Amanda Price and her husband were finally in the process of adopting their three daughters in 2022. The couple had fostered the girls for four years and planned to adopt them in 2020, but the COVID-19 pandemic caused delays.
The wait has been difficult for the biological sisters, who are now 6, 10 and 11 years old. The older girls struggled with memories of being mixed up in the foster care system. The oldest lived in three different homes before landing at the Prices. At school, the middle child was teased for having a different last name than his parents. “They’ve been through so much in their short years,” Price said.
Finding mental health professionals near the town of Oram in Robeson County, where they live, has been a challenge. By 2022, the girls had already changed therapists three times when their providers moved.
The situations weren’t ideal anyway because the therapists were better suited to treating adults. So the prices were ecstatic when they found a supplier that specializes in children. They didn’t even mind the 40 minute commute to the office.
A year later, however, they received the horrifying news: That supplier was also leaving the area.
“It can be sad for the girls because they really bond,” said Price, 42. “I’ve seen my girls cry because their therapist was leaving. … It was just another loss for them.”
Like much of rural North Carolina, the southeastern part of the state suffers from a severe shortage of mental health care providers. Columbus, Bladen and Scotland counties have no child psychiatrists, according to the American Academy of Child and Adolescent Psychiatry.
The need for more professionals is especially evident amid the children’s mental health crisis, which experts say is driven by social and academic stressors that have worsened during the COVID-19 pandemic. More than one in five high school students in North Carolina said they had seriously considered attempting suicide, according to a report released this year by the nonprofit NC Child.
More funds are especially important for children in the foster care system, experts say. A 2003 study by Casey Family Programs found that former foster youth experienced PTSD at a rate nearly five times that of the general population. They also had other mental illnesses such as depression, anxiety and drug addiction at increased rates.
Children in foster care are likely to experience traumatic events early in life, including poverty, displacement, and abuse. Exposure to multiple adverse childhood experiences — often called ACEs — puts children at risk for negative outcomes in adulthood, including mental health problems and substance abuse, said Barbara Halisi, director of clinical programs at Eastpointe, which manages mental health care. in several North Carolina counties.
“It’s like a blow against you,” Khaleesi said.
Children in foster care are likely to experience trauma even if they haven’t been abused, said Donna Yalch, director of community services at North Carolina Homes for Boys and Girls in Lake Waccamaw. “When a child is taken from their parents to be placed in a foster family, they already have one trauma and that is being removed from their family,” she said.
More children in foster care
Most local counties have seen a significant increase in the number of children in foster care. In Columbus County, the number more than doubled between 2018 and 2022, from 66 to 135, according to Algernon W. McKenzie, director of the county’s Department of Human Services. By the end of August this year, 112 children in the district were placed in foster families.
Robeson County has 368 children in foster care, officials say. Durham County, where the population is more than double that, had 297 children in foster care in June.
The growing mental health crisis among young people, including those in foster care, often means extended stays in emergency rooms or DSS offices. In the first three months of 2023, on average, half of the children who received Medicaid through Eastpointe and Trillium and were in such “inappropriate crisis settings” were under DSS supervision, the data show.
Eastpointe and Trillium are managed care organizations that serve many eastern North Carolina counties, including Bladen, Columbus, Robeson and Scotland.
Experts attribute much of the increase in children in foster care to the opioid epidemic that has ravaged local communities. As of last year, more than half of all children who entered foster care in Bladen, Columbus and Robeson counties did so because at least one parent abused drugs, NCDHHS data show. At Robeson, the figure exceeds 74%.
The strain on the foster care system is exacerbated by the shortage of foster families. From 2021 to 2022, the number of licensed foster homes in the state fell by nearly 25 percent, federal data show.
“I’ve had people I’ve talked to and they’re like, ‘You know, I can barely afford to feed my own family. How can I add another mouth to feed?”
The COVID-19 pandemic has exacerbated the problem, said Carrie Decker, supervisor of foster licensing at North Carolina Homes for Boys and Girls. Decker conducts regular training courses for prospective foster parents. Before the pandemic, 15 families regularly visited – the maximum according to state regulations. After COVID, classes often have fewer than five people.
The pandemic has made many potential foster parents fearful of health risks, and inflation has increased the financial burden of foster care, Decker said. “I’ve had people I’ve talked to and they’re like, ‘You know, I can barely afford to feed my own family,'” she said. “How can I add another mouth to feed?”
Monthly stipends for foster parents in North Carolina were increased by more than 15 percent in July with the passage of Senate Bill 20, a controversial measure that restricts access to abortion. Foster parents in the state now receive between $702 and $810 per month per foster child, depending on the child’s age.
In the Border Belt region of Bladen, Columbus, Robeson and Scotland counties, where more than 20 percent of residents live in poverty, the stipend often does not cover costs. “It’s not enough to feed and clothe them for a month,” Decker said.
Some people say the state should give better priority to placing children with family members or friends instead of foster care. But it can also create financial challenges.
Denise Shepherd takes care of her 18-year-old grandson and three other children, ages 8, 13 and 14, who are not related to her. The children’s parents signed over custody of Shepherd to prevent the children from entering the foster care system. Because she is not a licensed foster parent, she does not receive financial support from DSS.
Sheppard, 66, said she had to use a credit card to pay for food for the past four months. “Grocery is a challenge,” she said. “I have three teenagers here and the 8-year-old can eat almost as much as they do.”
Shepherd said she struggled to afford clothes for her youngest child before summer camp. “This was unacceptable. He will not look like a throwaway child,” she said. “For his confidence and for what he needs, he has to look good.”
Accessing mental health care for children can also be expensive. Decker said local foster families often travel at least an hour to Wilmington or Fayetteville for therapy sessions.
For many families, travel means time away from work. “We’ve had foster parents say, ‘If I ask for one more day off, I’ll lose my job,'” Decker said.
Identifying those in need
Decker said the lack of providers who accept Medicaid presents a particular problem for children in foster care. In North Carolina, all foster children must be enrolled in Medicaid, even if their foster parents have private insurance.
“If a medical practice doesn’t accept Medicaid, that foster child can’t go there,” Decker said.
Boys and Girls Homes in North Carolina offers therapy services to some children living in licensed homes, but Decker said recruiting providers is a constant struggle. “As a non-profit agency,” she said, “we cannot offer a competitive salary.”
Despite the many obstacles to foster care, Hallisi said she hopes the new solutions can help. The COVID-19 pandemic has led to an increase in virtual access to mental health care. For people living in rural areas, virtual appointments mean they no longer have to drive long distances for treatment.
“I think that’s one of the barriers that has improved with COVID,” Khalizy said. “You know, good things always come out of bad things.”
Khaleesi is also excited about new programs that allow students to access mental health care at school.
In August, UNC Health announced a partnership with Bladen County Schools that will place four personal therapists in schools across the county. “Virtual Care Centers” on campuses will also provide access to telehealth appointments with specialists and psychiatrists.
For foster children, Hallisi said early identification of mental health issues is key. Eastpointe currently conducts a daily 30-minute phone call with local DSS services to identify specific children who are struggling and need extra care, Hallisi said.
“Early identification and early promotion to access services really matters,” she said.
“I want to see if they can get some of their innocence back.”
Amanda Price’s daughters have not returned to therapy since their last provider moved. The work of gaining the trust of new therapists became emotionally taxing for the girls, Price said.
“They go talk to the therapist and tell them all these things. Then all of a sudden that one leaves and they have to earn somebody else’s trust,” Price said. “They won’t just start talking to someone until they start trusting them.”
This year, the Prices decided to homeschool their daughters. The teasing the girls experienced at school was a factor in their decision.
“I don’t want them to have to grow any faster than they already have,” Price said.
Today, Price’s daughters spend their days at soccer games, singing at church and playing with their dog, Cookie. They may return to therapy in the future. But for now, Price said they need time to settle in without worrying about meetings and paperwork.
“I want to see if they can get some of their innocence back,” Price said.
This article first appeared in North Carolina Health News and is republished here under a Creative Commons license.