Health is larger than our medical needs. It happens where we live, work and play. That's the reason Blue Cross and Blue Shield of New york (Blue Cross NC) invests so heavily in assisting our members and communities address the socioeconomic, environmental and behavioral factors that play an outsized role in shaping our overall health and well-being.
As a heath care organization, we are committed to serving populations using the highest needs and at the best risk. For example, a number of our efforts to address drivers of health challenges converge around foster care and kids, from infants to 18-year-olds. For just one, we advocate for a whole-person method of healthcare, that is great for parents helping keep families intact. And, when children do enter the state's foster care system within judicial order, they can face significant challenges. Inconsistent use of care and delayed responses to restorative treatment that addresses their trauma leave them at higher risk of experiencing long-term negative impacts on their own well-being.
Blue Cross NC activly works to ensure that these children as well as their families have access to specialized care and support that fits their specific needs – at the proper time, at the right place, and thru an extensive network of culturally-appropriate and responsive care and treatment providers.
More than 30,000 children and youth in New york take part in North Carolina's foster care system, including people who were adopted from foster care. Blue Cross NC is dedicated to helping them overcome barriers to good health so that they can lead fulfilling lives.
I recently asked Dr. Jacqueline McKnight to share her thoughts on the most pressing issues facing these children. Dr. McKnight is the social services deputy director in Mecklenburg County, NC, and she or he sits like a person in Blue Cross NC's Healthy Blue Foster Care Advisory Council.
Here is our conversation.
Dr. McKnight, you once served because the executive deputy commissioner of children's services in New York City, and now you function as one of the leaders from the largest social services offices in the state. From your perspective, what do you see because the most critical challenges children and their families in the foster care system typically face?
I think it's important to start by recognizing that a child or teen in foster care isn't based on the challenges they face. Let me see our communities and culture reframe the narrative so that we focus instead on each child like a vast reservoir of potential.
But it is true that children and teenagers in foster care face more hurdles on their path to success. When a child is separated from the parent carrying out a substantiated allegation of abuse or neglect, that's a profoundly traumatic event, often preceded and accompanied by other traumas. This cycle will likely have a life-long impact in some form.
A recent report from Think of Us and also the Annie E. Casey Foundation reveals the amount to which adolescents in state custody who're placed in group homes and institutionalized-care settings face unique and particularly complex challenges. In many cases, teenagers are placed long distances using their home and community, losing contact with siblings and friends.
Many of those youth finish up in challenging circumstances. They often feel like their living environments are competitive instead of nurturing. They face higher barriers to academic success and risk falling behind within their education. Some group homes offer minimal or inadequate behavioral and emotional services to assist children and adolescents heal from their documented trauma. In certain institutionalized group care settings, they may be also susceptible to further maltreatment.
That's eye-opening. From Blue Cross NC's focus on improving drivers of health, we know that data show a definite relationship between childhood trauma and physical and mental health problems. This is exactly why we support early intervention and preventative measures, early childhood education and efforts to ensure our overall health care infrastructure is better equipped to cope with children at risk. It may sound like children in group homes can face high risk of experiencing long-term effects on their well-being.
That's right. A young child that has six or even more adverse childhood experiences (ACEs) can get to get rid of Two decades off their life, on average, compared to their peers who've none, according to the CDC.
Adolescents placed temporarily in these congregate care settings face very real challenges that are often difficult to see on the surface. But these challenges of individualized trauma with no responsive ability to address it may accumulate quickly and also have consequences that stretch up.
How are we able to improve children's environment to aid well-being?
As a long-time child welfare worker, what's stood out in my experience is the fact that we often rely on removing children using their communities when there are better options available.
Far a lot of families have their kids taken from them because they do not have the financial way to provide adequate care. Families undergo difficult times, and face unemployment and housing instability, substance use and barriers to good mental health. The need to keep children safe is key. That said, any child and family services system ought to be working to find new ways to engage and support families before a tough decision needs to be designed to remove the child from the home.
With greater use of vital resources and services, particularly in trauma-responsive continuums of assessment and treatment and placement options, we – the collective ecosystem of stakeholders and responsible agencies – could perform a better job proactively identifying families in need. Our goal ought to always be to part of and supply the resources families need before crises erupt.
Youth in foster care need love, support and possibilities to obtain the restorative help they need, not institutionalization.
The urgency of these investments seems especially acute at this time, given how substance use is driving record amounts of children into North Carolina's foster care system.
Absolutely. Based on the North Carolina Department of Health and Human Services from 2022 to 2022, overdose emergency-room visits in New york increased by 23%. Over the past year alone, the N.C. Alcohol and Drug Council provided nearly 9,200 individuals with information and referrals for substance use disorder treatment.
This crisis is impacting families in each and every region of the state. Consider the list of the five counties using the highest numbers of overdose-related emergency room visits: Burke, Randolph, Carteret, Craven, and Catawba. It's clear that communities in the mountains, within the piedmont and also the coastal plains are dealing with this.
Unfortunately, as treatment providers get more overwhelmed, parents experiencing substance use disorder can find themselves waitlisted for treatment, or they may have trouble locating a high quality, evidence-based option for treatment. For instance, in the middle of the pandemic, many counties have had to redirect resources from the opioid crisis to address the immediate needs related to COVID-19. In addition, the highly infectious coronavirus has forced people into isolation, creating even more barriers to opioid treatment. Now hospitalizations and overdoses are soaring.
Tragically, when parents aren't able to find the help they need, this is when child and family services offices have little choice but to get rid of the child from the home. It's a vicious circle, really. This is exactly why it's so important to intervene early and with a deep commitment to supplying the resources families need to overcome challenges and to be whole and healthy once more.
Child safety should always be our first priority – but removing them using their family isn't necessarily the best choice – not when parents can get support and successfully participate in treatment programs, and never when removal means that, in worst case scenarios, youngsters are sometimes sent out of state or placed in group-living situations.
Blue Cross NC has certainly invested in tools to assist connect families with proven treatments quickly. Our collaboration with Quartet is making it easier for physicians to identify patients with substance use disorder and fasten them with the right care in the proper time – generally within 72 hours. We've helped launch resources that make it easier for all North Carolinians to make more informed treatment choices. We're investing in community-based efforts, harnessing local expertise to address challenges and opportunities unique to each community.
What other strategies perhaps you have seen that are effective at keeping families together?
There's lots of important work taking place, not just in Mecklenburg County, but across the state.
Through partnerships with local providers and community stakeholders, and our colleagues at Healthy Blue, we are working to intensify our recruiting efforts and wraparound case management supports for the kinship caregivers who keep children as well as their siblings together, within their communities with caring adults who know and love them.
Kinship care means that we enlist their godparents, stepparents, people in their tribe or clan, or any other adults with whom the kid shares a family relationship to take on the function of providing full-time care and protection. The key is to harness the strength of a pre-existing relationship that respects and sustains the family's cultural values and emotional ties. These bankruptcies are not informal, ad hoc arrangements. Kinship caregivers are chosen and serve following strict guidelines, particularly in consideration that they will be caring for a individual who has experienced trauma and adverse childhood experiences. The children and youth in their care still receive careful attention from case workers. But when a child can maintain family and community ties, it promotes stability and safety. That's a key to well-being.
Encouraging youth to engage in pro-social activities may also get this amazing impact. Taking part in after-school activities and community events might help youth establish independence within their families. That as well is a crucial type of support that can help avoid the family breakdown.
When you look at North Carolina's foster care system, what provides you with the greatest feeling of hope?
We make great strides here in Mecklenburg County toward meeting our goals of child and family safety. Yet, we need a committed number of partners and people, both outside and inside from the child and family services system, who share our conviction for the families within our community, and across our nation. What fills me with optimism? Understanding that, in New york, there are plenty of who already do share my conviction – who're prepared to do the effort to create things better.
I see that level of commitment over the state. New york has a diverse coalition of child- and family-centered policy makers. This year, legislators came together and unanimously passed House Bill 769, the Foster Parents' Bill of Rights, which supplies support to foster care parents. Child advocacy organizations like NC Child and Benchmarks possess a strong voice and presence that reaches across the state. You will find vibrant and trusted community partners, like North Carolina Association of County Directors of Social Services, that recognize the importance of this work.
What provides me with the greatest sense of hope? The children and also the families that we're all serving. In the end, they embody everything that's possible. After i try looking in their faces, a better, brighter present and future for North Carolina.
