Children at Risk -- Falling Through the Cracks

Born in a hospital in the then Soviet Union, Kevin was promptly abandoned by his biological mother and subsequently shipped off to an over-crowded, under-staffed orphanage. Left to fend for himself, without the comfort of loving arms to nurture him, he remained until he was adopted and brought to the United States at the age of five.

Megan lived with her brother and parents. Two kids, a dog, a cat and a quiet, lower-middle class neighborhood until a disastrous combination of circumstances resulted in a life that spiraled out of control. Alcohol, violence, neglect and financial instability eventually forced Social Services to intervene. The then six-year-old was placed in foster care until her maternal grandmother won custody.

Two very different children, born a world apart into tragic lives. Both ‘rescued' from certain misery. Both happy endings. But is it really that simple? Sadly, no. Despite the love, the stability and the security eventually offered to these children, the emotional scars left by the trauma of their early years are wreaking havoc in their lives and the lives of their families. Now fourteen, both Kevin and Megan suffer with lingering emotional damage. Megan has become a chronic runaway, Kevin is violent and impulsive. Neither has regard for consequences. Both have problems with relationships. Megan is finally showing signs of improvement; the jury's still out on Kevin. And like thousands of children across the country, they are slipping through the cracks, in danger of losing the help that they so desperately need.

While the government - federal, state and county agencies - are quick to point out the progress that has been made in ensuring the physical well-being of children with improved access to subsidized health care, what about the mental health of these young people? What the majority of us don't realize, unless it affects those we love, is that there exists a huge gap into which children like Kevin and Megan can easily disappear. Many private insurance providers only offer reduced benefits for short-term psychological care. Where does a family turn when a few out-patient appointments with a therapist aren't enough or when a young person becomes a threat to themselves or others? The expense involved in long-term therapy, or in a residential facility, can be staggering, ranging from $2 - 3,000/month and up. An expense which is often simply beyond the reach of the average middle-class family.

Ultimately most of these families turn to the government for help; a difficult decision for many, but nevertheless necessary. All too often however, this avenue turns into a dead end. Many of these families have an income which prevents them from qualifying for Medicaid, yet they risk losing everything they've worked for without some kind of assistance, thereby placing any other children in the family at risk. Although some states have eased their requirements, there are as many others that have not. States that take such basic assets as a home or even a car into consideration when determining whether or not a family qualifies for benefits. Desperate parents have been forced to sell their homes in an effort to qualify, only to find that the proceeds from the sale is considered annual income and puts them into a position where they now fail to qualify on the basis of income rather than assets. In the meanwhile, the monthly bills for the troubled child's therapy continue to accumulate...$24,000...$30,000...$40,000 annually. Where does a parent turn?

Many of these young people are removed from treatment programs early, due to the family's financial strain or by the facility due to non-payment. Quite often these children wind up heavily medicated or are regularly in trouble, both at home and at school. Still other parents are forced to give up custody of their children, thereby making them wards of the state in order to qualify for benefits. This option allows treatment to continue but eliminates the parents from the decision-making process in many instances. Many of these children ultimately land in more economical facilities where coming in under budget takes precedence over quality of care. In an ideal world, neither of these scenarios would be an option, but sadly this is not an ideal world and these difficult choices are being made by thousands of families every year.

There must be another answer. Although there is presently a $28 billion surplus in the Medicaid budget, to be disbursed over three years, the federal government has introduced legislation that would make matters worse by lowering the cap on Medicaid spending. All this during recessionary times when even more families are in desperate need of assistance. And yet, by the year 2000, 39 states had failed to spend all the funds allocated them for the 1998 fiscal year and were therefore required to return those funds to be redistributed to the remaining eleven states. Money that could have been used to supplement the existing Medicaid programs to include better care for emotional issues. Money that these states will be hard pressed to win back in the form of matching federal dollars.

This is an issue that deserves our attention. Desperately needs our attention. The solution is at hand, we simply need to reach for it. We need to encourage Congress to reach for it. And then, once we've reached it we need to grasp it and use it - to seal up the cracks before Sharee and Kevin and the thousands of children like them, slip through those cracks into oblivion. Before these bright and promising young people of today become the muttering homeless or the criminals of tomorrow. While they still have the hope of a normal, productive and happy life. While they, and the families that love them, still have hope.