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A Concerted Effort

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Fifteen-year-old Ivan Dietz breezes into his classroom in Grand Forks, N.D., still shivering from the biting October wind as he sheds his coat and drops it on a hook by the door.

As he heads for his desk, the defiant young man announces to anyone listening that his mother's mad at him again. He missed curfew last night. His tone is boastful, but he's clearly worried about what this latest slip might mean for his weekend plans.

Truth be known, Ivan will have to answer to more than his mom. As a student in Valley Junior High's day-treatment program, he'll have to make his case at school, too.

Ivan is one of four students in this class for disruptive teenagers. The classroom is housed in a mobile unit just a few steps from the main school building. Inside, it's orderly and neat. The walls are adorned with classroom rules of order and motivational slogans.

Although students are responsible for daily assignments, the real focus of the program centers on what happens between lessons--how students interact with their peers and their teachers. A team of three professionals monitors those interactions: Kevin Murphy, a teacher trained in special education; John Fuher, a social worker and former juvenile-services case manager; and Ruth Rieger, a teacher's aide.

But students keep tabs on their own behavior, too. At regular intervals throughout the day, the teenagers fill out point sheets rating themselves on a list of behavior markers targeted for improvement in their individual treatment plans. They hash out a final score in each category with their team-teachers, who complete their own set of sheets. These tallies become the basis for the reward--or denial--of such privileges as eating lunch with friends outside the program or being dismissed before the regular school lets out. Weekly class scores also determine whether the group will earn perks like popcorn and movies on Friday afternoons.

When students do act up, the team tries to steer them to constructive solutions. Today, for example, Ivan's edginess erupts into bouts of hostility. At times, Murphy dispenses with academics to stop and talk with him about his disruptive behavior. And Fuher has scheduled an after-school meeting with Ivan, his mom, and a case manager from the state's juvenile-services division.

Together, Fuher hopes they'll be able to get to the bottom of Ivan's outbursts. Ivan, not surprisingly, hopes to better his odds of spending Sunday with his girlfriend.

But ultimately, state officials hope this day-treatment classroom and the other half-dozen like it across the state will offer families the support they need to keep troubled teenagers in school--and out of more restrictive institutions.

North Dakota officials point to its school-based day-treatment program as a shining example of the state's efforts to redirect and coordinate services for families. But the story of how those efforts have evolved is as messy--and as instructive--as trying to understand the behaviors of teenagers like Ivan.

Ranked near the top of the national charts on many indexes of child welfare, North Dakota, a largely agricultural state with a population of some 640,000, seems an unlikely candidate to embark on a sophisticated and sweeping reform of its child-serving systems. Indeed, the 1994 KidsCount study, a project funded by the Annie E. Casey Foundation that gathers data on the status of children, ranked North Dakota second only to New Hampshire on overall child well-being.

Historically, the state's strong work ethic, sense of community, and emphasis on education have kept high school graduation rates high and such risk factors as child-death rates and juvenile violent crime low. But in recent years, gang activity, foster-care placements, child abuse, and teenage pregnancy have all been on the rise. The escalating number of children living in single-parent homes and young children whose mothers work fray at family life and strain school and agency resources. And the problems that have left the state's Native American population disproportionately poor and at risk continue to plague state officials.

To make matters worse, the state's dispersed population, sprawling distances, and scattered services make it even harder for families to get the help they need.

But North Dakota's determined rural mindset has also been an asset. "People help one another," says Pam Gilbertson, the state coordinator of the day-treatment program. "There is ownership of these kids and families."

Tight budgets and prolonged bouts of recession have also pulled people and agencies together out of necessity. In 1993, the state legislature even made it a mandate to establish committees in every region to coordinate children's services.

Admittedly, child-welfare reform has come to North Dakota in fits and starts, with nearly as many setbacks as accomplishments. But the state's struggle to overcome those obstacles may illuminate the path for others, particularly in rural states where resources are scarce and change seldom comes quickly.

One of North Dakota's biggest advantages on the road to reform has been the tenure and teamwork of managers in the state agencies that work with children and families. The directors of special education, juvenile services, and mental health have all held their jobs for several years running, well beyond the national averages for professionals in those fields. Experts praise Don Schmid, the director of children and family services, for setting and building broad support for a consistent family-friendly agenda in his nine years on the job.

But perhaps the most important catalyst for collaboration was a five-year child-welfare reform initiative launched by the Casey Foundation in 1988. North Dakota was one of five states the Baltimore-based foundation invited to apply for a grant to overhaul its child-welfare system and one of three, including Maryland and Connecticut, that made the final cut. (Connecticut later withdrew from the program.)

North Dakota's commitment to family-service reform, cooperative state agencies, and efforts to improve conditions for Native Americans all attracted Casey representatives. "What impressed the foundation was the collaboration we already shared," Schmid recalls. Based on the recommendations of a 1986 governor's commission, for example, the legislature had already established a children's-services coordinating committee, which brought together the heads of several state agencies under the direction of the lieutenant governor.

Casey pledged $3.75 million to the state over five years. The state agreed to use the money to pilot a new system of serving families and to match the Casey grant with state dollars each year.

The Center for the Study of Social Policy, a Washington-based group specializing in integrated-services projects, helped design and monitor the Casey initiative. The state coordinating committee was to oversee the effort, while a state coordinator and a working group of senior agency managers would tend to day-to-day management. Regional children's-services coordinating committees would serve as the governing bodies to lead the way in the two regions picked for the pilot.

The north-central region around Devil's Lake consisted of six rural counties, including two Native American reservations, with a population of just under 50,000. Nearly twice as many people live in the four-county northeastern region around Grand Forks, the state's second-largest city and home of the University of North Dakota. Both pilot regions trained case managers to help families resolve problems and tap into various sources of aid without jumping through bureaucratic hoops--and to reach those who had fallen through the cracks of the old system.

"That kind of case management wasn't being offered 5-1/2 years ago," notes Barbara Barker Kitco, the case management supervisor for the Grand Forks region. As a result, she says, families know more about what services are available and are getting more effective help.

Agencies at the state and local levels "had to learn that just because our mandates weren't quite the same, we were still talking about the same kids," says Gilbertson, the state's day-treatment coordinator. "It wasn't so much that people didn't understand, but they thought they had boundaries they couldn't move out of."

In the Grand Forks region, the school district's involvement made a critical difference, says Carol Meshefski, the former director of the children's-services coordinating committee there, who now works for a private agency. The district, for example, covered part of the salaries of case managers who worked with students' families. The coordinating committee also organized coalitions in each county to plan parent-education programs and established a school-based parent resource center in Grand Forks. The "children of change" program, another spin-off that took hold in the region, offers schools group counseling and other resources to help children caught in the middle of family breakups and other turbulent times.

Bringing agencies together was tougher in the Devil's Lake region, where families are more isolated, and cultural and jurisdictional issues have created barriers between tribes and agencies. But the committee still managed to expand services in schools, set up a bustling family center on the Devil's Lake Sioux reservation, and target more help to Native American families. More than half of the Native American high school dropouts who worked with program case managers completed General Educational Development certificates.

Both pilot regions also developed a novel strategy to funnel federal aid to their services for families. In fact, experts call the financial reconfiguring one of the most innovative state efforts to channel federal foster-care and Medicaid dollars into prevention and early-intervention services.

Consultants taught the state department of human services to reformulate the way it allocates costs so it could claim more federal funds under Medicaid, foster care, and an emergency-aid program funded under Aid to Families with Dependent Children. The department also learned how to draw funds to help pay for the services of professionals in other agencies--like probation officers, case managers, and guidance counselors--and channel new aid into child and family services across systems.

Such creative financing has brought several million dollars to North Dakota. The extra funds have allowed the state to shift more aid into prevention and early intervention and reduce the share spent on out-of-home placements. The regional coordinating committees are also learning to use the new cost-allocation procedures so they can submit claims to the state to draw funds for their own projects and services.

Casey Foundation representatives have praised the work of the pilot sites and the state's adeptness in using federal aid. But they clearly wanted the state to go further. State leaders moved slowly, they say, to give the children's-services coordinating committees in the pilot regions full governing authority and were even more reluctant to apply the initiative principles statewide.

Indeed, when the Casey grant ended in 1993, North Dakota had not fulfilled the foundation's goal to restructure children's services across the state. Turf issues, philosophical differences between state and foundation leaders, and a reluctance to take too many risks all made reform slow and uneven.

"We agreed throughout this process on the utility and value of the pilot efforts but seemed to always diverge on how much of this should be embraced as an exemplar of how the whole system should go," explains Douglas Nelson, the Casey Foundation's executive director. "I think we did not gauge, nor did they gauge, the extent to which we had different definitions of system reform."

State officials say they were ready to tackle reform on a broader scale but differed with Casey over what they saw as the particulars. "It was an honest professional disagreement," Schmid says. The foundation, for example, felt the regional coordinating committees needed to direct the planning and delivery of case-management services to make a real difference in how families receive assistance. But state officials thought having them coordinate and contract with existing agencies would offer more leverage.

Such differences, though not unusual in a foundation-sponsored integrated-services effort, put the state in an uncomfortable spot between the regional committees on the one hand and Casey representatives and the Center for the Study of Social Policy on the other.

"That extra push for the foundation's agenda was probably more forceful than what North Dakota could accept," Meshefski muses.

For others, "it was more a personality issue with the people who were sent to get the job done" says Al Lick, the director of the division of juvenile services in the state department of corrections and rehabilitation.

Clashes over authority arose between the state children's-services committee and the state coordinator originally hired to oversee the Casey initiative, who resigned in 1990. Successors also had trouble working effectively with the state and regional committees.

The regional coordinating committees met with their share of resistance, too, largely from existing agencies that viewed them as competitors. They also felt stymied at times by what they saw as the state's reluctance to give them the control they needed to work with those local agencies.

"There was an ongoing tug of war back and forth to define our roles," remembers Lieut. Gov. Rosemarie Myrdal, who served on the Grand Forks region's coordinating committee as a state legislator and now chairs the state coordinating committee.

Tensions reached their peak in 1991, when a state coordinating-committee member moved that the state drop out of the initiative. But committee members in the Devil's Lake region lobbied the legislature for financial and political support, and then-Lieut. Gov. Lloyd Omdahl and the Center for the Study of Social Policy worked out a compromise.

After that, "the state started giving our board more executive authority to make decisions on our own," says Barker Kitco, "and since then, it has allowed the board the freedom to spread its wings and really fly with this."

Like any large foundation grant, the Casey money in some ways became a double-edged sword. For example, notes Gary Gronberg, the director of special education for the state department of public instruction, "When the regional groups came together, they tended to focus on the Casey money rather than bringing their pocketbooks to the table."

"The coordination went fine as long as we had money," adds Chuck Sanderson, the former director of the coordinating committee in the Devil's Lake region. "But as soon as the money dried up, people pulled away." Sanderson now serves as the contract coordinator for the region's new children's-services coordinating committee, which has reorganized to contract with other agencies for services.~

"When the Casey money was gone, it took some of the pressure off about what was going to happen in North Dakota, and we could fend for ourselves," recalls Meshefski. "There wasn't any money to fight or agonize over."

Everyone agrees, though, that the state couldn't have come this far without the Casey initiative. "We learned an awful lot," admits Gronberg, "and we're now able to take the best parts."

"There were so many positive spin-offs," adds Lick from juvenile services. "It has saved us, saved our caseloads, and allowed us to make good decisions about kids."

The Casey plans helped support many collaborative efforts already in progress or on the drawing boards. Since the start of the Casey initiative in 1988, the state has been able to launch a number of promising efforts that gear its child-welfare system around the needs of families rather than agencies:

  • The children and family services division and the division of juvenile services share the cost of an intensive program to make caseworkers available to families referred through both juvenile and social services. The program provides virtually around-the-clock services to help families avoid having a child removed from the home.
  • Another jointly run respite-care program offers temporary relief from caring for a disruptive child to families identified by schools, county agencies, juvenile services, and human-service centers.
  • Case managers across the human-services and juvenile systems can get money from an all-purpose fund to help families get quick help in the form of clothing, transportation, or other emergency needs.
  • State agencies have also joined in funding an outreach program, mainly in the Bismarck area, that sends parent aides into students' homes to offer parenting instruction and advice.
  • The children and family services division has collaborated extensively with the University of North Dakota and helped tap federal funds to train child-welfare workers, foster-care parents, and case managers. The state is also using a Bush Foundation grant to provide training in infant and toddler care for child-care providers and foster parents.
  • A consortium of the state's Native American tribes is planning an institute to train tribal child-welfare staff, judges, and foster parents at community colleges using a mix of federal, tribal, and foundation aid.

Although the pace of reform was uneven under the Casey grant, supporters say what matters is that communities are becoming better equipped to solve their own problems, while state agencies have found a more fitting role. Schmid calls it "steering and not rowing."

Under the Casey initiative, many saw the original pilot committees as controversial because they challenged the status quo. But in 1993, the state legislature legitimized their role when it mandated that similar coordinating committees be set up in 12 regions across the state. Legislators also appropriated $75,000 in seed money for each of the regions, which were reconfigured to create separate committees for the four Native American reservations in the state.

"The way the state committee is relating to the local committees has changed completely," says Lieutenant Governor Myrdal.

"At every meeting you go to, people are referring to the regional committees," adds Sandy Bendewald, the director of the coordinating committee in the nine-county Jamestown region. People are optimistic, she says, that "it's going to make a difference."

The new regional coordinating committees will be eligible for funds through the state's federal refinancing effort but must first submit community plans to the human-services department. The Grand Forks regional committee, one of the two pilot committees, has become a leader in training the other regions, which are in various stages of planning.

Before the legislative mandate came down, the Fargo region already had an active children's-services coordinating committee. The area's recent surge in population, notes Kathy Hogan, the director of social services for Cass County, provided plenty of incentive for schools and agencies to join forces. "We have to share responsibility and talk to each other to get along," says Hogan, who also serves on the region's coordinating committee.

Besides finding their own reasons to come together, Hogan says the new regional committees will have to come to grips with how time-consuming collaboration is--and build their strategies around a "consensus about values" rather than divvying up families and their problems by agency.

"If we can keep focused on the child and the family as the center," she adds, "the rest is our problem to work out."

Nelson of the Casey Foundation says the state's continued support for the pilot regions and newly formed committees are signs that the momentum for reform has been growing. But everyone will have to stay on board for it to work, he suggests: "The difficulty of spending money and using public employees differently is so great that it is hard to proceed with it unless you've got support in the community, the bureaucracy, and the executive and legislative branches."

As the state shifts authority to the regional committees, Schmid thinks the results will hinge on how each community reacts. "There will still be strong personalities from different agencies who will feel their priorities are more important,~" he says~. "Why should they stay committed over time unless they see some benefit to the population they serve?"

The regional committees are also expected to play a key role in putting into action the recommendations of a major state study on children's services. The study, conducted by the Child Welfare League of America for a state legislative panel, calls for a $40 million multi-year investment in school-based and community-based social, health, child-care, and child-protective services.

"We are not aware of any state that has devoted the depth of time and commitment to examining the broad needs of children and families as North Dakota has done through this planning process," the report reads.

State agencies "understand that this is the only way they are going to get legislative support for this kind of program anymore," says Corliss Mushik, a state senator who chairs the committee that issued the report.

Federal measures encouraging more interagency coordination and local decisionmaking, like the Family Preservation and Support Act of 1993, are also driving reform. In fact, North Dakota recently won a $16.8 million federal mental-health grant that will help support multi-agency initiatives, including several more day-treatment sites.

"It's one of those moments in history," says Hogan of Cass County, when everything i~s ~"pushing us in a direction that's consistent."

Like the state's path toward child-welfare reform, its five-year-old day-treatment program has been fraught with bumpy patches along the way. Administrators, for example, were wary of putting a program for disruptive youths in their schools. But they now see the fruits of the collaboration.

"You begin to see kids who would have been frequently in the office coming to school regularly, smiling, participating," notes Marsha Fivizzani, the principal of Valley Junior High in Grand Forks.

A 1992 evaluation of four program sites showed broad support for day-treatment from administrators, teachers, parents, and agencies. Conducted by consultants from the University of Wisconsin at Madison and the University of Colorado Health Sciences Center, the study also showed that students like the program. Specifically, results suggest that day-treatment appeals to students because it eases them into a setting where they don't have to adjust to different teachers and classrooms--and motivates them to work their way back into regular classes.

Curtis Molsbarger, a 14-year-old student in the day-treatment program in Grand Forks, says he likes the classroom because he gets more help and privileges there. "It helps me stay out of trouble," he says.

Before Curtis entered the day-treatment program, his mother, Robin, says he had been skipping school a lot and got caught breaking windows, stealing, and loitering. He might have wound up doing time at the state reform school like his older siblings, she says, if things had gone on that way.

Now, Curtis goes to school regularly and is keeping up his end of a "contract" he worked out with Fuher and his family spelling out such responsibilities as cleaning his room and meeting a curfew. To make sure Curtis sticks to his contract, Fuher keeps in touch with his probation officer and visits his home weekly to help counsel the family.

The secure boundaries of day-treatment have kept Curtis from getting lost in the crowd, his teachers and parents say. "He gets a lot more attention there," says Robin. In the regular school, "I think he was too shy to ask for help."

Like Curtis, the majority of program students have brought up their grades and achievement, and significant numbers are attending school more regularly and committing fewer juvenile offenses. But most important, officials say, the program has helped save many troubled teenagers from out-of-home placements.

Still, state officials acknowledge that the program doesn't work for everyone. "Day-treatment can't always be the rescue wagon," Fuher says.

The evaluation, for example, pointed up the need to target more specialized help for single parents and other "disrupted" families. Program leaders and students also say they wish day-treatment could link youths to more after-school and summer programs to keep them productively occupied and prevent them from backtracking into trouble. And some students complain that the academic part of the program is boring.

Ivan says he finds the classwork is easy but the day-treatment point system harsh and demeaning. "We get treated like we're totally stupid," he complains. "I feel trapped."

Fuher was hopeful the outlook might improve for Ivan when he heard that the boy's mother and stepfather, who had divorced, were reuniting. But at the after-school meeting, his mother said it wasn't working out. The night before--the same night Ivan missed curfew--the couple had quarreled, and Ivan and his mother got locked out of his stepfather's house.

Ivan won't look up when his mother, Fuher, and the case manager parcel out warnings about his recent reckless behavior at home and in school. He looks frustrated, then angry, then resigned when his mother informs him that spending Sunday with his girlfriend is out of the question.

A few months later, he's back in juvenile detention.

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