State watchdog report points out concerns, strides in Nebraska child welfare system

LINCOLN — A government watchdog this year wrapped up investigations into the deaths or serious injury of five youths who in some way were under the State of Nebraska’s eye  — including a toddler who became severely sick from eating cannabis. 

Results of the probes, along with recommendations, were part of the annual report from the Office of Inspector General of Nebraska Child Welfare, which examines activity and points out deficiencies in the state’s child welfare and juvenile justice systems.

In addition to the 2-year-old in foster care who consumed THC, investigations completed this past fiscal year involved a 4-month-old state ward described as “skeletal and near death,” and three boys ages 11-16 who died by suicide.

The OIG in an earlier report this summer revealed the boys’ deaths, at different places and times, between December 2018 and December 2022. The account said that while the actions of state workers and caseworkers did not “contribute,” better support and consistent training in suicide prevention was needed for service providers and foster families.

DHHS accepted related recommendations — as well as others recommended as a result of what happened to the injured baby and toddler.

“We appreciate that DHHS accepted all the recommendations suggested by the OIG in our reports this year,” said Jennifer Carter, inspector general of child welfare.

Serious injuries

In the case of the 2-year-old and THC, the investigation “revealed concerns with DHHS’ management of the foster home and the process that allowed that home to be overfilled.”

According to the OIG summary, the toddler was admitted to a hospital in November 2021 with problems including acute respiratory failure and underwent tests including a spinal tap. A urine drug screen tested positive for cannabinoids.

A review indicated the foster parent allowed the toddler and siblings to leave with their biological mother unsupervised, and without proper permission, while the mother went to work. 

“Medical information suggested that it was possible that the toddler could have ingested the THC while with the biological mother or once back in the foster home.…”

At the time, case management was provided by Saint Francis Community Services, which was then a state contractor.

Recommendations included revising policy related to overfill, and reviewing steps to ensure that concerns about foster homes are relayed faster.

The case of the 4-month-old who nearly died from malnourishment dates back to 2019 while the infant was in an unlicensed relative foster home.

According to the OIG, between the time the baby was made a state ward in January 2019 and the serious injury report that April, the infant attended nine different medical appointments while placed in two different foster homes and was observed by a case manager or foster care support worker at least 15 times.

“Although policy and procedure was followed, this 4-month-old nearly died of malnourishment while in foster care,” the report said.

“Compartmentalization” of medical information contributed to a lack of awareness by all caretakers of the baby’s condition and regimen needed to gain weight.

The OIG said a comprehensive health care management plan should be developed for state wards that, in part, synthesizes pertinent health information into a “one mandatory document.”

Oversight restricted

By statute, the OIG said, it is only required to investigate deaths or serious injuries that did not “occur by chance” and that may have resulted from abuse and neglect. The watchdog office refers to those as “mandatory investigations,” and typically there are multiple pending at any given time.

Based on this year’s 522 incident reports and public complaints — which is an increase of about 15% over the previous year — the OIG identified the need to open nine new mandatory investigations.

Seven of those involve deaths or serious injuries of system-involved children, and two involved alleged sexual abuse.

It is possible that the number of mandatory investigations will increase, as the watchdog noted it is “still waiting on records before being able to fully determine if certain incidents require mandatory investigation.” 

The 11th annual report, which is 50 pages long plus appendices, also noted that a recent opinion from the Nebraska Attorney General’s Office has curtailed the Legislature-created OIG oversight of the state child welfare and prison systems, and said the latest report lacked some detail provided in the past.

Attorney General Mike Hilgers, in the mid-August opinion, said the Legislature’s design of the powers of the inspectors general to control and access state information from other branches of government violated the Nebraska Constitution’s separation of powers.

Carter, in a statement accompanying the report, said that while the DHHS has since “severely restricted” OIG’s access to information, her office will continue to try and meet its statutory obligations.

“We remain committed to the law and to the principles of accountability, transparency, integrity, and good government which form the foundation of the work of inspectors general,” she said.

Meanwhile, the Nebraska Legislature has hired an outside lawyer to help state senators find a solution to how the inspectors general can still do their jobs without having as much access to state data from the executive and judicial branches of government.

Youth Rehab and Treatment

Also included in the annual report are trends and observations regarding the state’s Youth Rehabilitation and Treatment Centers in Hastings, Kearney and Lincoln.

Challenges at the Hastings campus have been exacerbated, the inspector general said, by high staff turnover and an increase in youth population. Thirty-eight assaults on staff were reported there, compared to 19 the previous fiscal year.

Hastings reported a recent 1-to-6 staff-youth ratio, which is beyond the 1-4 ratio goal stated in a five-year strategic plan.

The Kearney facility has been sharing two of its mental health staff to cover the lack of mental health staff at Hastings.

Despite staffing challenges, the report said that Kearney has increased community engagement and volunteer opportunities for youth. The facility also has partnered with an equestrian program that lets youths care for and eventually ride the horses.

A partnership with the Department of Education appears to have improved education programming and in-classroom instruction at the centers, the report said. “This is more consistent with a traditional educational setting, helping to prepare youth to return to school when discharged.” 

The OIG noted disappointment that an advisory group — created to monitor the five-year strategic plan for the centers — had not met during the past year for its quarterly updates. 

“The OIG continues to recommend that DHHS and the Legislature include a more comprehensive and visionary look at what Nebraska needs the YRTCs to be,” the report said.