Abuse & Neglect Story Archives - West Virginia Public Broadcasting

Possible Solutions Offered For Foster Care System Problems

For many years West Virginia has led the nation in foster care rates, with more than 6,000 children currently in state custody. This year, the state legislature formed a work group to identify and address complaints of neglect and ineptitude in the state’s child welfare system. As Emily Rice reports, the work group reported their findings and recommendations to lawmakers this month.

West Virginia has led the nation in foster care entry rates since 2010 with more than 6,000 children currently in state care.

A legislative workgroup was formed in March to identify and address complaints of neglect and ineptitude in the state’s child welfare system. During November’s interim session, the workgroup reported their findings and recommended solutions to the Joint Standing Committee on Health.

Foster parents turned advocates, lawmakers and state officials presented lawmakers with ongoing problems and possible solutions in the state’s troubled foster care system.

Foster Care System Workgroup Update

Del. Adam Burkhammer, R-Lewis, and Sen. Vince Deeds, R-Greenbrier, gave a presentation on the Foster Care System Workgroup’s findings.

“We wanted to investigate the entire system for quality, efficiency and effectiveness,” Burkhammer said.

They said the workgroup’s report was a cumulative effort from several Senators and Delegates, including Sen. Patricia Rucker, R-Jefferson; Del. Jonathan Pinson, R-Mason; Laura Kimble, R-Harrison; Del. Margitta Mazzocchi, R-Logan; Del. Michael Hite, R-Berkeley and Del. Scot Heckert, R-Wood.

The increase in foster care has been largely fed by the state’s Substance Use Disorder (SUD) epidemic.

“When we talk about the leading factors of that (entry rate) 80 to 90 percent would probably go to substance abuse, as well as in poverty, family instability and parental education can kind of be bundled into one there,” Burkhammer said.

In 2000, six out of every 1,000 West Virginia children entered foster care. In 2021, more than double that number, 13 of every 1,000 West Virginia children, entered foster care. West Virginia’s entry rate increased 117 percent in those 21 years.

Burkhammer cited similar statistics from the state’s Child Welfare Dashboard, operated through the West Virginia Department of Health.

“That (6,000 children) leads the nation per capita at 19.8 per 1,000 children, versus the national average of 5.1 per 1,000,” he said.

For that reason, the workgroup focused on evaluating the state’s preventative services, where they found a lack of long-term planning, insufficient resources and a lack of adequate staff.

“There are 79 openings out of 390 CPS workers,” Burkhammer said. “That leads to high caseloads. High caseloads lead to poor quality in those caseloads.”

There is a need for attorneys appointed by a judge to represent the interests of people who cannot protect their rights. Those attorneys are called guardians ad litem (GAL) in family court.

“We’re always discussing that we don’t have enough of those to represent everyone through this legal process, and as well as all of our service providers are short-staffed and understaffed, and again, lead to high caseloads, which I believe ultimately leads to poor quality and attention to our children,” Burkhammer said.

Pinson, another member of the Foster Care System Workgroup, testified before the committee that in 2023, there were 157 GALs for the state of West Virginia. This year, there are 191, which Pinson said was an improvement, but not enough.

“That’s a pretty large increase, percentage-wise, 191, though for the entire state of West Virginia,” he said. “In 2024, from Jan. 1 until Oct. 31, there have been 4,708 new juvenile abuse and neglect cases.”

Pinson said that figure did not include active cases that are pending, so the workgroup estimates there could be as many as 10,000 active abuse and neglect cases for 191 GALs to handle.

“That means every guardian ad litem has at least 41 active juvenile abuse and neglect cases, not counting all the other legal work that they’re doing,” he said. “So as we think about guardian ad litems, we need to consider an increase in compensation.”

Pinson said though they may be overworked, West Virginia’s guardians ad litem are excellent attorneys.

“If we’re going to retain excellent attorneys for the children that we take custody of, we’re going to have to pay them,” Pinson said.

Burkhammer said the workgroup found that these problems could not always be attributed to a lack of funding, but a lack of urgency.

“Sometimes the money is there and the bills are not being paid in a timely fashion,” he said. “It was an ongoing complaint from everyone from service providers all the way down to families, of not getting timely payment and then ultimately not being able to provide those services and care to children.”

But, according to Burkhammer, the lack of urgency doesn’t end with spending.

“There’s a lack of urgency when we’re talking about court-ordered services that our biological families are ordered to participate in,” he said. “There’s delays in getting those implemented. Another area is data collection. Some of our reports are out of date. So when we’re talking about trying to fix an ongoing problem, we can’t be looking at one-year, two-year-old data. We need to be looking at real-time data.”

The workgroup looked into the foster care system’s transparency, and Burkhammer said that the workgroup found that confidentiality requirements often hindered the process.

“We want to protect the confidentiality of children, but at times, we’ve noticed that that extreme use of that confidentiality statute might create unintended consequences downstream when we talked about the complexity of the system,” Burkhammer said.

In fact, the workgroup found that the people who do have access to this confidential information are not performing their duties.

According to West Virginia state code, an MDT (multidisciplinary team) must be established for children in abuse and neglect cases to assess, plan and implement a system of services for those children and their families.

Burkhammer said the workgroup found MDT meetings are underutilized and lacking participation in West Virginia’s system.

“I think we all recognize sometimes we can put some really good law and really good code and really good policy on paper, but we have to make sure that’s being implemented in the field,” Burkhammer said.

The workgroup recommends the system require the MDT-appointed professionals to attend and participate in (MDT) meetings to set up a plan forward through the child’s case.

“I think one thing that would really help there is potentially adding a mediator to the MDT meetings, there’s really no leadership in the meeting, depending on who shows up and doesn’t show up,” Burkhammer said. “So a lot of times, the loudest voice in a room rules the day.”

The workgroup also found varying implementation dates for different programs, which Burkhammer thinks can be attributed to a lack of experienced workers and workers not receiving updated policies throughout their training.

The workgroup also found communication system failures among CPS workers, advocates and court officials.

“When we’re talking about this complex web of individuals all trying to work together, there’s no joint communication,” Burkhammer said. “So we do everything from text, email, phone call, trying to get information together, and simply there’s just a breakdown of communication when you start trying to piece everyone together.”

Burkhammer highlighted the passage of House Bill 4975 during the 2024 regular legislative session as a step in the right direction to resolve communication issues throughout the foster care system.

“We’ve got to continue to make sure that is rolled out and implemented properly, and then I believe in its initial success, we can then expand it into all of the stakeholders that I mentioned that have the ability to communicate together and utilize technology to our advantage,” Burkhammer said.

He told the committee that the workgroup also recommends increased intergovernmental cooperation.

“We have to build a coalition together and realize we all play a vital part in this, in solving this,” Burkhammer said. “And so building that cooperation between us, the sharing of information, the sharing of data, and working together, is essential to that.”

Pinson said he has learned about the foster care system through this investigation and in real life. He said that in his experience, there was a total lack of communication and resources for children and families

“My family, my wife and I, we’ve taken in foster children, and most generally, they show up with maybe a change of clothes or two, and so now you’re trying to think about, okay, how do I provide clothing for them,” Pinson said. “How do I provide a car seat for them, a bed for them, a crib for them, all of these things that they’re needed and they’re needed immediately, also while you’re trying to get them enrolled in school and make sure that you’re working out all the new transitional decisions.”

According to Pinson, a foster child is supposed to arrive at their custody placement with a $375 voucher from the state to help get the child settled in a new home. But, he testified the workgroup found complications with foster families reliably receiving a voucher and children losing purchased clothing and items while being moved from placement to placement.

“We can set forth requirements that children who are in state custody, that as these items are being purchased with state money, voucher money that they’re being inventoried and kept with the child,” Pinson said. “These items should belong to the children.”

Pinson also testified that often the vouchers are only redeemable at the chain retail store, Gabe’s, which doesn’t always stock all the necessities of caring for a child.

“If you’ve been to one (Gabe’s), you probably realize that there’s not car seats available,” Pinson said. “Very rarely we find beds and cribs and these things, so limited supply there.”

The workgroup also found an overall lack of resources like drug rehabilitation therapy counseling, Individualized Education Programs (IEPs), transportation and visitation services.

“There’s just certain areas that are doing certain things really well, and other areas not doing some things really well, which creates kind of that resource service gap for really all families, whether it’s biological kinship or or foster families in there,” Burkhammer said.

The Workgroup’s Proposed Solutions

While the workgroup found many problems throughout the Foster Care System, Delegates Burkhammer, Pinson and Deeds presented their proposed solutions.

To address foster children’s clothing and necessities, the workgroup presented draft legislation that would solidify the voucher program and implement an inventory process so children can keep what belongs to them, even if their placement is changed.

To address staff shortages, the workgroup recommends increasing pay. Burkhammer said lawmakers need to prioritize increasing reimbursement for Child Protective Services (CPS).

“High caseload leads to poor quality,” Burkhammer said. “I think we can prioritize that through increased pay.”

Burkhammer said compensating providers and families needs to be prioritized as well.

“Those that are on the front lines need to be paid for the services they’re providing,” Burkhammer said.

According to a state foster care policy from May 2022, the monthly boarding care payments for foster children range from $790 to $942, depending on the age of the child.

The workgroup recommends improving the use and leverage of federal funds.

“We found some gaps in where we were not utilizing federal funding, maybe to its maximum potential,” Burkhammer said. “And so that’s not needing state money. That just needs some policy rewrote and some approval from the feds.”

Burkhammer said the foster care system needs to utilize data better to prioritize needs and determine what is and is not working.

“A lot of times we’re just kind of throwing stuff out there,” Burkhammer said. “Let’s get a priority. And I think that’s going to come when we can see what is being effective and what isn’t.”

Burkhammer told the committee the system needs to improve access to preventative services and treatment resources to prevent children from being removed from their biological families in the first place.

“Pregnant mothers that are struggling with substance abuse need access to rehabilitation that lacks throughout the state,” Burkhammer said. “So we have between 15 and 20 percent on average, our babies in West Virginia are being born drug affected with drugs in their system.”

Burkhammer explained that by providing pregnant mothers with recovery resources before they give birth, there will be less of a chance the baby will be born dependent on substances and taken from the mother’s custody at birth.

During questioning, Del. Mike Pushkin, D-Kanawha, asked Burkhammer to clarify the number and extent of infants born affected by substances in West Virginia. Burkhammer answered that 15 percent of all infants born in the state have some exposure to a drug.

“Some would be considered NAS (neonatal abstinence syndrome) addicted, others may just be exposed to the drug,” Burkhammer said. “So when you talk about NAS, that would require they have a dependence on it, and it requires a methadone type treatment to bring them off of that while some it may not be, it may be in their system, but not to the point of dependency.”

Burkhammer added that the experts he has spoken with have told him they believe the number of infants born exposed to drugs is much higher.

Pushkin expressed his support for the bill, saying he hoped it would pass both chambers unanimously.

“Unless we really address preventative services, we’re going to keep beating our heads against the wall,” Pushkin said. “We need to fix it on this end as much as we can for the kids that are in the system now.

Pushkin said that one of the root causes of the crisis needs to be addressed as well.

“We’re going to keep getting more and more kids in the system if we don’t address the 15 percent of children born somehow affected by the drug epidemic,” Pushkin said.

On the topic of mothers struggling with SUD, Burkhammer said lawmakers need to consider adding a “long acting reversible contraceptive” program to the rehabilitation process. He did not elaborate and no lawmakers asked about that proposal.

Next, Burkhammer said the state needs to make transitional living programs available to the 30.86 percent of the state’s foster children who are 13 to 17 years old. He said many of those children lack a sense of permanency from their time in state custody, turn 18 and age out of the system with no place to go.

“There’s some really good programs out there with transitional living that we need to expand to make sure we’re grasping them kids because if we don’t expand transitional living, we will expand our jails,” Burkhammer said. “It’s a given that there’s a higher potential for those kids aging out of the system to end up incarcerated if we don’t give them those resources as they’re leaving our system.”

West Virginia leads the nation in rates of kinship placement, an arrangement where a child is removed from a parent or guardian and placed with another relative or someone familiar to them.

“We place them with somebody that knows them and tries to create some sense of stability throughout that traumatic event, but those kinship family resources don’t flow through the child placing agencies the same for a foster family,” Burkhammer said.

He recommended outsourcing resources for foster families, possibly duplicating the models used by child-placing agencies serving kinship families.

Burkhammer said West Virginia needs to improve its Adoption Family Resources.

“When you adopt a child, you go to court, everyone gets their picture taken (and) a lot of your services through that you were getting through that child placing agency end,” Burkhammer said. “It’s now that family’s responsibility, and so we need to continue to provide services through adoption and beyond to do that.”

Burkhammer told the committee he knows a lot of people want to help fix West Virginia’s foster care system, but many do not know where to start. He thinks the state can start by building volunteer coalitions in their local communities, dedicated to providing resources to families.

“Being a foster parent, a kinship parent, is difficult, and we’ve got to build resources around these families in their communities, with community folks,” Burkhammer said. “This isn’t asking the government to provide anything. It’s simply saying building these volunteer coalitions in our communities.”

During questioning, Del. George Miller, R-Morgan, asked how the workgroup plans to get communities involved and volunteering. Burkhammer answered that he believes churches and faith communities are the resource to look to, mentioning Chestnut Mountain Village by name.

“There are folks out there that that want to want to build beds, folks that want to provide meals, folks that want to provide clothing, and start clothing closets and offering all of those volunteer services,” Burkhammer said. “I believe they are out there. I believe West Virginians are charitable people. They just need some direction and in some leadership in it.”

Transparency And Accountability Draft Legislation

Sen. Vince Deeds, R-Greenbrier, opened his testimony by telling the committee that every one the workgroup talked to wants the best for the state’s children.

“I can report to you beyond a shadow of a doubt that everyone that we have spoken to, and this includes all, whether it’s the law enforcement, community, education, health care, Department of Human Services, everyone wants the best for our children,” Deeds said.

The draft legislation Deeds presented addresses child welfare transparency by setting up abuse and neglect reporting procedures that allow for reports to be made by email, fax, or an in-person printed form. He said this could supplement the 24/7 Centralized Intake Hotline currently used by the Department of Human Services.

Furthermore, the legislation would require that the person reporting suspected abuse or neglect receive an identifier number to track their report through the system. These other forms of reporting would be required to be treated the same as those that arrive through Centralized Intake.

Deeds said there would be no fiscal note for the new Centralized Intake supplemental program.

“So also, as you know, of course, there’s no cost on this as far as that goes, because, of course, it’d be part of their normal workload, and they can also the critical incident review team, can also, if they have the need, they can ask for outside experts for guidance,” Deeds said.

Deeds then discussed the screening out of reports by mandatory reporters, certain professionals that are legally required to report suspected abuse and neglect. The new draft legislation does not allow for any mandated reporter’s report to be screened out.

“I know, in my area, we have a lot of educators that file a lot of reports and they should, because they spend, they’re the one loving, caring adult that this child may see,” Deeds said. “They have an opportunity to see how this child is doing, and they would be a credible source of information, so need to be investigated by filing these mandatory reports.”

The workgroup also found that audio files from calls to Centralized Intake are not stored or cataloged They recommended keeping them on file for a year.

“That way, you can go back and review,” Deeds said. “If a person said, ‘Well, I called in and reported this.’ Well, what’s the identifier number? ‘I don’t have the identifier number.’ Well, you can go back and check the audio files and see if there actually was a file reported. And so it’d be really helpful to track that as well.”

Deeds said the same transparency bill would allow the foster care ombudsman broader authority to review certain information in abuse and neglect cases.

The Ombudsman reports information to the public and the legislature.

The transparency draft legislation would also require timely submission of a fatality or near fatality case to be reported to a new data dashboard.

Currently in West Virginia, the Critical Incident Review Team reviews fatalities or near fatalities of children known to the child welfare system in the last 12 months. The team meets quarterly to examine each case practice, policy and training needed to make program improvements.

The review is meant to identify areas that, if improved upon, may have prevented the death or severe injury of a child. They release a critical incident report annually.

In 2023, the team reported 16 fatalities of children known to the child welfare system, five of which are attributed to abuse and/or neglect.

“If there’s an incident that happens in our areas, you know, we have a lot of public outcry for it, and there’s a lot of misinformation that comes from that because of the delay in time,” Deeds said.

The draft legislation aims to resolve incidents where miscommunications may have cost a child’s life.

Earlier this year 14-year-old Kyneddi Miller was found dead, her grandparents and mother were later charged with felony neglect and abuse. There were conflicting reports about the actions of state agencies involved in the case and calls for accountability.

Police officers claimed they saw the now deceased Miller nearly a year before her death. They said they were concerned about the girl’s well being, so they went to Boone County’s Child Protective Services (CPS) office to file a referral. However, CPS, which is a division of the Department of Human Services, said they have no record of that.

GPS data, police reports, and audio obtained from the police officer who visited Kyneddi in 2023, all corroborate the police officer’s claim that they went to CPS to make a referral after completing a welfare check on the child.

During a June press conference on the incident, Brian Abraham, Gov. Jim Justice’s chief of staff, said he interviewed the police officers and came to the conclusion that they did visit CPS, but that the officers may have not followed the proper protocol; the officer failed to call the 1-800 number the department had provided him to report the abuse and neglect.

Miller’s mother and grandparents were indicted on charges of murder of a child by parent, guardian or custodian by failure or refusal to supply necessities, and child neglect resulting in death on Sept. 17, 2024.

Deeds said the child’s initials, sex, age, ethnicity, county of residence and the date of the incident would be listed on the new dashboard under the purview of the Office of the Inspector General.

“We don’t want to take away from the criminal investigation or the civil investigation, but we just want to be able to list, yeah, there this happened in this area, and there will be a follow-up with the critical incident review team,” Deeds said.

Deeds said the workgroup found shortcomings in the Critical Incident Review Team, so they included an expansion of the team in their draft legislation.

“It would establish a team with requirements to review fatalities and near fatalities in the child welfare system and make recommendations for prevention and intervention,” Deeds said.

In the draft legislation, the new configuration of the critical incident review team would include a mixture of personnel from the Department of Human Services, the judicial system, law enforcement, a Senator appointed by the President of the Senate and a Delegate appointed by the Speaker of the House.

“They are there as monitors to see the information come in, and it is completely confidential,” Deeds said. “You know, there’s no FOIA requests, and it’s written very clearly in the bill that everything is, to be examined and not open to FOIA requests as well.”

Deeds said the hope is that the expanded critical incident review team will be able to identify patterns of abuse and neglect, but they would have no voting power.

Medical Information Draft Legislation

Burkhammer presented the workgroup’s second draft bill, which aims to ease foster and kinship parent’s access to the medical records of the children in their custody. This bill would expand on the 2024 regular session’s House Bill 4320, which passed both chambers, but stalled out on March 8 before completing legislation.

“We need to know if kids are taking medication, what that medication is, how often, what doctor they’ve been seeing,” Burkhammer said. “So oftentimes kids come into your care, you’re essentially starting back over.”

The legislation would also allow managed care providers and child placement agencies access to the child’s medical records.

“We want to allow our MCOs, our managed care provider, and our CPAs, our child placing agencies, to have access to that information, still in a confidential manner, but allows for proper care as children move throughout the system there,” Burkhammer said.

During questioning, Del. George Miller, R-Morgan, asked if there was a need to change the states interpretation of a federal privacy law, the health insurance portability and accountability act of 1996 or HIPAA, laws would need to be changed to accommodate the draft legislation.

“West Virginia is kind of using the extreme side of the HIPAA law and not allowing parents in as well, not allowing their MCO and their CPAs to see that so we can stay within the bounds of federal HIPAA and still allow some flexibility in that,” Burkhammer answered.

Lawmakers will be able to consider those draft bills during the regular session in the spring.

Watchdog Agency Announces Plan To Sue State Secretary Of Health Facilities

The agency federally mandated to protect and advocate for those with disabilities in West Virginia has announced plans to take the Secretary of the Department of Health Facilities to court.

Updated on Friday, Oct. 11, 2024 at 12 p.m.

Disability Rights of West Virginia (DRWV) sent a notice of claim Monday to members of the media and state officials, alleging that Michael Caruso, secretary of the Department of Health Facilities (DHF) is failing to protect the rights of patients served by state health care facilities. It outlined particular concerns at William R. Sharpe, Jr. Hospital and Mildred Mitchell-Bateman Hospitals, the state’s two psychiatric facilities.

Michael Folio, the legal director of DRWV, alleged that the quality of care at these facilities is suffering because mandatory reporters are not sufficiently reporting instances of suspected abuse. Under state law, a mandatory reporter is a person legally required to report suspected abuse or neglect of vulnerable populations, including children, the elderly and people with disabilities.

“They’re vetting or clearing these suspected violations with their bosses and supervisors and administrators before they’re filing,” Folio said. “What we’re seeing is an alarming number of cases where leadership is instructing them not to file.”

Folio said mandatory reporters who do not report suspected violations independently violate state law.

“They don’t need, nor should they consult their supervisor to get approval to do that, because they already have an independent duty to do it,” he said. “If they fail to report it, they actually can be guilty of a misdemeanor.”

Folio said staffing issues at health care facilities can disincentivize reports of suspected abuse, which can result in the suspension or termination of providers.

“It goes back to staffing, it goes back to training, it goes back to oversight, leadership,” Folio said. “This is why I think we’ve just pretty much decided as a protection advocacy agency, that enough is enough.”

DRWV will file to seek an Action for Declaratory and Injunctive Relief from the court.

“The declaratory relief is a declaratory judgment action. What that means is we are asking the court to declare this is what the legal obligations are, and then we would show that Sharpe and Bateman, to a lesser degree, are failing to comply with those legal obligations,” Folio said. “So that’s the declaratory part of it. The injunctive part is asking the court to enjoin or stop them from continuing to violate these policies, these provisions, these regulations.”

In an email response, Annie Moore, director of communications for the Office of Shared Administration, which oversees the Departments of Health, Human Services and Health Facilities, said DHF cannot comment on pending litigation and said that DHF takes any allegations of patient abuse very seriously.

“It is notable that the individual filing this suit has a history of making concerning allegations regarding the state hospitals that ultimately have proven to be baseless or mischaracterizations,” Moore said in an email. “Nonetheless, we are committed to investigating all potential claims of abuse or neglect thoroughly. The facilities routinely report allegations of abuse and neglect to Adult Protective Services (APS) and encourage staff to report any suspected incidents to APS for review. The facilities have policies and procedures regarding the reporting of potential abuse and neglect. Rather than threaten litigation, it would be more beneficial if specific allegations were brought to the facilities’ attention so that they might be addressed. Patients’ safety and well-being remains our top priority.”

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Marshall Health.

**Editor’s Note: This story was updated on Oct. 11, 2024 at 12 p.m. to include a response from the Department of Health Facilities.

Mother, Grandparents Indicted For Murder In Death Of Kyneddi Miller

On Tuesday, the grand jury indicted them on charges of murder of a child by parent, guardian or custodian by failure or refusal to supply necessities, and child neglect resulting in death, Boone County Prosecutor Dan Holstein said.

CHARLESTON, W.Va. (AP) — A grand jury on Tuesday returned an indictment on a murder charge against the mother and two grandparents of a 14-year-old West Virginia girl whose emaciated body was found in her home.

The body of Kyneddi Miller was found in April in the Boone County community of Morrisvale. Her case prompted a state investigation into whether law enforcement and child protective services could have intervened to prevent her death.

Deputies responding to a report of a death at the home found the girl in a bathroom and said her body was “emaciated to a skeletal state,” according to a criminal complaint filed in Boone County Magistrate Court.

The complaint said the teen had an eating disorder that led to “overwhelmingly visible conditions” and physical problems, but the mother had not sought medical care for her in at least four years. Miller was being homeschooled at the time.

Felony child neglect charges initially were filed against the girl’s mother, Julie Miller, and grandparents Donna and Jerry Stone.

An arraignment hearing has been scheduled for Oct. 18. It wasn’t immediately clear whether the three defendants had attorneys. Holstein said a copy of the indictment wouldn’t be made available to the public until Wednesday.

Brian Abraham, Gov. Jim Justice’s chief of staff, has said state police were summoned to check on the girl at her home in March 2023 but found no indication that she had been abused. A trooper then made an informal suggestion to the local human services office that she might have needed mental health resources.

But no follow-up checks were made, according to Abraham. The trooper indicated that Miller had appeared healthy to him but she said anxiety about being around people due to COVID-19 caused her not to want to leave her home.

Expert: W.Va.’s Drug Epidemic Is Holding Back Its Economy And Hurting Its Children

A senior policy advisor to the Legislature presented a sobering picture of West Virginia’s drug epidemic on Monday.

Despite the state’s billion dollar response, West Virginia has led the nation in overdose death rates since 2010, according to a senior policy advisor to the legislature.

Jeremiah Samples, former deputy secretary at the now reorganized Department of Health and Human Resources (DHHR) and current senior policy advisor to the Legislature, presented an analysis of the state’s substance use disorder (SUD) crisis to the Joint Committee on Health on Monday.

“The bottom line is that we have not made enough progress on this crisis,” Samples said. “We’re nowhere near where we need to be, and our data relative to other states, and even our own expectations, has fallen far short. We need to reassess all of our SUD strategies and expenditures through the prism of what is impacting real people in our society.”

A survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that 208,000 people in West Virginia used illicit drugs in the last month.

“That’s an average,” Samples said of the number. “It’s a gut-wrenching number to hear, but that’s where we stand.”

Samples also cited a West Virginia University Match Survey that found 359,880 West Virginians used drugs in the past year.

“We can’t sustain that as a society,” Samples said. “That is, it’s crippling to the state.”

In 2010, West Virginia’s fatal overdose death rate per 100,000 people was 28.2. Even after the state spent millions combating the problem, in 2022, West Virginia’s fatal overdose death rate had grown to 80.9 per 100,000 people.

“Our overdose death rate since 2010 has increased by 135 percent,” Samples told the committee. “West Virginia’s overdose death rate is 151 percent higher than the best state in the country, 85.6 percent higher than the national average and 36.4 percent higher than the next worst state (Tennessee).”

Samples cautioned against taking overdose death reports out of context.

“Any downturn is positive,” Samples said. “Those are real lives that people, that are not dying. However, the trend, we’ve had a couple blips where we’ve gone down in the past, but the trends are really what matter, and from a trend perspective, we have increased exponentially since we started leading the nation in overdose deaths.”

According to CDC data, the nation saw a 6.7 percent decrease in overdoses from January 2023 to January 2024. During that same period, West Virginia saw a 1.92 percent increase in overdoses.

“West Virginia is not keeping pace with the decrease in other states,” Samples said. “Before the pandemic, we were at a plateau of sorts. The pandemic hits and fentanyl issues become exponentially worse. Overdose death rates across the country explode. They increased in West Virginia, more so than most states. I think we were perhaps third, we saw the third biggest increase during the pandemic. But the bottom line is, we’re not decreasing at the same rate as some of these other states. So we’re not coming back down to that plateau. We need to get to that plateau and then continue to go down.”

The Current System

Samples explained that West Virginia’s state government response involves “over a dozen agencies,” led by the Governor’s Council on Substance Abuse, founded in 2018, and the Office of Drug Control Policy (ODCP), founded in 2017.

One of those agencies is the Bureau for Behavioral Health (BBH), the designated state mental health authority recognized by the federal government as the single state agency for substance abuse services.

The bureau receives federal block grant funding for substance abuse and prevention. It is responsible for SUD provider infrastructure and manages the state’s Crisis and Referral Line, 1-844-HELP4WV, contract.

“They (BBH) apply for these big federal grants,” Samples said. “They’re responsible for the infrastructure of the state for SUD and their annual budget is roughly $225 million.”

Samples said from 2017 to 2020, BBH was forced to send $34.2 million back to the federal government for funds that were not used from those grants.

“This came up in LOCHHRA (Legislative Oversight Commission on Health and Human Resources Accountability) last year,” Samples said. “We’re unclear from 2021 forward, how much money has been sent back, but it is something that the legislature and the state should explore and investigate.”

In 2023, legislation was passed directing the ODCP to report to the governor’s office. In the DHHR reorganization, the ODCP was placed administratively within the Department of Human Services.

Samples said it is hard to track SUD spending in West Virginia, but the state fiscal year 2025 budget for the ODCP is $2.3 million.

“You can directly attribute hundreds of millions again, in direct expenditures on SUD, just in West Virginia, annually,” Samples said. “And then there’s hundreds of millions more we know that we’re spending that are indirect, for example, child protective services, the child welfare crisis, there are hundreds of millions in indirect costs in just child welfare alone.”

A 2021 study that includes the economic impacts of the crisis by the West Virginia Center on Budget and Policy estimated that the drug crisis costs West Virginia $11.3 billion a year.

Samples also cited a Center for Disease Control and Prevention (CDC) report that found West Virginia experienced 1,335 known overdose deaths in 2022.

“Despite all the investment and expenditure, since 1999 we’ve seen a 1,680 percent increase in our overdose death rate,” Samples said. “Since 2010 which, again, 2010 is when we started leading the nation, [we’ve seen] a 135 percent increase. Since 2017, [we’ve seen] a 56 percent increase. So we have not been getting results. We’ve not been reversing the trend.”

According to Samples, Medicaid is the largest source of treatment funding for SUD in the state, serving approximately 50,000 members with an SUD diagnosis annually.

Medicaid is expected to spend about $140 million on SUD medical and behavioral health claims in West Virginia in 2025. In addition, Medicaid spends approximately $70 million on medication-assisted treatment (MAT) drugs.

“Medicaid’s annual expenditure, when you include MAT and the services, the claims are about $210 million,” Samples said. “Fatal overdoses have increased amongst the Medicaid population from 2018 to 2020, and so we’ve not seen appropriate progress there either.”

West Virginia Medicaid’s Substance Use Disorder Waiver

Since the launch of West Virginia’s Medicaid SUD Waiver, or 1115 Waiver, fatal overdose rates have continued to rise.

West Virginia Medicaid’s biggest SUD expenditure is the 1115 Waiver, which was developed to help increase the availability of SUD prevention and treatment services for Medicaid members.

The waiver was requested by the state and approved in 2017 by the federal government. It allows the state to provide additional services beyond what the federal government requires.

In 2018, the Bureau for Medical Services announced the expansion of services under the SUD Waiver, adding coverage of methadone as a withdrawal management strategy, a Naloxone distribution initiative, coverage of adult residential treatment, peer recovery support systems, withdrawal management services and the use of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) tool to identify SUD treatment needs in the Medicaid community.

The SUD Waiver cost $12.2 million in 2019 and increased to $129.3 million by 2023. The Federal Reserve was responsible for $114 million of the 2023 total. West Virginia paid $15.3 million the same year.

Projected expenditures in 2027 are expected to grow to $161 million, according to Samples.

West Virginia Medicaid has proposed further expansion of the SUD waiver to the federal government. The application is under review with the expiration of the current waiver on September 30, 2024.

Proposed expansions include:

Expanding peer support to more settings
Sending quick response teams to clients who have overdosed or are experiencing a crisis
Providing Medicaid coverage to eligible individuals incarcerated in state prisons starting 30 days before their release
Offering involuntary secure withdrawal management and stabilization for individuals deemed to be a danger to themselves or others
Supporting a holistic and integrated approach to treatment
Education and outreach for Human Immunodeficiency Virus (HIV) and Hepatitis C (HCV) concerning substance use
Addressing social determinants of health to encourage self-reliance and support continued recovery housing offering clinical-level treatment services.
Supported house and supported employment
Offering the TRUST protocol for people with stimulant use disorders
Reimbursing short-term residential and inpatient treatment services in settings that qualify as an institution that treats mental diseases for Medicaid-eligible adults with serious mental illnesses.

West Virginia’s SUD Outcomes

Samples then shared some encouraging outcomes with the committee from this spending.

According to CDC provisional data, there was a decrease of 9.4 percent in overdose deaths nationally from March 2023 to March 2024. In West Virginia, that same data showed a decrease of 4.91 percent during the same time period.

Samples also cited a decrease in new HIV cases from 153 in 2021 to 100 in 2023.

“This was a really big deal a couple of years ago, Kanawha County alone, which was one of the worst hit counties, saw a 66 percent decrease from 2021 to 2023,” he said. “The 2024 data, which is available online, it’s looking really good. It’s actually even more positive than that. So kudos to everyone that’s worked on that.”

According to a 2022 report from the CDC, 2,400 people were living with HIV in West Virginia.

“Other positives, Medicaid, managed care organizations, providers, recovery homes, they’re starting to make a lot of progress in better measuring our outcomes, better measuring what’s actually happening in the state, so we can pivot and actually make progress on this crisis,” Samples said.

Samples also said he is hopeful about the West Virginia First Foundation, the organization formed by an act of the legislature that is responsible for dispersing West Virginia’s opioid settlement funds.

“The first foundation, this is a new development and something that I think we should have hope for. The foundation stems from efforts by the Attorney General Patrick Morrissey, securing an opioid settlement of approximately $1 billion,” Samples said. “This is the number one per capita opioid settlement in the United States.”

Drugs And Economics

While there are some positive indicators for the future of West Virginia’s drug epidemic, Samples said the state has not had any significant successes but has seen plenty of failure.

“The failures have consequences, the economic impact of the drug crisis,” Samples said. “One study said $8.8 billion a year in impact. Another study said $11.3 billion a year in impact, just on the economy, a 12 percent economic drag on our GDP (Gross Domestic Product), annually.”

Samples said the drug crisis costs West Virginia at least one-eighth of the state’s total economy based on spending on health care, substance use treatment, criminal justice costs, the societal burden of fatal overdoses and lost worker productivity.

The “drag” on West Virginia’s GDP is more than double that of the next highest state, Maryland where substance use disorder-related costs consumed 5.4 percent of its GDP.

Then, Samples addressed West Virginia’s labor workforce participation rate (LFPR), or, the number of people in the labor force (working or looking for work) as a percentage of the total population 16 years and older. West Virginia’s LFPR is at 55.1 percent in July 2024, according to the St. Louis Federal Reserve.

“We’re no longer last, and I don’t say that in jest,” Samples said. “I mean, we were last place in labor force participation rate from 1976 to 2022, so progress is progress, and we are making some progress in that realm, but the drug crisis is holding us back.”

According to Samples, the economic impact of productivity loss for non-fatal substance use disorders has a reported cost of $316 million dollars and 1,206 jobs to the state, while the economic impact of productivity loss due to overdose fatalities carries an additional cost of $322 million and 5,905 jobs.

“When you look at the unemployment rate, which is at 4.2 percent right now, relative to our labor force participation rate, our labor force participation rate has pretty much been level, but our unemployment rate has gone down,” Samples said. “There’s just people not in the job market looking for work, and this is attributable to the drug crisis.”

West Virginia has the highest death rate for working-aged populations and the second lowest life expectancy in the U.S. at 72.8.

“Even going back to 1990 West Virginia has had a lower life expectancy than the national average, but there’s been a gap that’s built, and even as the national life expectancy has gone down, we’ve gone down more,” Samples said.

West Virginia’s Children Pay A Price

According to Samples’ report, 83 percent of child welfare removals were from homes with known drug use.

“West Virginia’s foster care rate grew 61 percent from 2010, to 2021,” Samples said. “It’s 23 percent higher than the next worst state, and 118 percent higher than the national average.”

Data from the Annie E. Casey Foundation shows that West Virginia leads the nation in its foster care entry rate.

“The difference between the entry rate and the foster care rate, entry foster care rate, is just kids in foster care,” Samples said. “The entry rate is kids coming in.”

Samples said West Virginia has led the nation in foster care entry rates since 2010.

“We are 131 percent worse than the national average, and 54.9 percent worse than the next worst state in foster care entry rates, and that’s Alaska,” Samples said.

In 2000, six out of every 1,000 West Virginia children entered foster care. In 2021, 13 out of every 1,000 West Virginia children entered foster care. West Virginia’s entry rate increased 117 percent from 2000 to 2021.

According to the U.S. Department of Health and Human Services Administration for Children and Families Administration on Children, Youth and Families Children’s Bureau, in 2020, West Virginia had the highest percentage of children nationally suffering from substantiated maltreatment with drug abuse by the caregiver.

2020 CDC data also showed West Virginia had the highest rate nationally of infants screened in by Child Protective Services (CPS) with prenatal substance exposure.

Also in 2020, there were 712 babies screened in by CPS in West Virginia with drug exposure, compared to 526 babies screened in California, which has a population of 39.5 million people. West Virginia has a population of 1.7 million people.

“We only have about 17,000 babies born in the state a year,” Samples said. “It’s not a lot. If you extrapolate from our birth score numbers, then you’re looking at and not just the difference between neonatal abstinence syndrome (NAS) and in uterine substance exposure. NAS is worse. The babies basically full-blown addicted, is kind of the simple way to say it. we’re looking at around 2,500 babies every year that are exposed to drugs in the womb.”

The Future

In his final address to the legislature, Samples told lawmakers West Virginia’s drug epidemic response needs to be reevaluated.

“The most important thing we need to do, in my opinion, is we need to measure what matters so that we can then pivot and organically improve our response to this crisis,” Samples said. “We need to measure every aspect of our substance use disorder policies and expenditures, and we need to tie it back to a core societal measure.”

Samples left lawmakers with a list of proposed policy solutions including:

Mandatory Treatment (Casey’s Law)
SUD Transparency Act: SUD Outcome and Expenditure Dashboard
Save Babies from Drugs Act
Improve CPS Management of Cases with Drug Addiction
Measure Outcomes of Recovery Homes
Analysis of syringe exchange outcomes and criminal penalties for illegal needle distribution
Enhanced drug testing and SUD services for those on government benefits
SUD Relocation Supports
Public Reporting on SUD expenditures and program outcomes
Expenditure and Opportunities Audit:
Ending Addiction Amongst Inmate Population
Expand Inmate SUD Services via RSAT and GOALS programs
Develop a ratio of law enforcement needs across communities and increase funding for more officers

“Our economy still struggling, I would propose that really we look at 10 core measures and that we use a smarter approach, which is really just an acronym for specific, measurable, attainable, relevant, time, evaluated and resourced,” Samples said.

Samples said he is “leaving the legislature next month,” but offered no further information after thanking legislative staff and lawmakers.

“It’s been an honor,” Samples said. “The President and the Speaker have been great to me. You all have been great to me. You know you’re wonderful people, and I’ll just always be available to you, should you need anything. I believe in this body, and I believe what you do, and I believe in your hearts.”

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Marshall Health.

Death Of Kyneddi Miller Sparks Policy Conversations Around CPS And Homeschooling

Kyneddi Miller was found dead in her home in April. A police report said the 14-year-old girl was found deceased in what a police report described as a “near skeleton state.” Her grandparents and mother have been charged with abuse and neglect. Now officials are pointing fingers at what organizations and policies created the crack that Miller fell through. There is also a rally planned for Wednesday morning by community members.

Kyneddi Miller was found dead in her home in April. A police report said the 14-year-old girl was found deceased in what a police report described as a “near skeletal state.” Her grandparents and mother have been charged with abuse and neglect.

Now officials are pointing fingers at what organizations and policies created the crack that Miller fell through. There is also a rally planned for Wednesday morning by community members.

There are conflicting reports about the actions of state agencies involved in the case. Police officers claimed they saw the now deceased girl nearly a year before her death. They say they were concerned about her wellbeing so they went to Boone County’s Child Protective Services to file a referral in person.

Officials with CPS, which is a division of the Department of Human Services, say they have no record of that.

But GPS data, police reports, and audio obtained from the police officer who visited Kyneddi in 2023, all corroborate the police officer’s claim that they went to CPS to make a referral.

Brian Abraham, the governor’s chief of staff, said he interviewed the police officers and has come to the conclusion that they did visit CPS, but that the officers may have not followed the proper protocol.

“Based upon that information the troopers relayed to me, with cooperating evidence, I am with 100 percent certainty that they were present that day at the office and made an informal communication with the department,” Abraham said.

(left to right) Chief of Staff Brian Abraham, West Virginia Department of Human Services Secretary Dr. Cynthia Persily, West Virginia State Superintendent of Schools Michele Blatt, and West Virginia State Police Chief of Staff Maj. James Mitchell.

*Courtesy of WV Governor’s Office*

Department of Human Services Secretary Cynthia Persily said the police should have called a 1-800 number to officially make a report, instead of going to CPS and speaking with staff directly.

“So consequently, we won’t get into the situation where we have someone who says that they made a report, or a referral, or whatever we want to call it, of abuse and neglect without that actually happening,” Persily said.

A Call For Home School Reform

Police are mandatory reporters of abuse, meaning if they see abuse they have to report it. So are teachers, but because Miller had been pulled from school, teachers no longer had access to her.

Now many lawmakers, agency heads, and the governor are calling for changes to home school laws in the state.

They say public school classrooms are often where child abuse is discovered and have attributed Miller’s homeschooling status a factor in her death.

The pre pandemic national rate for home schooling is around 3 percent. A study in the Journal of Adolescent trauma notes that children are homeschooled in nearly half of all child abuse cases.

West Virginia State Superintendent of Schools Michele Blatt said she would like to strengthen homeschool requirements.

“The West Virginia Department of Education is eager to work with the legislature to really see how we can strengthen the guardrails around our homeschool reporting requirements,” Blatt said. “While we know that we have a great deal of homeschool parents that do things the right way and take care of their kids and it’s the best choice for those families, I think that our 7,000 foster kids in the system is proof that not all parents do what’s best for their children.”

The House passed Raylee’s law after hours of debate. It was never taken up by the Senate.

*Perry Bennett/West Virginia Legislature Photography*

Delegate Shawn Fluharty has been a proponent of homeschool policy reform ever since he received a call about a young girl in his district, Raylee Browning in 2018.

“I was contacted by her former teacher Carrie Caliberty years ago, about the situation with Raylee who was taken from a public school while a CPS report was being investigated by her abusive father,” Fluharty said. “And months later, Raylee was found dead in the home.”

He said Kyneddi Miller’s story is eerily similar. Fluharty wants to change the oversight laws for homeschooling in the state.

“We’re just saying this process of removing a child needs to be vetted properly,” Fluharty said. “And if there’s a mere hindrance, on the time period of removing a child from public school, to homeschool, so that we know that child is safe, then too damn bad!”

School Choice Advocates Push Back

On the other side of the debate, Advocates of school choice are saying that home schooling has become a scapegoat for other systemic failures.

Sen. Patricia Rucker, a Republican from Jefferson County, is a staunch advocate for home schooling and the chair of the newly created School Choice Committee in the State Senate. She said there were missed opportunities to intervene in the child’s life before she died.

“It is really interesting to me that this entire story is focusing on the fact that they put in a Notice of Intent (for homeschooling),” Rucker said. “Even though this is a family that had not been in a public school for over two years, and had already broken the law and already should have thrown red flags before they ever even put in their application.”

Sen. Patricia Rucker, R-Jefferson, is a home schoolteacher to her five children.

*Will Price/WV Legislative Photography*

Prior to homeschooling Miller was truant for an extended period. Then after two years of homeschooling her mother had failed to complete the required academic assessment. And the school failed to take action.

There are existing laws that require the school to follow up on a student who has failed to complete an academic assessment. However, those laws lack mandatory enforcement mechanisms.

Change Needed

Rucker said that there are multiple other factors that contributed to the girl’s death, including an overloaded and under-funded CPS system.

“There were clearly many, many ways in which folks dropped the ball. Home schooling was not the way that we might have been able to save this young girl,” Rucker said.

Multiple bills that would address CPS, absenteeism in schools, and child welfare in the state were introduced to the floor. None of those bills made it across the finish line in April.

“It’s very concerning to me that no one in current leadership is taking any responsibility for any of the things that have happened, or failed to happen,” Rucker said. “If we’re gonna have a system that the people of West Virginia are going to have faith in, it means that if things go wrong that someone needs to tell them what went wrong, and take responsibility, and say how they’re going to change it.”

Brian Abraham, the governor’s chief of staff, said it’s going to be up to policy makers to craft laws that balance protecting vulnerable children while also protecting West Virginians’ right to home school their children.

“The governor wholeheartedly supports school choice and the parents’ right to choose homeschool,” Abraham said. “But, you know, we can see it has potential ramifications. It’s a trade off. We have to find the sweet spot.”

On Wednesday, June 19 at 9 a.m. at the Boone County Courthouse there is a rally for accountability and action. The rally was planned by the group “Parents Against Child Abuse.”

Child Welfare Removal: A Difficult Process For Children

Even in ideal circumstances, the removal of a child from their home by Child Protective Services is always traumatic. Emily Rice spoke with community advocates about that process and what resources children need to adapt.

Even in ideal circumstances, the removal of a child from their home by Child Protective Services (CPS) is always traumatic.

There is no easy way to take a child away from the only home they have ever known, according to Kelli Caseman, executive director and founding member of Think Kids West Virginia, a children’s advocacy group.

“Even if they’re living in a home where they’re abused or neglected, they still, you know, usually love mom and dad very much,” Caseman said.

The number of children in foster care in West Virginia increased by 57 percent between 2012 and 2021, according to the West Virginia Center on Budget and Policy. Most experts in the field attribute the influx to the ongoing opioid epidemic in the region.

Shanna Gray is the state director of West Virginia Court Appointed Special Advocates, or CASA, and a foster parent. She said the reason for removal will dictate how and what the process looks like for the child and family separation, and the process will differ from state to state.

For example, a family working with CPS to improve their circumstances would have a safety plan in place, making the transition less jarring for the child if they were removed.

“Maybe the child isn’t fully separated, parents aren’t losing rights or anything, but the child goes and stays with grandma for a week, a seven day period to say, ‘Hey, Mom and Dad, get this resolved, whatever we have, what we are requiring, we’ll be back in a week to check in and see,” Gray said. “So it might be a temporary separation during that safety plan, the different those different types of safety plans are unique.”

However, in cases where children are determined to be in “immediate danger,” separation is far more abrupt.

“It’s very difficult,” Gray said. “It’s tough. Sometimes kids in these situations, obviously [it is] age dependent, they don’t have a scope of what they have been or have been experiencing is always they don’t always know that what they’re experiencing is not the same as what other people experience.”

While Gray is familiar with the removal process, CASA does not get involved until the case goes to court.

“We’re the child advocate from a community lens,” Gray said. “So when there’s a child abuse and neglect proceeding before the circuit court, the family and child have a CPS worker, of course, and that’s the social services side. They have a guardian ad litem who is appointed to them and that’s the attorney and the lawyer side. The parent also has either a public defender or a parent’s respondent attorney. And then in areas where CASA is available, the judge may appoint a community advocate or a CASA volunteer.”

The CASA volunteer is meant to be independent and objective, according to Gray. They conduct an investigation and compile recommendations for the judge to disseminate to all parties in the case.

In the past, out-of-state placements isolated the children and impeded their progress according to Caseman.

“Often, when a child isn’t getting that love and attention at home, they look for it at school, and often get it there,” Caseman said. “And so not only do these kids lose the home, the only home they may have ever known, but then they lose those community supports that often teach them resilience and support.”

Both Caseman and Gray advocate for community support to help children in the custody of an overburdened system.

“But what we’re not doing is really working collaboratively to ensure that people know where their services are, where they can be referred to, and then identify the gaps where there are no services,” Caseman said. “And we do know that there are definitely places in the state where there are just no services at all.”

Gray said CASA’s work is defined by the guiding principle that children grow and develop best with their family of origin when that can be safely achieved.

She cited a study from the University College London and King’s College London that found when a child grows up in foster care, that child has an 80 percent higher chance of developing a long-term terminal illness.

“Young people really internalize about being in foster care, ‘What did I do? How did I come into foster care, why this happened to me, was it my fault?’ And so all of those mental impacts have very real long term mental, emotional, social and physical outcomes,” Gray said.

According to West Virginia’s Child Welfare Dashboard, of West Virginia’s more than 6,000 foster children, 38 percent were placed in certified kinship or a relative’s home. Twenty-seven percent are receiving therapeutic foster care at stabilization and treatment homes.

If you suspect or know that a child is being abused or neglected, call the Centralized Intake for Abuse and Neglect at 1-800-352-6513.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Marshall Health.