to purchase or possess, or present fraudulent identification for the purpose of purchasing or possessing a tobacco product.

This is a noncriminal offense and is subject to a civil fine, or the minor may be ordered to perform community service or attend a program on how to stop smoking. Failure to comply with a court order regarding these penalties may result in the delay or restriction of the minor's driving privileges.

SAFE SCHOOL CLIMATE ACT (Effective Date June 12, 2006)

The Safe School Climate Act was enacted to prevent school harassment, intimidation, and bullying of students. The Act requires any school employee, student, or volunteer who has reliable information that a student has been subject to harassment, intimidation, or bullying to report the incident to an appropriate school official.

Chicora Elementary---A Story of How a Community Can Make A Difference

methridge@carlockcopeland.com (Mike Ethridge) — Thu, 12 Oct 2006 23:18:11 -0500

This is a story of how a community pulled together and saved a school. And in saving the school they saved their community's children. Yes, the hard work of turning around failing urban schools can be done.

Read about how the Chicora neighborhood in North Charleston saved their school.

Happenings around the state for children with ASD

methridge@carlockcopeland.com (Mike Ethridge) — Tue, 03 Oct 2006 09:13:06 -0500

Check out this link or a list of various events around the state for families with children suffering from ASD.

PDD Pilot Program Will Hopefully Provide Autism Therepy in 2007

methridge@carlockcopeland.com (Mike Ethridge) — Fri, 29 Sep 2006 10:59:40 -0500

Last year the South Carolina legislature funded a Pervasive Developmental Disorder (PDD) pilot program with $3 million (which will be matched by federal Medicaid funds). While a far cry from what is needed, this program will hopefully provide a number of South Carolina children suffering from an Autism Spectrum Disorder with the opportunity to receive meaningful therapy.

The PDD pilot program will be run by the South Carolina Department of Disabilities and Special Needs (DDSN). DDSN has worked with a number of state agencies and other interested parties over the last few months to develop the program. DDSN's first hurdle is to obtain the federal approval at to how the money will be spent. Several weeks ago DDSN held a public meeting to detail the proposed program.

Here are a few highlights from that meeting:

$3 million has been appropriated to DDSN (to be matched by federal money)
the PDD program is a designated Medicaid pilot project for children diagnosed with a PDD by age 8
the program targets the youngest ages feasible for treatment effectiveness
the treatment cannot exceed 3 years
the program will fund no more than $50,000 per year for treatment
findings will be reported to the General Assembly by June 30, 2007

By December DDSN will announce the application process for families who might be interested. The DDSN will assess individuals to determine if they meet the Medicaid medical criteria, and the Department of Health and Human Services will determine financial eligibility.

This legislation (the text of which is presented below) is the result of the efforts of a group of parents known as the Ryan's Law Gang. The legislation they had hoped to pass would have required that all insurers in the state provide coverage for all autism spectrum disorders. Those efforts unfortunately failed, but the PDD pilot program will at least make it possible for some families to access services that were previously inaccessible.

With over 2700 cases of autism in South Carolina and with the number of children diagnosed growing exponentially, we are going to have to find a way to make crucial services available to these children. When all is said and done, the DDSN believes the pilot program might serve 100 children. The pilot program is a start but only a start.

Statute appropriating the money for the PDD Pilot Program

“The three million dollars appropriated to the Department of Disabilities and Special Needs, as the agency authorized to treat autistic disorder, shall be designated for a Medicaid pilot project to treat children who have been diagnosed by eight years of age with a pervasive developmental disorder. The pilot project must target the youngest ages feasible for treatment effectiveness, treatment of each individual child shall not exceed three years without a special exception as defined in the waiver, and reimbursement for each individual participant may not exceed $50,000 per year. The Department of Disabilities and Special Needs and the Department of Health and Human Services will determine the areas of the State with the greatest need and availability of providers. Children participating in the pilot project will be selected based upon an application system developed in compliance with the Medicaid waiver. Treatment will be provided as authorized and prescribed by the department according to the degree of developmental disability. In authorizing and prescribing treatment the department may award grants or negotiate and contract with public and private entities to implement intervention programs for children who have been diagnosed with a pervasive developmental disorder. “Pervasive developmental disorder” means a neurological condition, including autistic disorder and Asperger’s syndrome, as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. By June 30, 2007, the department shall report to the General Assembly and the Governor on the developmental progress of the children participating in the pilot project. This provision does not establish or authorize the creation of an entitlement program or benefit.”

A New Blog to Start Some Much Needed Conversation

methridge@carlockcopeland.com (Mike Ethridge) — Sun, 24 Sep 2006 15:34:17 -0500

Children are the single most powerless segment of our population. They cannot support themselves, they cannot vote. Physically, they are not very strong. They know very little about the world. They are entirely dependent on the kindness and charity of adults. And every year tens of thousands of children are the subject of some type of legal proceeding in courthouses across the state of South Carolina. Whether they are in court because they have been the victims of abuse or neglect, or whether they are in court because of delinquency, court involved children are disproportionately and dramatically children of poverty and children of color. These children cannot speak for themselves. They cannot fight for themselves, and their families cannot afford to pay anyone to speak or fight for them.

What are the issues that are most pressing or seem most relevant to our children? How can our communities emerge with a single collective voice for our young people? This blog is based on the idea that the communities of our state will become all they can be only when we begin to collectively address the unmet legal and social needs of our children. Hopefully, this will be a place where the community can begin to participate in a conversation about those needs and about how they can best be met.

Huge numbers of South Carolina children end up in juvenile detention every year. Thousands of others, who are victims of abuse or neglect, are removed from their homes shuttled from one foster home to another. These court involved children in our state fail in devastating numbers.

Low expectations, inappropriate labeling, emotional, behavioral, and cognitive disabilities related to prior abuse, zero tolerance disciplinary practices, high stakes testing, failing inner city schools, lack of family support, all conspire to prevent thousands of children each year from succeeding.

Can something be done? Absolutely.

How do we do it? I don't know. But I do know the answer begins with conversation, argument, debate and collaboration. Hopefully, this will be a place where we can at least begin the conversation.