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An expert take on child welfare in NC

I recently had the pleasure of chatting with Jan Elliott, former director of Pitt County Social Services and recipient of North Carolina’s 2021 State Director of the Year award. Jan lives in rural North Carolina, which added some technical challenges to our call. On a hot day, she sat sweltering in the one place where she was guaranteed reception: her car, parked at the local library. The situation was not ideal, but the conversation was too important for her to be bothered by temporary discomfort.

Why did this chat matter so much to her? Because her personal passions and professional responsibilities intersect around advocacy for families. Over the course of her career, Jan has demonstrated time and again not just a compassion for children and young people, but also a nimble capacity for helping households when they face difficult circumstances. Every time we talk, I walk away with new insight and sage advice.

Despite her retirement last year, Jan remains dedicated to helping children and families get on track toward a brighter future. She cherishes any opportunity to brainstorm solutions and engage in productive conversation on behalf of young people across the state. That’s why she has agreed to sit on the advisory council for Blue Cross and Blue Shield of North Carolina (Blue Cross NC) to support children and families impacted by foster care. Collaborating with experts from across the state, she’s helping North Carolina improve care delivery in the child welfare system. The work focuses on strategizing the transition from the current, fragmented county-level approach to a single statewide plan driven by intensive, local coordination.

Throughout this conversation, Jan offered sharp insight, and her stories illustrated how steadfast commitment to families can transform lives.

Jan, your work on behalf of North Carolina’s children and their families is clearly a driving passion. Why do you feel so committed to this work?

I’ve been involved with social services work since 1970, and I’ve spent most of that time working with families and children. I’ve seen the struggles that so many families have. I’ve seen parents trying to do the best they can with children … then things happen. That doesn’t have to spell the end of a family. It shouldn’t spell the end of a family.

My work has been guided by the understanding that with the right support, we can prevent some devastating family crises from happening in the first place. When crises do erupt, we can help families recover, reunite and thrive.

It’s always been important to me to uplift parents and to make sure that children have the best opportunities they can have.

Can you share an experience that illustrates the unique challenges children, young adults and their families face today?

Well, this happened to me early in my career … but I think it still says something about the challenges we see today. More importantly, I think it demonstrates cause for optimism that many of us maintain today.

I once worked with a parent who was on public assistance. She had several children. Her eldest child had significant developmental disabilities, which left him more or less confined to his bed. Housing was always an issue. Money was always an issue. But I could see she was working hard to be the best parent she could be and to get this little boy the services he needed, even when that meant that he couldn’t stay with her.

But because she was living from house to house, people didn’t give her credit. They kept accusing her of not loving her children. People wrote her off because she looked rough and talked rough. The real problems the family faced weren’t from lack of love … she needed help. Nobody was listening to her, and she needed that voice to help her get what she needed to get for that child.

I began fighting on her behalf as an advocate, and we were able to get her son placed in a facility that could meet the child’s needs and which was close enough for her to visit regularly. That was so important. It meant she could continue to show him love. At the same time, he was getting the medical attention he needed, and that gave her the space to focus more on taking care of her other children.

I grew up in a middle-class family. Before then, I didn’t understand the struggles people had. It really made an impact on a young social worker. It really made me appreciate that with the right intervention and strategic support, families facing difficult circumstances can thrive.

Does that early experience influence how you think about the challenges inherent in North Carolina’s current county-by-county approach to health care for foster care?

Well, thankfully that story had a happy ending … it wasn’t necessary for her children to enter the foster care system. In those days, caseloads were huge, but every family getting public assistance had a caseworker who worked to support and advocate for them from the beginning. Today in most counties, families get a caseworker only after a CPS [Child Protective Services] report has been filed, and even then, caseworkers get assigned only to those cases that require investigation.

The point is that family support today is rarely focused on prevention the way it used to be. Also, in most counties, a new caseworker will “take over” from the investigator when a family’s case transitions to in-home support, so there’s less continuity of care.

Social services still always acts with the best intentions. But sometimes we cause trauma to our children. Anytime a child enters foster care, that’s trauma. Sometimes it feels like, once that process starts, we’re constantly stirring up a child’s life, and they’re always trying to figure out what’s going to happen next.

If we could put more money on the front end focused on prevention while children were still in their homes … where families could get the services they need more easily … where people could advocate for those families, we could prevent a lot of children from having to come into care.

The proposed statewide plan does that.

Imagine the challenges you and that parent would have faced if her children had entered the foster care system. Just recently Blue Cross NC chatted with Laurie Potter (director of Hyde County Department of Social Services) when our Extra Miles Tour visited Swan Quarter. Most Hyde County children experiencing foster care are placed in homes more than 100 miles outside the county. That disrupts continuity of care. One social worker travels more than 2,000 miles a month to fulfill their mandated visits to the seven children scattered across the state – that’s nearly the distance to Los Angeles.

One child resides nearly 400 miles from home. It seems like the burden placed on a parent working toward reunification would be insurmountable.

Yes. Not only that, but in the particular case I just described, the child’s developmental disabilities would have complicated matters even further.

When I worked for Pitt County, if I needed help with a child with really complex needs, there would be a good chance we’d have to look outside the county for a place that could really meet those needs. If the only place that can really serve that child is in another LMEs [local management entity] catchment area, then the home DSS [Department of Social Services] office has to jump through all sorts of bureaucratic hoops. For example, a county has to iron out special contracts to work with an LME outside the scope of their routine operations.

It can take weeks and weeks for that to happen, and while this is going on the child sits in limbo. Sometimes bouncing from house to house. Sometimes sitting in a DSS office.

This is a theme that we’ve heard time and again on the Extra Miles Tour. In Hyde County, two children spent more than 200 days in hospital emergency rooms simply because there was nowhere else for them to go. Reliance on emergency room services for those two children alone cost taxpayers an estimated quarter of a million dollars. But this isn’t unique to Hyde County. We’ve heard similar stories in many places we’ve visited.

How will North Carolina’s hopeful move to a statewide system of care address these challenges?

The state-wideness is certainly one of the most significant improvements. Families, health care and social services providers will really benefit from not having to jump through all those hoops. There are all kinds of barriers and discontinuities that won’t exist if and when North Carolina adopts the statewide plan. Social workers won’t have to drive the distance to California every month, because it will be easier to coordinate care with local and designated care managers and share information from one county to the next.

But that’s not all. The draft statewide plan calls for care managers who are engaged in health care and well-being planning that includes trauma-informed and responsive support for that child. DSS staff don’t always have the resources to understand all of the mental health and physical health needs, resources and medications. Social services folks don’t talk the same language as health care providers. Care managers could be a partner to help understand all that – to help with the thought process and be engaged. I really like the idea of care managers being part of a team, all working together to make better decisions.

There’s also an emphasis on investing in child welfare services at the home level, supporting families before challenges escalate to the point where the child needs to be taken into care. The state plan lays out a roadmap for connecting families (who are on Medicaid) to services. That has a lot of potential, especially when paired with the Family First Prevention Services Act … the federal law change that’s designed to be putting services up front. 

As someone who thinks a lot about how a college education transformed my own life and how fortunate I was to have had such a strong support system when I left home, I particularly applaud how the statewide plan will, if all goes well, extend support to young adults well after they leave the foster care system.

You’re absolutely right. DSS currently works with kids through the LINKS program up to age 21, if they agree to participate. But the statewide plan will follow children longer, ensuring that they have a better chance at finding early career success or fulfilling their higher education aspirations. It will help them develop fundamental skills, like budget management, that are essential to any young adult’s success in life.

Here's another thing: Currently, once a child gets adopted, DSS stops following them. For all intents and purposes, they leave the foster care system. But an adoption isn’t always a happy ending. Sometimes adopted children – especially teenagers – enter back into the foster care system. Children who had assumed they’d found their forever home once again find their family life disrupted.

With the statewide plan, care managers will still follow children who’ve been adopted. They’ll help them and their families get access to expanded and enhanced services. This increases the odds that an adoptive family will be able to weather storms … that adoptive homes will truly be forever homes.

Blue Cross NC recognizes that supporting children and young people in the foster care system is integral to our mission to improve health and well-being for all. You have joined us in this work, serving on our foster care advisory council. What drew you to this work with Blue Cross NC in particular?

Besides the fact that you’ve been my health insurance provider? [Laughs]

A while back when they were just getting started on this work, folks from Blue Cross NC reached out to me to talk about foster care. They wanted to find out what was happening in Pitt County. We talked at length. The interest they showed and the understanding they had really connected with me. I later found out that the Blue Cross NC team had engaged pretty much every county in NC. The signs were there: People were taking the charge thoughtfully and with serious commitment.

The reach out … the understanding … all that drew me in when Blue Cross NC called me back and invited me to join the workgroup. I heeded the call, and I haven’t been disappointed. It’s a workgroup with people who bring lots of different perspectives to the table. It’s been interesting hearing the different experiences and ideas.

You know, it’s just been really stimulating to finally meet and partner with leaders in this field I’d always heard about – the ones doing important work in other parts of the state. I loved the fact that Blue Cross NC brought that many experts to the table, from so many different and diverse parts of the community, to talk about what children and families needed.

We all come from different places … but we all work with children.

Well, Jan, I appreciate your time today, and I look forward to continuing our work together.

It’s my pleasure. Conversations like these are so important.

Our children deserve a chance. Just because they’re born into whatever they’re born into doesn’t mean that they don’t deserve to thrive. I feel it's our obligation as parents and as North Carolinians to ensure that every child gets a fair shot at a fulfilling adulthood.

authors photo

Angela Boykin

Angela Boykin

CEO of the Blue Cross NC Healthy Blue Medicaid Plan

As CEO of Blue Cross NC Healthy Blue Medicaid Plan, Angela's areas of expertise include regulatory compliance, operational excellence, strategic planning and analysis, risk management, and new business development. This combination of skills helped her develop deep-rooted health insurance industry knowledge and made her uniquely qualified to lead our quest to enter North Carolina’s evolving Medicaid market.

When not at work, she enjoys volunteering at her sons’ schools, cheering from the sidelines at their baseball games, and reading 3 or 4 books at the same time. She also enjoys writing her own blog focusing on parenting kids from high school through their college years.

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