Carmen Hooker Odom like to say a few words about some of those successes , as well as the areas where improvement is called for.

We’re proud of our grades in the children’s health insurance program. Close to 90,000 children are now enrolled in NC Health Choice. We asked communities to lead the effort in identifying and enrolling children at the grassroots level, so they could tailor messages specifically to local families.  This has been tremendously successful.  The state also worked hard to make these programs accessible, easy to apply for and family-friendly.

A large number of agencies, families, advocates and legislators have worked together to promote the Health Check and N.C. Health Choice Program for children—another key to success.  Recently, I worked with the Institute of Medicine to develop a special task force to identify cost efficiencies and provide a means to ensure the maximum number of children can be enrolled through this program.

North Carolina has achieved its lowest infant mortality rate in the state’s history — 8.5 deaths per 1,000 births — but we still have a long way to go. Nationally, North Carolina is ranked 47th in the country — only three other states have a worse rate. Our biggest area of concern is the fact that infant mortality rates for African Americans and American Indians are more than twice that for whites, and there is no evidence that this gap is narrowing. This is unacceptable. We are greatly challenged to eliminate these disparities.

We can credit the hard work of Public Health and local communities for the gains that have been made so far. Three federal Healthy Start grants fund community-based initiatives in 14 counties to address disparities in infant health outcomes, particularly in African American and American Indian communities. Other programs are focusing on reducing unintended pregnancies and improving the overall health of women of childbearing age. Low birthweight continues to be an area of grave concern and a focus of a number of these programs.

North Carolina’s immunization rate of 87.5% for two-year-olds ranks among the best in the nation. This true success story is directly attributable to a decision by the General Assembly to make vaccines available to children at low or no cost, and to a statewide initiative that enjoys the participation of primary-care providers. Many vaccine-preventable communicable diseases — measles, tetanus, polio, diphtheria — have been virtually eliminated; mumps and pertussis have been markedly reduced. For the first time in several years, no cases of rubella were reported in 2001, which is a testimony to the work of local health departments in providing immunization education and services, particularly those focused onnew immigrant populations.

The numbers of newly reported cases of congenital syphilis and perinatal HIV/AIDS have dropped dramatically—another success story. Tuberculosis, however, is a communicable disease that will require more concentrated efforts. Over 50 percent of childhood TB cases in North Carolina are in immigrants from Latin America.  Tuberculosis control measures will continue to be focused on this at-risk population.

Asthma, the number-one chronic childhood disease and a leading cause of school absences, disproportionately affects Native American, African American and poor children in this state.

North Carolina maintains a high level of active prevention efforts through community coalitions and the Asthma Alliance of North Carolina, a partnership of public and private organizations working together to reduce asthmaillness and death. In support of asthma management and awareness activities, the NC General Assembly allocated funds to the Division of Public Health for the next two years to develop and enhance community-based childhood asthma initiatives. In North Carolina, one-third of children entering kindergarten have had tooth decay.  Community water fluoridation and preventive dental sealants are the two best ways to prevent decay.

Due to the successful public-private collaboration between private dental offices and the state, almost 90 percent of people on community water systems now receive the benefits of fluoridated water. Now, one of the Department’s top priorities is to increase the proportion of high-risk schoolchildren with preventive dental sealants.  Since 1996, the proportion of North Carolina fifth-grade children with dental sealants increased from 28 to 37 percent.  We want 50 percent of children to have dental sealants.

The Division of Public Health has taken the lead in an innovative collaborative program that is being observed nationally.  Into the Mouths of Babes trains medical professionals to provide screenings and fluoride treatments for children up to age three, and educational services for caregivers in order to prevent tooth decay and encourage them to seek dental care when needed.

There is not much positive to say about the grade of F on access to dental care for school-age children. We have redirected our resources toward creating innovative ways to increase the proportion of low-income children receiving needed dental care.  Over the last decade, we have helped counties increase the number of facilities where low-income patients can receive dental care from 7 to 62.  But at the same time, access decreased by 8-15%.  Adequate funding is the key to addressing this perplexing, ongoing problem.

About 8 percent of North Carolina’s very young children are at risk because of developmental or physical disabilities, developmental delays, chronic diseases or other conditions like low birthweight or prematurity.  Early intervention services are one way we work to help these children get a good start in life.  Last year, nearly 10,000 children from birth to age three were provided early intervention services through DHHS.  That was a 19 percent increase over the previous year, earning us a “B.”

Still, we are striving to do more. We have developed a comprehensive plan to better coordinate resources, better involve the medical community, expand the network of providers, and partner more effectively in planning services at the state and local levels. We’re attempting to look at family needs more holistically, and to reach more young children in a more coordinated, efficient and accessible way.

It is good news that the child death rate in North Carolina has dropped more than 25 percent since 1988, to the lowest rate ever recorded in our state this year.  We’ve gained a lot of ground in reducing the rate of child deaths, but that also means that we have a lot to lose.  Budget and personnel cuts in state programs could turn that trend in a negative direction for the first time in a quarter century.Twenty-four children died as a result of child abuse homicide in 2001– killings by a parent or another caregiver.  Though the trend in child abuse deaths is downward, the high numbers of cases of child abuse and neglect are completely unacceptable. DHHS divisions are working with other state, local and community agencies, groups, advocates and policymakers to find more effective ways to combat these heartbreaking problems. There is much work to be done.

The epidemic of overweight and obesity is one of the toughest public health issues facing the entire country.  It is not an issue that can be solved by public health alone, but we can provide the leadership.  The N.C. Healthy Weight Initiative, established by a grant from the Centers for Disease Control and Prevention, formed a 100-member task force and last month released their report, Moving Our Children Toward a Healthy Weight:  Finding the Will and the Way. The statewide plan provides 12 recommendations for action that calls for individuals and families, business and industry, government and non-government organizations, and policy makers at all levels to work together. It’s a major step in the right direction.

An especially tragic problem for our children is the percentage of teens who are using and abusing tobacco, alcohol and drugs. Our grades in those areas are abysmal, in spite of the hard work of so many agencies, organizations, and communities. These are difficult problems, and will require ongoing efforts. There are no easy answers.

We’re improving in the area of teen pregnancy. In 2001, the pregnancy rate for girls ages 15 through 19 was the lowest rate reported for our state in over 20 years.

Since 1990, adolescent pregnancy rates have declined by more than 30 percent in North Carolina, due in great part to the hard work of the Adolescent Pregnancy Prevention Coalition of North Carolina, the Division of Public Health and others.  However, the state still has the twelfth-highest birth rate for 15-19 year olds in the U.S.  North Carolina also has the nation’s highest birth rate among Hispanic adolescents.  All this in a country that has the highest teen birth rate in the industrialized world.

Unfortunately, due to budgetary constraints, DHHS funding has been eliminated this fiscal year for almost one-fourth of the local agencies that were funded last year to provide teen pregnancy prevention programs. We will closely monitor the short-term impact of these reductions.

So, in looking at the 2001 Child Health Report card, we have much to celebrate. We also have a lot more work to do, both to maintain the gains we have made and to improve in those areas where our grades are poor. Every improvement means better health for our children and a better outlook for our state. It will take all of us, working together, to raise this vitally important grade-point average. Our goal is a straight 4.0. Working together, we can get there.

In the lawsuit filed in Durham Superior Court, Lewis Pitts, an attorney for Legal Aid of North Carolina, asks a judge to force Easley and Lake to follow the law governing juvenile justice. Under the law, the two lead an advisory council that is supposed to meet four times a year and recommend to the legislature ways to improve children’s access to services ranging from mental health treatment to special-education classes.

Instead, the State Advisory Council on Juvenile Justice and Delinquency Prevention did not meet for two years until February, and neither Easley nor Lake attended then. Meanwhile, the budget for the state Department of Juvenile Justice and Delinquency Prevention has been cut from $160 million in fiscal 2000 to $128 million in 2002.

The council made no recommendations at the February meeting but is expected to meet again Thursday. Easley will participate by phone, a spokeswoman said.

The defendants have 30 days to respond to the lawsuit, after which a hearing would be scheduled. Pitts said all he and his fellow lawyers are asking is that state leaders look for ways to improve access to services for troubled children.

"I think what’s going to be very interesting is, will there be legal maneuvering to avoid the issue, or are they going to work with us," Pitts said.

The suit seeks no damages.

Easley was not available for comment, and Lake could not be reached. Easley’s spokeswoman, Cari Boyce, said that she could not comment on litigation but that the governor has tried to improve the lives of children by supporting the state’s early child-care initiatives, Smart Start and More at Four, as well as after-school programs.

But those are not the kinds of services the six children in Pitts’ lawsuit needed.

Little help available

Despite excruciating efforts, the suit says, guardians and foster parents could not get preventive services for which their children were eligible. No one could find help for a 14-year-old Durham child who was born with cocaine in his system and is now thought to be in a gang. A Durham woman could not get mental health treatment for her nephew, 15, who was taken from his mother because of her drug abuse.

Two more Durham teens couldn’t get special education through the public schools despite learning problems, the suit says. A 10-year-old from Wilson County who is eligible for special education and mental-heath services has not received them and recently attacked another child in school.

The odyssey with Jess

Tuesday, retired Marine John Higginbotham and his wife, Renee, stood before reporters and walked them through a two-year quest to get treatment for their 11-year-old son, Jess Gonzalez, who has been in their custody since he was 3.

Higginbotham said Jess was taken from his mother at 5 months because she was addicted to crack. He and his wife, who have a son 10 years older than Jess, decided to take the boy in because they had room in their lives and wanted to spare him the world of foster care.

"He was cute and cuddly and bright and smart — and he still is," Higginbotham said.

But over time, Jess showed signs of mental illness. At first, he hoarded food in his bedroom in their Onslow County home. Not cookies, but bologna and bread.

He started having trouble in preschool, acting out. At home, he began torturing the dogs, trying to drive a plastic sword through their boxer’s mouth and tormenting their chihuahua.

He was diagnosed with Attention Deficit-Hyperactivity Disorder, and for a while, medications helped. But by the second grade, his "storytelling" had turned into blatant lies; he began experimenting with fire, and he became increasingly hostile to Renee. They put him in therapy that year.

When he was in the third grade, doctors said he should be placed in a residential psychiatric hospital for children. The Higginbothams could find no openings in any such facility in North Carolina.

They found a hospital in Virginia, but their insurance required them to pay 20 percent of the cost, which would leave them with a bill of between $6,000 and $30,000 for a stay of three months to one year. They decided to get financial help from Onslow County, and Jess was signed up for Medicaid.

That’s when the Higginbothams found themselves in a Catch-22.

They had a hospital, and they had insurance, but using Medicaid money required permission from the state Department of Health and Human Services. And the department, which is in the midst of a statewide mental health reform, is trying to reduce what it calls "out-of-state" placements.

Officials with the department’s Division of Mental Health denied Jess’ placement. Instead, the Higginbothams were offered the help of home aides.

Jess attacked his mother shortly afterward and was committed to his first psychiatric facility. In the course of the next two years, he would be committed to seven. He picks his fingers raw, staples his lips and sticks needles into his body. He had incidences in which he barked like a dog on all fours, kicked a pregnant woman, threatened to kill a hospital staffer.

Higginbotham took over much of Jess’ care because of his aggression toward Renee. In an effort to appeal the state’s denial of the out-of-state hospital best-suited for his problems, the former aviation mechanic began to spend a lot of time in courtrooms and filling out paperwork.

Finally, some action

In the end, Higginbotham wrote a five-page single-spaced letter to his senators and to health officials in Washington, detailing his odyssey. In March, at age 11, Jess finally was placed in a suitable private facility in Charlotte, Higginbotham said.

"I became enough of a squeaky wheel to get greased,” Higginbotham said. He and his wife want Jess to get well, to come home and live with them as a family, to one day go to college just as his older brother has.

He cannot imagine how a single parent, or any family without the considerable resources he committed to his son’s cause, could ever find appropriate treatment for a child like Jess.

"Had the state advisory council been meeting, I could have appealed to them,” he said. "All I wanted was 20 percent for my co-pay. They spent far and above again on Jessy than what it would’ve been if they had done what I asked in the first place."

For the past two years, the North Carolina General Assembly has faced unprecedented budget shortfalls. As a result, vital services for older adults, children, working parents, people with physical and mental disabilities and newborn infants have been cut or completely eliminated. Other critical needs must be addressed – our mental health and our child welfare systems remain in crisis.

This fiscal year, we again face another enormous state budget deficit. Solving the budget problem must not mean more cuts to vital services for the state’s most vulnerable citizens. Solving the budget problem must not mean turning our back on the progress the state has made in public education. Solving the budget problem must not mean impossible choices among equally critical services and programs. Solving the budget problem should mean raising revenue where necessary to cover essential services.

STATEMENT OF PRINCIPLES

Adequate Resources – We believe that the North Carolina General Assembly must find adequate resources to support services for our state’s most vulnerable citizens. We are willing to pay our fair share to provide adequate revenue for essential programs and services.

Good Government – We believe that there are appropriate services that government must provide whether the economy is up or down: child protection, mental and physical health, quality child care, public education, caring for the vulnerable, disabled and elderly, and infrastructure—roads, public safety, and clean water.

North Carolinians Stand Together – As consumers of government services, we should not be pitted against one another. We believe that in order for North Carolinians to reach their full potential, old and young, able and disabled all need to stand together and support one another. We will not sacrifice older adults for children, public education for health care or child protection for the environment. These all are essential and we stand together to support them.

It’s time to recognize that confining troubled teens in large, prison-like correctional institutions is the wrong answer to youth crime.

Sadly, Gov. Mike Easley and his juvenile justice department haven’t seen the light. Instead they’re proposing to spend $90 million scarce tax dollars to build three new and improved youth prisons.

Last fall, reports emerged that staff at the Swannanoa Youth Center had allegedly molested three teens. In May, the state auditor documented dire deficiencies in all five of the state’s juvenile training schools — infrastructure hazards, weak education, inadequate counseling and deep staffing problems.

Before the ink on that report was dry, the Easley administration stepped forward with its $90 million construction plan. If the existing youth prisons were no good, the logic went, we’ll just go and build some better ones. [Last week, an advisory council to the Department of Juvenile Justice recommended shelving the construction plan].

A better mouse trap (or teen trap) isn’t what delinquents need. And it’s not what Tar Heel taxpayers deserve.

Large correctional facilities are expensive. They breed violence and abuse. And they invariably suffer high recidivism after graduates return home.

Institute of Government study found that 88.5 percent of youth released from state custody were charged with a new criminal offense within three and a half years. Recidivism rates of 50 percent to 90 percent are routine for youth facilities nationwide. That’s why Barry Feld, a leading juvenile justice scholar, calls training schools and youth prisons "the one extensively evaluated and clearly ineffective method to treat delinquents."

Better answers

What’s the alternative to youth incarceration? The answer is twofold: lock up fewer kids (and for shorter periods); and build smaller facilities for those who do require incarceration.

Twenty years ago, Michigan’s Wayne County (Detroit) took a group of serious youth offenders and it flipped a coin: some youth went to state correctional institutions and the rest were placed in intensive probation and counseling programs. The probation youth committed few crimes in the period they might have been confined. Incarcerated youth committed many more offenses once they returned home. After two years, the two groups had committed roughly the same amount of crime.

In other words, incarceration didn’t reduce crime at all. Yet it cost three times as much as the probation programs.

Since 2000, Wayne County has assigned serious youth offenders to local "care management organizations" rather than routinely shipping them to state corrections. The care management groups assign most teens to intensive home-based "wraparound" programs or community-based group homes. Incarceration is way down, costs have dropped, and only 1 percent of supervised youth last year committed a new felony.

When it created the Department of Juvenile Justice and Delinquency Prevention four years ago, North Carolina likewise sought to reduce the population of confined youth. New rules were enacted allowing incarceration only for teens convicted of felonies or multiple misdemeanors.

Yet for three years the youth corrections population barely budged. Admissions to youth facilities dropped. But because authorities sharply increased the average period of confinement, daily population fell only from 901 in 1998 to 811 in 2001. The population did decline substantially in 2002, but the department’s latest annual report notes that "the length of stay will continue to increase." So the progress may be short-lived.

The department’s rationale for the longer stays — that they "will lead to further rehabilitation" — is absurd given the state auditor’s finding that treatment programs are "disorganized, lack resources, and/or were perceived to have a second or third class status."

Some serious youth offenders require confinement, of course. But juvenile justice experts increasingly concur that small correctional homes are more effective than large institutions.

"Small is extremely important," says Ned Loughran, head the Council of Juvenile Correctional Administrators. "The kids coming into juvenile facilities need a lot of specialized attention…With large (facilities) it’s like going to a large urban high school. Kids get lost, and these kids can’t afford to get lost."

Missouri closed its trouble-plagued training schools 20 years ago and erected a network of small (30- to 40-bed) facilities and day programs that keeps youth offenders close to home. This allows Missouri corrections staff to provide family counseling and extensive transitional support as youth leave corrections — key gaps noted in the North Carolina auditor’s report.

Today, only 8 percent of teens released from Missouri youth facilities are incarcerated as adults within three years, far below the rates in most other states. And Missouri spends less on youth corrections than most states (including North Carolina).

Missouri’s success, like that of Wayne County, is not isolated. A growing body of evidence demonstrates that most youth offenders can be safely supervised in intensive home-based programs, with lower costs than incarceration and equal or better outcomes. For youth at extreme risk, small youth-friendly facilities are far more effective than large institutions.

The State Advisory Council on Juvenile Justice and Delinquency Prevention was required to make recommendations to the General Assembly after recent passage of the state budget.

Of 36 reforms proposed at a special meeting Wednesday , the one that provoked the most debate effectively shelves the governor’s $90 million plan to build three new juvenile jails by 2007. Gov. Mike Easley proposed the new construction based on department recommendations and auditors’ criticism of the state’s five youth prisons , all of which are more than 30 years old.

The prisons house 576 young people between ages 10 and 21 convicted either of felonies or of more than five misdemeanors.

"If we’ve learned anything in the 25 years I’ve been a judge, it’s that warehousing these kids doesn’t work," Halifax County Chief District Court Judge H. Paul McCoy Jr. told fellow council members. He supported multiple, regional facilities. "Even if it costs more, I think it will be worth it in terms of the kids’ lives," he said.

It might actually cost less, department Secretary George Sweat said. He said his office suggested replacing the three dilapidated prisons in Lenoir, Buncombe and Cabarrus counties mainly because the audit cited them as immediate hazards. He said they also face a time crunch: If construction began today, buildings wouldn’t rise for three years. Legislators are already asking to speed the process.

The department expects to have plans for possible new facilities by September, complete with price tags, in time for the council to make a recommendation to the General Assembly in November.

"If five to 10 proves better through study, that’s what we’ll do," Sweat said of the facilities.

The council’s next scheduled meeting is Aug. 21. Wednesday marked its third meeting in two years, although the governor is required by law to convene it quarterly. In May, guardians sued him and council co-chairman Chief Justice I. Beverly Lake Jr. on behalf of six children who they allege were failed by a dormant council.

Easley has yet to attend a council meeting in person, but Lake came Wednesday and called it productive. So did the attorney leading the children’s suit.

"Had this council not met, I think we’d still be looking at $90 million being wasted on a breeding ground for crime and recidivism," Legal Aid of North Carolina attorney Lewis Pitts said. "We’re pleased they’re meeting and rethinking this."

Although current achievements deserve praise, North Carolina has failing grades in several categories.  In large part, these failures result from a lack of support for effective programs that address critical problems.  As children continue to suffer from abuse and neglect, drug use, and firearm deaths, we cannot afford to turn our attention elsewhere.  These failing areas require our attention now.  At the same time we need to maintain gains already made in successful programs.

Fortunately North Carolina has a Plan that tells us how we can improve the health of our children.  The North Carolina Institute of Medicine’s Comprehensive Child Health Plan: 2000-2005 is the consensus statement of child health experts in our state.  Indicators in the Report Card represent the extent to which the Plan’s recommendations are being followed.  If North Carolina can find ways to follow the guidance provided in the Plan, the health of North Carolina children will continue to improve.  If not, we are likely to see more failing grades.

We hope that the Report Card underscores both the challenges and the potential for accomplishment in this important aspect of our citizens’ health and health care. As we improve the health of our children, we assure the future of our state and communities.

Easley’s plan would replace three facilities in Lenoir, Buncombe and Cabarrus counties with prisons that would be built by early 2007. Private contractors would build the three prisons. The state would borrow the money to pay for them.

The plan is subject to approval by the General Assembly.

Easley said in a news release that high-quality centers were critical to helping "our children turn their lives around so that they can become productive citizens."

The audit released last week was prompted by allegations from three youths that a staff member repeatedly molested them at Swannanoa Valley youth development center near Black Mountain.

Officials with the governor’s office and the state Department of Juvenile Justice and Delinquency Prevention, which oversees the prisons, said the new plan is not the result of the audit but of weeks of work with the governor’s office to improve what are called "youth development centers."

"This is a major step in the right direction for the state,” George Sweat, the juvenile justice secretary, said in a written statement. "These facilities will help us tremendously. They will be designed for the population we have, and the end result will be that these youth have an even greater chance of succeeding."

The state’s five juvenile prisons NC, four for boys and one for girls, house 576 youths ranging in age from 10 to 21. Youths are sent there either for committing felonies or more than five misdemeanors. All five centers are more than 30 years old.

She has worked in the field of child health and maltreatment for over 20 years both as a medical provider and and advocate, teacher and researcher. Her research, published in numerous journals, books and monographs, has revolved around the growth and development of children, puberty, child sexual abuse, and child fatalities, especially those from abuse. Dr. Marcia Herman-Giddens received her Physician Associate degree from Duke University Medical Center in 1978 and practiced pediatrics there for many years as well as directing their Child Protection Team. She received her doctorate in public health in 1994, and after three years as the medical director of the State Child Fatality Prevention Team, has been engaged primarily in child advocacy, teaching, and research.

Make no mistake, the youths sent to juvenile prisons in Swannanoa, Concord, Butner, Kinston and Eagle Springs are not merely naughty kids. They have been sentenced by juvenile courts after being found guilty of felonies or at least five misdemeanors. Had they been over the age of 16 when they were convicted, they would be in the state’s adult justice and corrections system.

The state Department of Juvenile Justice and Delinquency Prevention was created five years ago to bring Cabinet-level attention to the problem of youthful crime. While the number of youths in the prisons has fallen by 55 percent over that period, mostly because of smaller and more localized efforts, the amount of money spent has steadily increased. The state now spends $60,978 annually on each juvenile inmate while spending only $29,269 per adult inmate held in maximum security.

A significant part of the problem is the facilities’ run-down condition. All of them are at least 30 years old. Fire alarm systems do not work properly. Some buildings have had to be abandoned because of asbestos. Some units have no fences. The department has asked for $40 million in state funds this year for building repair and renovation.

One result of the crumbling infrastructure and outmoded designs is that the units cannot even keep inmates safe and off the streets. Last year 134 inmates tried to escape and 82 succeeded. There have been reports — and a subsequent lawsuit — alleging that inmates have been molested and injured.

The system also is not receiving the guidance and leadership it needs. Governor Easley and Chief Justice I. Beverly Lake Jr. head a council that is supposed to give the program oversight, yet except for one meeting in February that neither man attended, the group had not met in two years.

Auditor Campbell recommends that three new juvenile prison units be built for $90 million. Money is tight this year and legislators justifiably want to see more accountability from juvenile justice officials before they open the state purse. They also should look for evidence that the units are more than warehouses filled with young people who one day will be back on the street — older and quite possibly meaner, without the benefit of decent education or rehabilitation.

But the legislature itself is not without blame. The epidemic of budget cutting in recent years, as opposed to responsible and targeted tax increases and the elimination of tax loopholes, helps explain the deplorable physical conditions that make it difficult for staff members to control tough kids, much less teach and counsel them. One shocking result is that half of the young people leaving the system cannot even read.

Campbell’s audit envisions adequate facilities, efficient education and rehabilitation programs, competent staff and teachers, and state leaders who provide more than lip service. His vision is encouraging even as his audit is worrisome.