Children can exhibit a variety of behaviors that result from the types of environments that they have been exposed to. In doing so, if they are under the supervision of professionals who have a lack of preparation for some reason or other, the responses to their behaviors are inevitably subpar. Mental health awareness has become more important over the last several years, and continues to be deserving of attention.
Children are sometimes misdiagnosed simply as a matter of convenience, as shameful as it is to admit. This sort of leaning into convenience has been more prevalent throughout recent decades is it relates to medicating children rather than properly identifying the root causes of problems. Adults become overwhelmed and resources strained, which in turn, results in there being a lack of preparation and training to seek out and identify the root cause of a child’s behavior.
Something as seemingly simple as the guidance counselor to student ratio in Durham Public Schools has a negative impact on the overall well-being of students. Blatantly put, there are not enough guidance counselors to go around. The result is that sufficient attention is not available to take proactive measures, and students are left to suffer consequences as opposed to receiving rehabilitating tools for the root causes of their behaviors. Continuing in this direction only yields a result similar to what we have seen for countless years with the prison systems – there is no true rehabilitation. Of course, it doesn’t help that these are systems often driven by bottom line profits, thereby neglecting and further frustrating any existing issues. If there is more focus on tackling the root cause of a child’s behavior in the right way by using preventive measures, mal-treatment of children can be minimized and ideally, altogether avoided.
Durham Public Schools has been working diligently on its 2024-2025 Strategic Plan. At the February 3, 2023 Update for REALTORS® that was held at the DPS Staff Development Center, Dr. Pascal Mubenga, Durham Public Schools Superintendent, highlighted five key points of the Strategic Plan for 2024-2025. Included in this plan was a continued effort of what was set out for 2018-2023 to provide a safe school environment to support the whole child. Dr. Mubegna acknowledged that there is an insufficient ratio of guidance counselors to students, and stated that this issue is being actively worked on to ensure the needs of children and the goals of the Plan are met. The objectives of this key point are to ensure that the social and emotional needs of students are met. There is solace in the fact that we are progressively moving away from reactive and into proactive.
This has unfortunately come to a head in other places. In Maryland, for instance, the American Civil Liberties Union and other non-profits recently filed suit against the Maryland Department of Human Services in response to its over-medication of children in the Maryland foster care system. Allegations included are that there are children who have not been diagnosed, but are receiving medications. In conjunction with this allegation is the assertion that there is a lack of oversight. For example, it has been reported that a 16-year-old was at one time given four medications. It has been further reported that children have been prescribed medicines without the informed consent of an adult, and that parents often are not aware of the prescription changes and/or additions until sometime later [1].
On a personal note, there was an instance in which I needed to update contact information in North Carolina for my minor child, and because the child did not make the request, the pediatrician’s office refused to update the information, citing that North Carolina law requires a child’s consent when he or she is over the age of 12. This is a child who has been taken to the same pediatrician since birth. This results in parents having restricted access to medical records for a minor child.
Similarly, in Charlotte, Novant Health refused to follow a parent’s instructions to drug test her 12-year-old, citing that North Carolina law requires the consent of a patient over 7 years of age under those circumstances. Comments from a Novant Health spokesperson included that minors are permitted under North Carolina law to restrict access to their records for treatment for sensitive matters such as pregnancy, substance abuse, sexually transmitted diseases or behavioral health. The spokesperson further commented that this is common throughout the United States [2].
These types of gaps in communication and consent that are allowed are the exact types of scenarios that have the potential to lead to what has been illuminated about what has been happening in Maryland. HIPAA law (Health Insurance Portability and Accountability Act) drives these types of policies that leave children susceptible to receiving improper treatment, and in some instances, no treatment at all [3]. Why and how can we, in good conscience, allow children to make these types of decisions that pertain to their health? We battle things like vaping and illegal drug use amongst young adults and children, but allow policies such as these to exist that have the potential to lead children down paths of self-destruction. We are allowing an age group that is not fully developed mentally to be the decision-makers under what could be life-changing circumstances.
These types of restrictions on parents should be subject to limitations, and qualified by specialized circumstances. For instance, NC’s Department of Health and Human Services began implementing an initiative at the Crossnore Communities for Children home in Winston-Salem that allows for birth parents and children to grow their family relationships while the children are in foster care. These are children who entered into the foster care system in NC due to their parents enduring some life-changing circumstance that hindered their ability to care for their children. Children under this program receive mental health treatment [4]. Situations such as these would warrant the blanket medical care and medical record restrictions that have been implemented at the state and federal levels.
According to Mental Health America’s 2022 data, Maryland’s youth had a lower rate of mental illness and higher access to care in comparison to North Carolina [5]. Data such as this plays into the hands of the allegations presented in the lawsuit against the Maryland Department of Human Services. If there is a lower rate of mental illness and better access to care, that naturally lends the conclusion that it is easier to get treatment that may not be necessary. In contrast, North Carolina consistently ranked lower for all metrics. There was reportedly a higher rate of mental illness and lower access to care. This data reflects the dissatisfaction that has been communicated about mental health care for NC’s youth in foster care. NC has plans to provide for better access to mental health care for its foster care children through specialized services delivered exclusively to them through managed-care companies [6]. Still, the question remains whether or not states with more access, such as Maryland, in conjunction with the implementation of the HIPAA allowances for parental restrictions leaves children susceptible to the subpar practices that have been allegedly occurring throughout the Maryland foster care system. As the lawsuit sets out, there needs to be better oversight.
Through the work that InStepp does with women, there are inevitably children who have been impacted, and possibly traumatized along the way. Studies have shown that children who come from homes where they have been exposed to intimate partner violence are likely to exhibit similar behaviors in their interactions with others [7]. When details about a child’s history go unnoticed or unaddressed, law and policies in place restricting parents combined with the disparity between mental health issues and access to care leave children to their own devices. Partnerships with local government programs, organizations, and non-profits allow InStepp to help to facilitate access to care. For example, The Center for Child and Family Health works closely with the Durham community on its initiatives to help children with processing the stress and trauma that they have encountered. Nationally-recognized childhood trauma experts receive training from The Center, which helps their service to their respective communities [8].
Suffice it to say: The tide is slowly turning.
Works Cited
- https://dcist.com/story/23/01/17/maryland-lawsuit-psychotropic-drugs-children/
- https://www.wcnc.com/article/life/parenting/children-kid-minor-restrict-medical-test-records-age-charlotte-north-carolina/275-367b4278-2419-41a5-bf23-518ef2921a9e
- http://unitedcivilrights.org/members/hipaa/hipaa-parent-info1.pdf
- https://journalnow.com/news/local/dhhs-enters-foster-care-initiative-with-local-crossnore-home/article_d0d0d982-91db-11ed-8832-434927928cb8.html
- org/issues/2022/mental-health-america-youth-data
- https://youthtoday.org/2023/02/unmet-needs-critics-cite-failures-in-health-care-for-vulnerable-foster-children/
- https://assets.speakcdn.com/assets/2497/children_and_dv.pdf
- https://www.ccfhnc.org/resources/putting-trauma-informed-care-on-the-map/