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Our Vision for Maine: Every child has the opportunity to
be a child and the education, resources, and support to become a healthy and
productive adult. Maine now enjoys
the fourth highest rate of children with health insurance in the United States,
including both private health insurance and government-provided health insurance;
12,603 children were enrolled in the newly expanded Medicaid and child health
insurance program called Cub Care as of March 2002. Our efforts have increased
the overall rate of people (both children and adults) with health insurance
in Maine, which is the opposite of national trends. With 183,000 children
and adults receiving Medicaid or Cub Care, these are the highest numbers of
people receiving state health insurance in the history of Maine. A waiver has been submitted to allow the State
to provide health care coverage for "non-categorical" adults. Assuming
the waiver is approved by the federal government, the program would begin
within the next year. Enroll qualified adults and children in the
newly renamed MaineCare (formerly Medicaid and Cub Care) program. Outreach
efforts continue, as Maine places a high priority on assuring that as high
a percentage of eligible persons as possible are actually enrolled in MaineCare.
The Partnership
For A Tobacco-Free Maine (PTM) is the primary program responsible for tobacco
prevention and control throughout the state of Maine. The PTM was originally
developed as a result of the tobacco excise tax legislation passed in 1997.
In November 1998, Maine along with 45 other states across the country sued
the tobacco industry for the recovery of the states’ Medicaid health care
costs attributed to tobacco use. As a result of the Master Settlement Agreement
the industry committed to paying the states approximately $206 billion over
the next 25 years. Of the $206 billion over the 25 years, it is estimated
that Maine will receive $50 million per year. Through the Fund
for a Healthy Maine, the 119th Maine State Legislature dedicated
all of the state tobacco settlement funds to health programs. A substantial
portion of those funds has been allocated specifically to the PTM to create
programs that work to reduce tobacco use and tobacco-related chronic diseases.
Two programs in the Bureau of Health (BOH) are partnering with the PTM to
develop, implement and evaluate selected programs funded by the tobacco settlement.
The two programs are: the Maine Cardiovascular Health Program and the Community
Health Promotion Program. An initiative, Healthy Maine Partnerships, was established
to link these three programs in order to facilitate the coordination and collaboration
of the various related program activities. The PTM, a comprehensive
program, also receives funding from a cooperative agreement with the CDC and
is designed to reflect the CDC’s Best Practices Guidelines for Statewide Tobacco
Prevention and Control Programs. The mission of the PTM is to reduce death
and disability due to tobacco use among Maine citizens by creating an environment
in Maine that is supportive of a tobacco-free life. The statewide program,
which focuses its efforts primarily on population-based strategies to effect
policy and environmental change, has four primary goals: The PTM supports
several programs and activities that help to achieve the above goals. These
include: The Maine Bureau of Health in the Department of Human Services
is a national leader in health promotion and disease prevention. Thanks to sustained efforts to prevent
tobacco use among youth by Partnership For A Tobacco-Free Maine, a comprehensive
tobacco prevention and control program within the Bureau of Health, smoking
among high school students in Maine has dropped 36% since 1997.
Maine is one of the few states that continues to allocate all tobacco
settlement funds to health programs which include early child care, voluntary
home visiting, Medicaid, substance abuse treatment, expanded drug programs
for the elderly and disabled as well as the statewide comprehensive tobacco
prevention program. Partnership
For A Tobacco-Free Maine continued strategies to protect youth from tobacco
use and addiction include:
1)
promoting and tracking Tobacco-Free School Policy initiatives and distribution
of signage to schools that meet PTM criteria
2)
promoting Tobacco-Free Athletes Program for soccer, basketball, baseball and
softball
3)
promoting tobacco-free municipally owned playing fields
4)
providing train the trainer workshops in the Life Skills Training Program
for middle school health teachers
5)
supporting local Youth Advocacy Programs that work on strategies that support
tobacco-free living
6)
promoting "No Buts", a responsible retailing outreach and training
program
7)
supporting the statewide media messages that "tobacco is an addictive
drug, the tobacco industry is deceptive and manipulative and secondhand smoke
is a health hazard."
1)
Youth addiction and access to tobacco products through social sources
2)
Countering tobacco industry messages that glamorize and normalize tobacco
use targeting young adults Maine has several efforts currently underway
to prevent children from abusing substances or to treat those who do:
1)
The State Incentive Program: Maine has recently been awarded $3 million
each year for the next three years, plus an additional $20,000 for training
in Year 1, to work comprehensively to reduce binge drinking by 10% and tobacco
use by 15% by achieving the following goals:
a)
Coordination of Funding: to develop and implement a sound strategy to identify,
coordinate, leverage, and/or redirect, as appropriate and legally permissible,
all substance abuse prevention resources (funding streams and programs) within
the State that are directed at communities, families, youth (age 12-17), schools
and workplaces.
b)
c)
Development of an Evaluation Tool: to measure progress in reducing substance
use by establishing targets for measures included in the National Household
Survey on Drug Abuse. Eighty-five percent, or $2,555,000, of the
State Incentive Program grant will be awarded to “sub recipients” The remaining
fifteen percent will be used for a project evaluation, staffing for the program,
materials, and administrative costs.
2)
The Maine Safe and Drug-Free Schools: The Data Collection Project is
a partnership between Maine’s Office of Substance Abuse (OSA) in the Department
of Behavioral and Developmental Services (BDS), the Maine Department of Education
(DOE), and the Research Triangle Institute (RTI). The purpose of the Safe
and Drug Free Schools and Communities Act of 1994 (SDFSCA), also known as
Title IV of the Improving America’s Schools Act (IASA), is to prevent violence
in and around schools and to strengthen programs that prevent the illegal
use of alcohol, tobacco and other drugs by enhancing the State’s capacity
to gather data on alcohol, tobacco, and other drug (ATOD) and violence prevention
programs. This law requires parental involvement and coordination with related
federal, State, and local efforts and resources; and it makes federal assistance
available to states, local educational agencies, public and private nonprofit
organizations, and institutions of higher education for selected programs,
services, and activities.
3)
"Youth Voices” on Maine Public Broadcasting System (PBS) : Maine
PBS worked with four Maine Youth Voices groups two years ago, guiding them
through the design and production of their own public service announcements
(PSAs). At the same time, a Maine PBS producer and crew created a documentary
that followed the efforts of these four groups, culminating in the completion
of their PSAs. This collaboration continued with a second production in the
2000-01 school year when Maine PBS worked with a second set of four Maine
Youth Voices groups, each of whom created its own 5-7 minute mini-documentary
or dramatic production analyzing some facet of the underage drinking issue
in their respective communities. In the 2001-02 school year, this collaboration
continues for a third year, with another production planned for broadcast
in the spring of 2002.
4)
Substance Abuse Treatment in Juvenile Correctional Facilities: , Juveniles
residing in the Long Creek Juvenile Development Center (formerly the Maine
Youth Center) and the Mountain View Youth Development Center (formerly the
Northern Maine Youth Detention Center) now receive more comprehensive substance
abuse services and treatment.
5)
Adolescent Drug Courts: Adolescent drug courts began operating in February
2000 through the cooperative effort of the Office of Substance Abuse (in BDS),
the Juvenile Division of the Department of Corrections (DOC), and the Judiciary.
Drug treatment court programs are offered in the Biddeford, Portland, Lewiston,
Augusta, West Bath, and Bangor district courts. Evaluation reports show an
improvement in abstinence from drug use and in increased work and school attendance.
2)
Safe and Drug Free Schools: With a change in federal policy through
the reauthorization of the Safe and Drug Free Schools law, current work will
need to focus on working with local education agencies to continue to use
this funding for alcohol, drug and violence prevention activities, and to
streamline and simplify the reporting process to ensure wide participation
of school systems.
3)
Underage Drinking Initiatives: This effort is currently expanding to
include college-age students. Through a new discretionary grant from the Office
of Juvenile Justice Programs, five colleges will develop environmental strategies
to change campus drinking behavior. In addition, the University of Maine system
will develop a systemwide effort to combat underage and risky drinking behavior
of students.
4)
Substance Abuse Treatment: With the creation of the adolescent drug
treatment courts, it became clear that there was an inadequate array of treatment
services for young people. Using the remainder of a federal treatment capacity
expansion grant, OSA will increase the availability of more intensive out-patient
treatment options for youth in the drug court communities. In addition, an
RFP has been issued to create a new residential adolescent substance abuse
treatment program.
1)
New drugs continue to become available, and old drugs that have not been seen
in large quantities for many years are resurfacing. Youth report that it is
relatively easy to access an array of illegal drugs as well as alcohol and
tobacco. Their alcohol and drug use leads to a high rate of accidental death
and injury as well as being strongly linked to many of the other social problems
that youth face.
2)
It is critical to ensure that all systems are aware of potential substance
abuse, and can screen for it and locate appropriate treatment resources.
3)
We must ensure that both the prevention and the treatment opportunities that
are offered are effective for the population to whom they are targeted. For another successive
year, Maine has realized one of the very lowest rates of teen pregnancy in
the United States according to the Centers for Disease Prevention and Health
Promotion. Similarly, the teen abortion rate for Maine has declined for the
fifth year in a row. For the seventh year in a row, Maine ranks in the top
five States (4th) for the lowest rate of teen pregnancy. These rates are a
tribute to Maine teens, their parents, communities, health education efforts
in Maine’s schools, family planning agencies, Bureau of Health program efforts,
and access to prevention services through Maine Medicaid and school health
programs. The Bureau of Health’s Teen and Young Adult Health Program supports
many of these efforts, including: accessible family planning services; consultants
to schools and communities to develop comprehensive health education curricula
that includes effective family life education; community education with businesses
and youth serving organizations; and media campaigns promoting abstinence.
These efforts are complimented by other State and local agencies whose programs
promote healthy choices for our youth.
1)
Further support Maine schools in developing health curricula that are aligned
with the Maine Learning Results and that use
effective strategies for teaching abstinence-based family life education.
2)
Develop a partnership between the Bureau of Health and the Office of Substance
Abuse to assist communities in addressing the connection between underage
drinking and teen pregnancy.
1)
Supporting communities as they develop programs and services that support
young people in making healthy life choices.
2)
Supporting parents and families to increase their communication with their
children and adolescents about facts and values on sensitive issues, including
adolescent sexuality. Infant death is a critical indicator of the
health of a society since it reflects the overall state of maternal and infant
health and the many social, environmental, and health care system factors
that contribute toward the health of both of these vulnerable populations.
One hundred years ago in Maine, about 1 in 8 babies born did not live to see
their first birthday. Today, for babies born full term, that number has dropped
to 1 in 1000. During the last decade, Maine has consistently had the lowest
or one of the lowest infant mortality rates in the nation. Over the 15-year period (1985-2000), Maine’s
annual infant mortality rate (IMR) ranged from a low of 4.4/1,000 live births
(1996) to a high of 8.9/1,000 live births (1985). Comparing rates from year
to year can be misleading because of the potential for large rate changes
as a result of Maine’s small population. For that reason, it is more accurate
to look at 5-year averages. For the same 15-year period the 5-year average
IMR ranged from a high of 8.1/1,000 live births (1985-1989) to a low of 5.3/1,000
live births (1995-1999). The infant mortality rate is made up of two
major components: neonatal mortality (death in the first 28 days of life)
and postneonatal mortality (death from one month of age until the first birthday).
The leading causes of neonatal death are birth defects, disorders due to prematurity
and low birth weight, and pregnancy complications. The leading causes of postneonatal
mortality include sudden infant death syndrome (SIDS), birth defects, and
injuries. Preventable pregnancy complications resulting
in fetal or neonatal death include those associated with alcohol use (fetal
mortality is 77% greater in women who use alcohol), tobacco (fetal mortality
is 35% greater in women who use tobacco) and illegal substances. Tobacco addiction
is also associated with low birth weight, prematurity, sudden infant death
syndrome, and respiratory problems in newborns as well as an estimated 15%
of costs for all complicated births. The initiation of early and adequate prenatal
care is another essential intervention that may improve pregnancy outcomes
and reduce infant mortality rates. This stems from the fact that much of prenatal
care consists of screening for risks, treating any medical condition or risk
that arises, and providing education, as well as early and ongoing adequate
prenatal care. Monitoring this indicator over the same 15 year period (1985-2000),
we also see improvement in this area. By individual years, the proportion
of pregnant women receiving early and adequate prenatal care ranged from 65.1%
in 1985 to a high of 84.8% in 1998. Looking at 5-year averages, the proportion
of pregnant women receiving early and adequate prenatal care increased from
66.8% (1985-1989) to 84.7% (1996-2000). Next steps involve continuing known strategies
that contribute to Maine’s low infant mortality rate. Those include primary,
secondary and tertiary prevention activities, such as:
1)
Community-Based initiatives: Community-based efforts that work to create community
environments that are healthier for families (such as Communities for Children,
Campaign for a Healthy Maine, Healthy Communities).
2)
Universal Home Visits: Traditionally home visits during a child’s infancy
were offered to high-risk families. Now Maine’s system of home visits is being
expanded to include almost all newborns of first-time parents.
3)
Universal Vaccinations: For the past five years, all necessary childhood vaccines
have been provided for free by the Bureau of Health to licensed health care
providers for all children.
4)
Folic Acid: Ensuring that all women of reproductive age take adequate amounts
of folic acid is critical to preventing spina bifida and neural tube defects.
5)
Nutrition: Supplemental nutrition products and education through such programs
as Women, Infants & Children (WIC), Maine Nutrition Network, and University
of Maine Cooperative Extension assure proper nutrition to pregnant women and
young children, with a focus on those at high risk.
6)
Screening Programs: Preconception and prenatal genetic testing and counseling
services, and universal newborn screening for metabolic disorders.
7)
Preventive Care: Availability of preventive reproductive health care through
private and public providers such as family planning clinics, and rural and
migrant health centers. Assuring that women before conception or during pregnancy
have access to effective tobacco and substance abuse treatment programs.
8)
Access: Medicaid and MaineCare cover all pregnant women and infants under
200% of Federal Poverty Level, which is about 40% of pregnant women and infants
in Maine.
9)
Specialty Care: Transportation services to and availability of specialty care
for high-risk pregnancies and sick infants are important for all Maine pregnant
women and infants. Maine’s tertiary care hospitals provide these critical
services throughout Maine, and programs such as Katie Beckett and Children
with Special Health Needs Program assure coverage for specialty care for some
sick children.
1)
Access to prenatal care relative to: geographic distribution of providers
in relation to the population; the ability to pay for the services; transportation
for women and infants living in rural areas or without access to a vehicle;
the ability for pregnant women and parents to balance employment demands within
the hours that provider services are available.
2)
Maintain or expand funding for MaineCare for the provision of prenatal and
well baby care.
3)
Maintain funding for parent education and support through home visitation
through the Fund for a Healthy Maine (FHME).
4)
Changing demographics and the need for responsive perinatal health care. For
instance, we need to respond to the varied health challenges of refugee populations
such as nutritional deficiencies, infectious and non-endemic diseases, and
traumatic circumstances.
5)
As new information about preventing birth defects becomes known, we face challenges
in disseminating that knowledge.
6)
Maine continues
to be one of 13 states that have a universal vaccine policy, reflecting the
Department of Human Services’ philosophy that vaccines should be freely available
to all children, regardless of their ability to pay for them. In accordance
with this universal policy, the Maine Immunization Program provides all recommended
vaccines for children 0 18 years of age, and influenza, pneumococcal, and
first dose measles, mumps and rubella (MMR) for adults. Currently over 700
providers throughout Maine participate to receive vaccines, free of charge,
from the Maine Immunization Program to administer to their patients. We have
established a goal of providing immunization coverage to 90% of the children
in Maine. Maine has always
had some of the highest immunization rates in the country, and despite declining
childhood immunization rates nationally, Maine has sustained high coverage
rates. According to the National Immunization Survey, a large, on-going survey
of immunization coverage among pre-school children in the United States (19
- 35 months old), Maine ranked 6th in the nation for children up-to-date with
a series of 4 DTP/DTaP, 3 Polio and 1 MMR (4-3-1) with a rate of 84%, higher
than the national average of 78%, for the period January to December 2000.
Preliminary results for this 4-3-1 series show Maine ranking 1st in the nation
with 86% coverage for the period of July 2000 June 2001. For the period
July 2000 to June 2001, Maine led the nation for the 4-3-1-3 series with a
rate of 86%; the national average was 78%. The rate for the 4 DTP/DtaP, 3
Polio, 1 MMR, 3 HIB series (4-3-1-3) was 85%, again making Maine 1st in the
nation and above the national average of 77%. This progress is
not without challenges, however; when additional vaccines are considered,
Maine’s rank changes. For example, preliminary results of the 4 DTP/DtaP,
3 Polio, 1 MMR, 3 Hib, and 3 Hep B series (4-3-1-3-3) show Maine ranking 17th
in the country with a coverage rate of 78%. The lower rate on the 4-3-1-3-3
series is believed to be due to lower Hepatitis immunization, reflecting public
concern about thimerisol, a mercury-based preservative believed to be contained
in some pediatric vaccines. While Maine’s pediatric vaccines do not contain
thimerisol, this is a powerful example of the importance of sustained educational
efforts for healthcare providers and the public about immunizations and vaccines. Maine was the first
state to secure funds for developing an Internet based multi-state computerized
immunization registry, ImmPact. ImmPact is intended to be a repository for
accurate and up-to-date immunization records for all persons born, residing,
or receiving vaccine in the State of Maine. The primary purpose of the system
is to collect data related to vaccine administration, and to promote effective
and cost efficient prevention of vaccine preventable diseases. After completion
of an initial pilot phase, the Department of Human Services has recently promulgated
rules for the operation of the immunization information system. The program
is currently in the process of active provider enrollment into the ImmPact
registry. Currently approximately 110 pediatric providers are enrolled in
the registry, reflecting approximately 36% of Maine pediatric population. During 2001, rules
related to Immunization Requirements for School Children were amended to add
varicella to the list of required immunizations, as well as to amend the exemption
language for clarity and to conform with the provisional statute. While the
amended rule will likely become effective in April 2002, the varicella requirement
will not be implemented until the start of the school year in 2003. The new
requirement will be phased-in incrementally over a five-year period. The Maine
Immunization Program will work with school nurses and other staff from the
Department of Education concerning the implementation process. During 2002, the
Maine Immunization program will work to better identify high risk and underimmunized
populations across the State. Identification of these populations will aid
in the development of strategies that can be used to reduce barriers to immunization
for these populations. This year, the Maine
Immunization Program will increase efforts focused on adult and adolescent
populations. Strategies focusing on immunization, proactive leadership and
advocacy will be used to provide audience-appropriate information, and the
knowledge and motivation that are essential for successful immunization programs
for these groups. Future activities
will include the development of quality vaccine preventable disease surveillance
and outbreak control systems, based on national models of excellence. Specifically,
the program will undertake development of a surveillance system for varicella.
Such a system may include sentinel reporting at pilot sites to create baseline
data prior to the implementation of the school requirement for varicella.
Protocols will be developed with input from sentinel sites to include active
surveillance for complications of varicella. Development of high-quality surveillance
systems will assist the State’s preparation and ability to respond in the
event of bio-terrorism events, a concern that emerged with national urgency
after the events of September 11, 2001. Maine will continue
its efforts to increase enrollment of providers and children in the immunization
registry, and remains committed to preparing for future public health challenges
with innovative and effective immunization information systems. The Maine
Immunization Program will also continue to develop partnerships around information
technology, to ensure that such tools provide maximum benefits to the public
and private healthcare communities across the State. Many challenges
lie ahead for the Immunization Program. National funding priorities may threaten
the State’s ability to continue to proactively focus on developing a strong
immunization infrastructure. With the potential for reduced federal funding,
the Maine program may need to rally additional resources in order to continue
to provide universal vaccination coverage for all of the State’s children.
Issues pertaining
to the vaccine supply continue to present challenges to the program and to
health care providers who seek full immunization of their pediatric populations.
During this current year, nearly every recommended childhood vaccine faced
shortage situations, and currently revised schedules for several childhood
vaccines are in place, due to the inability of the vaccine manufacturers to
keep current with the needed national supply. These supply challenges will
force the Immunization Program to work closely with Maine health care providers
to ensure that patient tracking systems effectively recall children for booster
doses when supplies are once again adequate. The rising cost
and complexity of the vaccine schedule present significant challenges, which
require extensive work on vaccine accountability systems within the Immunization
Program. In 2003, the program will continue to establish rigorous accountability
procedures, to ensure that public vaccine resources are maximized. To this
end, the program will continue to establish benchmarking and evaluation processes,
and work closely with health care providers to ensure that proper vaccine
handling and storage protocols are in place. These challenges present opportunities
to strengthen the productive collaborations between the Immunization Program
and Maine’s health care community. Finally, as immunization
programs are increasingly successful in containing and eliminating childhood
diseases, an ongoing challenge remains to communicate to the public the importance
of sustaining a commitment to full vaccination of the State’s children. As
disease incidence is reduced, and the devastating results of disease become
increasingly distant, a potential for complacency may creep into the public
mindset. A constant challenge, directly related to the success of immunization,
remains keeping Maine’s childhood immunization rates among the highest in
the nation. The program will continue to work towards our Healthy People 2010
goal of 90% immunization coverage, and will continue to be a strong educational
and technical assistance resource to all Maine people. Over the four years
since passage of Chapter 790 which established the Children’s Mental Health
Program, expenditures for Children’s Services from BDS alone increased from
$17.9 million in FY98 to $33.0 million in FY01, or a growth rate of 84%. During
this period the expenditures for Medicaid seed money increased from $4.9 million
to $13.2 million, or by 166%. The Children’s Services
budget for FY02 totals $36.7 million in State appropriations, which will generate
an additional $29 million in federal Medicaid matching dollars, for a total
of $65.8 million. To date, Maine’s mental health system has:
1)
Significantly reduced in the number of children placed in out-of -State hospitals
and residential treatment facilities. At the time Chapter 790 became law,
the out-of-State census of Maine children was approximately 260. In December
2001, the census was 107, due in part to substantial development of Maine
residential treatment options by Department of Human Services (DHS), and to
systemic changes initiated by BDS in collaboration with Department of Education
(DOE), Department of Corrections (DOC) and DHS.
2)
Implemented an interdepartmental Systems Access component. Children’s Crisis
Services are called in when a child is at risk for an out-of-home or out-of-state
placement, assuring the consideration of less restrictive options before placing
a child outside of his or her home.
3)
Reduced the lengths of children’s hospital stays through the use of discharge
meetings. Discussions at these meetings involve hospital staff, community
case managers, BDS utilization review staff and state agency personnel from
DOE, DOC, DHS and DOE.
4)
Expanded the Clinical Case Management pilot in Southern Maine to other BDS
regions in the past year to provide mental health clinical services to State
wards through the co-location of master’s level mental health staff in DHS
regional offices.
1)
Refine Medicaid policy for key behavioral health and developmental services
for children and youth delivered in community and local settings that offer
treatment and support to children and their families.
2)
Commence operational usage of the BDS Enterprise Information System (EIS).
The EIS represents the foundation of an electronic information and data system
that supports the children’s system of care, providing an automated mechanism
for client enrollment, service monitoring and fiscal expenditures.
3)
Further advance BDS Children’s Services quality improvement activities and
functions, centering on strategic protocols and procedures for BDS Quality
Improvement Specialists and the service provider community. Focus on contract
monitoring of service delivery, technical assistance, analysis of system trends
and identification of areas for improvement.
4)
Training for Targeted Case Management services agencies emphasizing family
strengths practices and actively involving families as equal partners in case
management agency training teams.
1)
Promote and implementing an integrated and comprehensive children’s system
of care.
2)
3)
Avoid the consequences of developing parallel systems of care that, by their
nature, present institutional and service inequities that are driven by arbitrarily
defined eligibility criteria for services, classes of children, funding mandates,
special populations or divergent State agency missions. The desired alternative
is the development of a system of care that responds to all children in need
and to their families, within established and equitable parameters for access.
The journey toward implementing a standards-based education
system in Maine’s public schools has been marked by many milestones, including
the publication of Maine’s Common Core of Learning, the work of the Learning
Results Task Force, the inclusion of the
Guiding Principles of the Learning Results in statute and of their Content Standards and Performance Indicators
in major substantive rules, the enactment of the Omnibus Bill for the implementation
of the Learning Results in the Spring of 2001, the adoption of amendments to Chapter 125 Basic
School Approval and to Chapter 127, a major substantive rule outlining assessment
and graduation requirements, and the establishment of a system of Learning
Results. Further, the development of a
comprehensive local and state assessment system to measure student achievement
of the Learning Results has
been undertaken. This has been an inclusive journey engaging educators, parents,
students, school board members, legislators and other citizens in redefining
what it means to be educated in Maine schools. The Omnibus Bill for the implementation of the Learning
Results charged the Commissioner with
developing rules to accomplish the purposes of Standards and Assessment of
Student Performance of the Learning Results as outlined in Title 20-A, Chapter 222. It was determined
that Chapter 127, Instructional Program, Assessment, and Diploma Requirements,
a major substantive rule of the Department, last updated in 1991, was the
appropriate vehicle for these rules. The process to amend the rule began in
November 2001 and concluded in April 2002. Chapter 127 frames the implementation
of the system of Learning Results in Maine. The standards-based accountability model
in Maine is one of assistance to the personnel in a school unit, so personnel
can focus on improving student performance. Department activities in the coming
year include:
1)
The provision of technical assistance to school units statewide.
2)
The piloting of the School Assistance Process.
3)
The development of assessments and assessment systems as options for school
unit adoption.
4)
The establishment of Comprehensive Education Plans by local school systems.
1)
Move away from a focus on course offerings to emphasize assessment of student
learning.
2)
Establish and implement local assessment systems.
3)
Implement the School Assistance Process.
4)
Define a thoughtful and appropriate process for reviewing the content standards
of the Learning Results as specified in Chapter 131, the Learning
Results rule. In 1995, School Administrative Units (SAUs) received minimal
MaineCare reimbursements for the health-related
services provided in the SAU. Since
that time, SAUs have been reimbursed by MaineCare
more than $86 million through the MaineCare/Department
of Education collaborative. Of this total the majority of reimbursements
(approximately 78 million) has been for School Based Rehabilitation Services (SBRS), and approximately
$8 million has been reimbursed for Day Treatment
Services. MaineCare reimbursements have been utilized by the local SAUs
in a variety of ways. Almost half (43%) stated that they used the revenue freed
up by these reimbursements to maintain or
expand special education and/or health related
programs; more than a quarter of the respondents (28%) used the revenues to purchase equipment or materials related to special
education and/or health related programming;
and, approximately 11% of the SAUs allocated
these revenues to pay for licensure, other professional fees and/or continuing professional education. More than 90% of the reimbursements
have been reinvested by SAUs in some type of
health-related program. In April, 2001, four regional trainings relating to school
based reimbursement options were provided
by personnel from the Bureau of Medical Services
and the Special Services Team to 120 local
superintendents, directors of special services,
chief financial officers, support staff,
billing agents and others. Several other
trainings related to the MaineCare in Schools
Initiative have been offered over the years to Maine
Administrators of Services for Children with Disabilities (MADSEC)
and Maine Association of School Business Officials (MASBO).
1)
Complete technical assistance materials and provide regional trainings to
SAUs in the areas of Day Treatment Utilization and Reimbursements requirements
and Targeted Case Management Utilization and Reimbursement Requirements.
2)
Continue collaborative meetings between Bureau of Medical Services staff in
policy, record keeping, finance, provider relations and Office of Special
Services consultants in education, policy and funding, school nursing, school
based health centers.
1)
Planning, Developing, Implementing and Evaluating a system of School-Based,
School-Linked Mental Health Services.
2)
Exploring strategies in collaboration with MaineCare for improving access,
availability and affordability of appropriately trained support staff to provide
the health, mental health and educational support services necessary for Maine
students to improve functional abilities within the school and community environment.
3)
Exploring strategies in collaboration with MaineCare for improving the access,
availability and affordability of transition services for children who leave
the 0 to 5 year system and enter the K-12 system, and for students who exit
the secondary schools and continue into post-secondary and work experiences.
4)
Exploring strategies for improving reimbursement and funding options for services/programs
offered through School Based Health Centers. P.L. 2001, Chapter
452 “An Act to Implement the Recommendations of the Task Force on Educational
Programming at Juvenile Correctional Facilities” requested interagency initiatives
to address the effectiveness of discharge and transition services for youth.
Since public schools play a critical role in the reintegration of Maine’s
juvenile offenders, it is important that the transition process be well conceived
and supportive. The Department of Education and the Department of Corrections,
in collaboration with a constituent group, are developing standards and technical
assistance pertaining to reintegration planning and transition services. The
constituent group includes juvenile correctional officials, juvenile community
corrections officers, organizations representing school boards, school administrators,
teachers, parents, and the Truancy, Dropout, and Alternative Education Advisory
Committee, as well as other interested local officials and community members. Reintegration Teams
for youth leaving Mountain View and Long Creek Youth Development Centers will
better coordinate services between schools and correctional facilities. The
Reintegration Process provides that when a youth is committed to the Youth
Development Centers, notification will be made to the Superintendent of that
youth’s local school administrative unit to establish communication and information
sharing linkages. Educational records will be transferred to the school at
the facility. When the youth has progressed through treatment levels to the
extent that he or she is ready to be released, the schools will be invited
to participate in a Community Reintegration Planning Meeting at the center
where progress on the Rehabilitation Plan will be discussed. Schools will
form their own Reintegration Team consisting of the Superintendent or designee,
Principal, teacher(s) of the reintegrating student, the student, parent or
guardian, school counselor, and the juvenile community corrections officer.
This team will develop an individualized plan, covering school programs, placement
and activities, which will be monitored and adjusted as needed. The plan will
have been fulfilled upon achievement and maintenance of plan standards. Supporting
this process are local school board policies and training for counselors and
school employees regarding confidentiality of information. Technical assistance
developed by the Department of Education includes: implementation of statewide
standards; Reintegration Team training in the management of records and confidential
information; establishment of individualized plans through Reintegration Teams;
and development of systemic understanding between schools and development
centers.
1)
To maintain communication links as staff turnover occurs.
2)
To ensure ongoing training for Reintegration Teams.
3)
To continue departmental collaboration. The Girls Project
is a Children’s Cabinet initiative to address the growing numbers of girls
in the juvenile justice system. The project began
by taking an in-depth look at a group of girls at the Long Creek Youth Development
Center (formerly the Maine Youth Center). Consistent with national research,
almost every girl had a history that included physical, emotional and/or sexual
abuse. They struggle with mental health and substance abuse problems. They
have experienced academic failure and exploitation by older males. Their crimes
are usually related to familial and social relationships. Early childhood
trauma appears to be a major factor underlying these girls’ mental health
and substance abuse problems, as well as their criminal behaviors. The juvenile
corrections system recognizes the need for gender specific treatment for these
girls and others like them in Maine. The Girls Project will research best
practices for assessing and treating Post Traumatic Stress Syndrome while
recognizing that treatment needs to be integrated, individualized and consistent
with best practices for adolescent girls. The immediate goal
is to develop ways of responding to girls in the correctional system that
will help them create successful lives by addressing their needs appropriately.
Another short term goal is to better serve girls who are involved in more
than one department of government; for example, those in the custody of the
Department of Human Services who also receive mental health services from
the Department of Behavioral and Developmental Services. A long term goal
of this project is earlier identification of girls dealing with trauma, so
that meaningful intervention can help them sooner, hopefully before they enter
the correctional system. Maine continues
to receive federal funding under the Stewart B. McKinney Act for administration
and provision of grants to school administrative units for developing programs
and services for homeless students to assure their access to school. Maine’s
state plan for meeting the provisions of federal and State law for homeless
students is aligned with Maine’s coordinated plan to assure that all students
may achieve the Learning Results. Maine currently
funds two projects the Portland Street Academy in Portland and the Merrymeeting
Project in Bath. The Portland Street Academy records contacts made with 198
homeless youth in 2000-2001. There were 72 different schools of origin reported
by youth participating in the project. The Street Academy, as part of the
Portland Partnership for Homeless Youth, helps homeless or street -involved
youth to find greater stability in their lives. Using Rapid Response funding,
individuals develop goals around eight life areas including primary care,
mental health, social supports, substance abuse, education, vocation, employment,
and housing. The Merrymeeting Project in Bath served 46 youth in 2000-2001,
and has an ever-increasing volume of referrals. Its effective outreach program
specifically designed for the rural, coastal area establishes mentoring relationships
that allow for further development of efforts to address issues and educational
needs. The Project engages in crisis intervention, assessment, referrals,
transportation, family mediation, clothing and food provision, and educational
goal-setting. The Reauthorization
of the Elementary and Secondary Education Act (“No Child Left Behind” legislation)
includes revisions to the McKinney-Vento Act that broaden the definition of
homelessness and increase responsibilities of schools to meet the education
needs of homeless children and youth. Maine currently is working to transition
students from Shelter Schools to their schools of origin or current location,
as States receiving funding can no longer maintain separate educational programs
for homeless youth. Maine must ensure
that all barriers to enrollment, attendance, and success in school are removed.
Challenges in this regard are:
1)
Developing a greater public awareness and sensitivity of homelessness.
2)
Creating a one-stop, on-site service delivery system for youth.
3)
Providing more transportation.
4)
Ensuring safe homes.
5)
Providing housing options.
6)
Securing designated funding for homeless students.
7)
Providing alternatives in education.
8)
Providing outreach programs particularly in rural areas. Concern with the
rate of students being expelled across the State, and the limited to non-existent
access to educational opportunities when expulsion occurs, has lead to a focus
of attention on Maine’s expelled youth. The Muskie Institute is currently
conducting a research survey of all high schools to analyze the similarities
and differences in the policies, actions and reactions of schools in regard
to expulsion, and the types of behaviors that have led to removal from school.
Currently, schools have limited options to deal with problems when they occur,
thus the reliance on expulsion. Schools and communities must develop the capacity
to deal with emergencies and problems within the community and school system.
A forum was held
in Aroostook County for stakeholder groups in education, law enforcement,
and social services to explore options to expulsion. A steering committee
has been formed to pursue integrated case management. This community-school
partnership could serve as a model for others facing the challenge of meeting
behavioral and educational needs effectively.
1)
To direct attention to the issue of expelled youth.
2)
To utilize the data gathered by the Muskie Institute concerning expelled youth
to form a response to meet the needs of schools and this population.
3)
To track the success of the Aroostook County Integrated Case Management project
to consider use of this approach as a model for other regions. Alternative Education
programs have been established in at least 90 schools statewide with a rising
increase in creative alternatives for youth K-12. Most programs are for high
school-age youth, but programs for elementary and middle school youth also
exist. Creating a shift in addressing a student’s learning needs may be small
or very significant. Alternatives for Maine students have a clearly stated
purpose: to promote a sense of belonging and caring; to have clear instructional
objectives; to provide for individualized attention; to be innovative and
flexible; and to help all students meet the Maine Learning Results and its Guiding Principles successfully.
Alternatives in education work toward reducing the dropout rate and increasing
the number of high school completors in today’s climate of the ever increasing
need for training and education to ensure success in the workforce. A Summer Institute
will be held for educators exploring Alternatives in Education.The purpose
of the Institute will be to help educators help students meet the rigorous
standards of the Learning Results and its assessments, while remaining flexible to meet
the needs of students who need alternative approaches to learning.
1)
To develop and disseminate educational approaches to meet the divergent needs
of learners.
2)
To encourage school systems to develop alternative education opportunities.
3)
To create a funding mechanism for the start-up costs of alternative education
programs.
1)
The enhancement of Maine’s public K-12 education system on a foundation of
quality standards, high expectations for all students, and preparation for
post-secondary education study is underway.
2)
The standards for the review and approval of educational personnel preparation
programs have been realigned with Maine’s Learning Results, with Maine’s
results-based initial teacher certification standards, with Maine’s infusion
of technology expectations, and with an adaptation of the National Council
for Accreditation of Teacher Education (NCATE) standards. This realignment
resulted in revisions to Chapter 114 - Policy, Procedures and Standards for
the Review and Approval of Educational Personnel Preparation Programs, effective
March 4, 2002.
3)
Increased coordination among Maine’s public higher education systems is underway.
4)
The creation of the Higher Education Attainment Council, charged with creating
a vision for higher education attainment in Maine along with establishing
appropriate timeframes as well as benchmarks for measuring improvement, assessing
progress, and assuring adequate capacity to meet goals is being encouraged.
5)
The establishment of a community college system through the collaboration
of the University of Maine System (UMS), and the Maine Technical College System
is being pursued. The community college initiative is referred to as the Community
College Partnership of Maine. At the heart of the partnership are agreements
between the associate and baccalaureate degree levels. To date, some 124 agreements
have been finalized. While there continue to be associate degree enrollments
in both the University of Maine System and the Maine Technical College System,
several hundred partnership students are presently enrolled in the “associate
to baccalaureate” degree program.
6)
Establishing stronger links among systems at all levels 0-5, K-12, and post-secondary
is also a priority.
1)
Given the current cycle of program approvals, the first educational personnel
preparation program assessment under the revised standards for review and
approval will occur during the academic year 2002-2003.
2)
The Council will begin its work in late-spring or early- summer, 2002 and
will be administered by the Maine Development Foundation.
3)
A report outlining key progress indicators, assessments of quality, and recommended
next steps to establish a community college system in Maine is being finalized
for submission to the Governor.
1)
The assessment of educator personnel preparation programs utilizing the revised
standards will represent a significant shift from evaluating program compliance
to evaluating the performance of candidates.
2)
Legislative funding for the Council will represent 50% of the resources necessary
for the Council to function effectively. The other 50% will need to come from
private contributions.
3)
Support for, and further implementation of, the community college partnership
initiative are seen as critical to the realization of efforts to encourage
more Maine citizens to pursue higher education. Challenges include developing
additional articulation agreements and continuing efforts to reduce tuition
for partnership students. Over the next few years, Maine’s goal is to provide 30,000
youth in Maine with mentoring relationships. Currently there are an estimated
5,000 mentoring matches in Maine, which represents 1.7%of Maine’s young people.
Maine’s Children’s Cabinet created the Maine Mentoring Partnership, as a partnership
of government, public and private mentoring program providers, funders and
private for-profit supporters to increase accessibility of mentoring for all
Maine youth. Maine Mentoring Partnership is an organizational member of Maine’s
Promise, the Maine partner of America’s Promise. The mission of Maine Mentoring
Partnership is to advocate for, support, and foster youth mentoring programs
in Maine. Maine Interfaith Mentoring, the first initiative of Maine
Mentoring Partnership, is a statewide, faith-based mentoring initiative to
build an infrastructure and replicable model to support Maine communities
of faith as they partner with schools and community organizations. Its mission
is to increase the number of mentoring relationships available to children
and youth in Maine by mobilizing volunteers from congregations across a wide
interfaith spectrum. A State Mentoring Partnership is a collaborative effort of
public and private sector leaders that serves as an advocate and resource
for mentoring. It also acts as a broker, establishing partnerships between
organizations that provide mentoring services and organizations that are sources
of potential mentors to help increase the quality, capacity and scale of mentoring
statewide. Maine Mentoring Partnership is:
1)
Further developing its statewide Leadership Council to raise the vision and
re-evaluate the strategic direction for mentoring in Maine, which will open
doors to new resources for mentoring and increase the visibility of mentoring
throughout the State.
2)
Developing a Providers Council with representation from local mentoring partnerships,
coalitions, and providers to advise about mentoring needs around the State.
3)
Re-evaluating the Strategic Plan to bring mentoring to a responsible scale
in Maine by:
a)
Defining the need for mentors statewide;
b)
Assessing the barriers that prevent mentoring providers from meeting the need;
c)
Putting forth a reasonable numeric goal for reaching scale; and
d)
Outlining a clear strategy to overcome those barriers and measure how well
Maine is progressing toward its goal.
4)
Formalizing the Executive Director position to support and orchestrate the
efforts of the Leadership and Providers Councils.
1)
2)
Technical Assistance and Training Providing mentor/mentee training and technical
assistance to organizations interested in starting, strengthening or expanding
quality mentoring programs, partnerships or coalitions.
3)
Public Awareness Continuing to develop the media campaign to raise awareness
of and the need for mentoring statewide.
4)
Public Policy Creating a strategy to expand and strengthen the public investment
in mentoring.
5)
Resource Development/Distribution Continuing to generate public and private
sector resources.
6)
Data Collection/Tracking Continue to develop a statewide system to track
the prevalence of mentoring and to evaluate the impact of mentoring on student
outcomes and attitudes. The Regional Children’s Cabinets are developing plans to
highlight the plight of youth who are homeless and developing services to
meet their needs. Rapid responses to youth, within the first 24 hours of their
becoming homeless, coupled with an assessment of a youth’s issues and the
development of safety plans with youth and their families, significantly reduces
the number of children on the streets or in shelters.In March the 120th Legislature
approved $375,000 for services for homeless children in all three regional
cabinet regions of the State (the Homeless Children’s Initiative.) The Regional
Children’s Cabinets supported two pieces of legislation to address the issue
of homelessness among youth in their regions:
1)
Partnership for Homeless Youth
[2]
established a mandate for development of comprehensive community
plans for youth who become homeless.
2)
Youth in Need of Services (YINS)
[3]
extended services by establishing a one-year
pilot to provide outreach and intensive case management to youth 14 years
and younger in need of assistance for securing stable housing. The Regional Children’s Cabinets accomplishments in reducing
homelessness of youth include:
The Region I YINS pilot shows promising results with early
intervention of youth in York and Cumberland counties. Youth are remaining
in their homes and in school, with intensive case management services and
mediation provided by local agency. Cross systems work is leading to improved
linkages with State agencies, schools, law enforcement agencies and local
service providers. RCC II began developing a Pilot Program for youth who are homeless
in the central part of Maine. They held a day of Technical Assistance and
Action Planning, followed by meetings throughout the Region to review and
identify the challenges and opportunities to creating a continuum of services
for youth who are homeless. The Regional Cabinet will define next steps to
assess, plan, and develop comprehensive and best practice services, including
involuntary treatment for youth who are homeless in the region. Region III initiated the Rapid Response
to Youth Who Are Homeless Pilot in the Bangor area. The goals of the program
are: to respond when a youth becomes homeless
or is in immediate danger of becoming homeless; to get a youth off the
street and into a safe, stable home within 72 hours of becoming homeless;
and to reconnect him/her with his/her school system and/or family as soon
as possible. The initial results of this Rapid Response program show that
youth who received the services had significantly better outcomes than the
comparison group of youths. For example, 12 months from the initial intake,
100% of the Rapid Response youth were in school, in a training program, or
had a job. Only 31% of the comparison group did. At the one year mark, 0%
of the Rapid Response youth indicated that during the last six months they
were involved with gang activity, had been hurt by someone, attempted suicide,
were involved with juvenile justice system, had inadequate clothing, had gone
hungry, or had engaged in prostitution. This 0% figure is in stark contrast
with the percentages for the control group of 31% [gang activity], 38% [hurt],
17% [suicide], 42% [justice system], 23% [inadequate clothing], 31% [hungry],
and 31% [prostitution]. Over the next year
we will be implementing on a statewide basis (including Region II) the newly
enacted and funded Homeless Children' s Initiative. Ending the homelessness
of children continues to be our goal. 1,883 Adult and 267 Youth Gatekeepers schools
and community agencies received training in suicide prevention. 30 School
Health Education Teachers were trained in the ASAP/Lifelines curriculum to
develop help seeking skills among students. 152 people learned to conduct
awareness sessions in their communities. 2,815 individuals participated in
awareness education. 139 Substance Abuse Clinicians, over 300 BDS Mental Health
Clinicians, and 142 DHS clinicians receive training annually. The Maine Youth
Suicide Prevention Program (MYSPP) built a comprehensive set of strategies
consistent with recommendations from the Office of the Surgeon General. The
collaborative effort among State and private sector agencies and individuals
strives to increase public awareness about preventing youth suicide, reduce
the incidence of suicide behavior among Maine youth aged 10-24, and to improve
youth access to appropriate prevention and intervention services. The program’s strategies include: increasing
public awareness that suicide is preventable, training educators, public safety
personnel, clinicians, clergy, health care providers, and others about suicide
prevention; disseminating data and information resources statewide; and training
and guiding agencies and groups on effective suicide prevention methods and
practices. The project has
developed and distributed a wide variety of materials for youth:
1)
1,250 posters and 56,000 book covers designed and developed by youth distributed
to schools statewide,
2)
8 public service spots developed by and for youth and distributed to radio
stations in five communities around the state,
3)
106,440 Teen Yellow Pages booklets updated, reprinted and distributed to every
school Superintendent in 2001 plus 110,000 of the same developed and distributed
in 1999. Throughout the year,
requests for MYSPP interventions all around the state came from school employees
who had attended MYSPP gatekeeper training! The MYSPP gatekeeper trainer,
working with local crisis service provider agencies, responded to calls for
assistance from elementary, middle and high schools. While the specific circumstances
varied, many involved suicidal behavior among multiple students in one school
community. Our coordinated response provided training, awareness education
and crisis intervention services. Individual students received the crisis
assessments and stabilization services they needed. A fifth grade boy
who took part in developing the MYSPP videotape on youth firearm safety (produced
with Children’s Cabinet funds) sought help for a suicidal peer. He went to
his Guidance Counselor and told her of his concern; she knew how to respond
and followed up with the peer. The peer did, in fact, have a very well thought
out plan for the next day using his father’s gun, to which he indeed had access.
The peer got the help he needed. The Guidance Counselor went back to the boy
what had approached her initially to thank him his reply was “I just did
what the video said to do!”
1)
Finalize and disseminate school suicide prevention, intervention and post-intervention
guidelines to Maine schools.
2)
Improve the system of providing suicide prevention technical assistance to
schools by increasing coordination among Children’s Cabinet agency programs.
3)
Secure grant or other funding to provide requested support to local communities
and to evaluate the impact of MYSPP implementation.
4)
Solicit assistance from adolescent boys in improving their access to services.
1)
Development and dissemination of suicide prevention and crisis prevention
protocol guidelines for Maine schools.
2)
Continuing to provide state of the art educational resource materials and
program information statewide.
3)
Providing training and technical assistance to school health educators to
implement suicide prevention education within the school health education
curriculum.
4)
Continuing to provide gatekeeper training to adults and youth in schools and
communities statewide which will, in part, depend on increasing the number
of trainers to deliver youth suicide prevention gatekeeper training and awareness
education statewide.
5)
Continuing to provide training for facilitators of skill-building groups for
high-risk youth.
6)
Continuing to increase public awareness of suicide prevention through the
development and dissemination of suicide prevention public service messages,
presentations and materials for adult and youth audiences.
7)
Providing ongoing, advanced level education in effective suicide prevention
practices to clinicians statewide.
8)
Continuing to improve the quality of suicide data to effectively measure suicide
attempts and completions.
9)
Evaluating program effectiveness. The guiding principle
of the MYSPP is to Do No Harm. This means that suicide prevention work must
be done carefully and in a systematic way. However, most calls for assistance
either come in the midst of a crisis or are requests to work only with youth.
It’s a continuing struggle to work towards proactively building safe and caring
school climates where adults are trained to recognize and assist at-risk youth,
and ensure that suicide prevention protocols are in place and linkages are
made with community crisis services. Demands from schools
and community agencies continue to increase, without a corresponding increase
in MYSPP resources. While we are beginning
to see some positive results from early evaluation of program activities,
it is very difficult to evaluate the impact of the MYSPP. Expanded assessment, diagnostic, and treatment services for
youth offenders in various correctional settings is now available. Over the
past two years BDS, in collaboration with the Department of Corrections, Juvenile
Services, has been developing a mental health program for adolescents placed
at the Long Creek Youth Development Center in South Portland. BDS mental health
personnel have been instrumental in the development of the new Assessment
and Orientation Unit and in implementing a mental health screening protocol
for all youth admitted to the facility. The mental health program has conducted
behavioral health assessments for residents that include assessment, diagnosis,
intervention planning and treatment needs of youth. BDS resources will be
provided at the new Mountain View Youth Development Center in Charleston.
Committed youth are now receiving more comprehensive assessment and treatment,
and improved community placements utilizing the Maine Operating Approach.
(M.O.A.) The MOA is highly intensive, and fosters vocational and educational
skill development, and changes in thinking, feelings, and behaviors to promote
responsibility and accountability. The program also prepares the resident
for transition and adjustment to less restrictive phases of programming and
gradual movement toward release. The MOA strategies include Assessment and
Case Management; Therapeutic Milieu/Normative Culture; Cognitive Behavioral
Psycho-educational Program; Skill Development; and Progression through a Phase
and Level System. In addition to the facility-based programs, BDS has placed
mental health program coordinators (LCSW’s) in each of the four regional Juvenile
Services offices of the Department of Corrections. These staff consult with
Juvenile Community Corrections Officers in their regional offices to assist
in developing case plans and accessing appropriate mental health services.
A primary goal of this collaboration is to divert potential future involvement
with the juvenile justice system, and specifically new admissions to youth
correctional facilities. Continue to refine mental health services at the Youth Development
Centers. Continue
to facilitate collaboration between BDS and DOC to ensure the continued effective
delivery of these services to juvenile offenders. The Long Creek Youth
Development Center [formerly the Maine Youth Center], and the Mountain View Youth Development Center [formerly the Northern
Maine Youth Detention Center], instituted
a total multi-disciplined team approach in working with youth committed and held within these facilities.
Mental health services at the Centers have been enhanced by placing
a BDS Mental Health Program Coordinator there
to review and assess the mental health needs
of the youth and assist with after care planning. Caseworkers from the Department of Human Services assist in
developing coordinated plans for youth in
their custody while in the facilities and upon
release to the community. A liaison funded
by the Department of Education assures appropriate
education plans are in place for those youth released from the facilities. DOE consulted with DOC in developing the Learning for Life curriculum now in place in both facilities.
This educational approach uses project-based learning with real-life
application that takes into account individual
learning styles and abilities. In the beginning
steps for developing a continual process of Quality Improvement at all levels, including the practice, program
and system levels, the Division of Juvenile
Services (DJS) will take steps to assure the development of comprehensive correctional case plans focused on dynamic
factors related to the risks of continuing
antisocial conduct. The recently organized
collaborative between the Behavioral Health Sciences
Institute and DJS to create the Center for Juvenile Justice will assist DJS
to accomplish the following in the next year:
1)
Entire staff train in the techniques of Motivational Interviewing.
2)
All staff trained on the techniques of Integrated Case Management.
3)
Reliability and validity of assessment instruments measured. (Youthful Offender
Level of Service Inventory)
4)
Initiation of a program to ensure program effectiveness. (Correctional Program
Assessment Inventory)
5)
Alignment of its policies and procedures to be compliant with Title 4-E provisions
of the Social Security Act.
6)
Continuation of its efforts to implement a comprehensive program of Integrated
Case Management and Intensive Aftercare Services.
7)
Regular reviews of detained youth, with the goal of identifying viable alternatives
on a timely basis.
8)
Participation in a research study to review detentions in Maine.
1)
The Division of Juvenile Services will develop plans to assure all programs
offered to juvenile offenders are based on demonstrated effectiveness related
to client needs and responsivity factors.
2)
Recidivism rates will be reduced by 20%.
3)
Continual improvement of programs and services, which target criminogenic
needs of committed juveniles, will improve public safety.
4)
The Division will introduce and monitor correctional case management practices
to assure continual improvement in the scores of pre- and post- assessments
of risk factors of juvenile offenders.
5)
The Division of Juvenile Services will attain and maintain quality assessment,
case planning and program effectiveness.
6)
The Division will reduce the number of detainee days, consistent with public
safety concerns, by providing a variety of programs and services for targeted
juveniles. In 1998, Maine high school students reported
receiving high levels of HIV risk reduction information and skills. Maine
educators report a high rate of teaching specific HIV topics compared to other
states. Maine male high school students indicated a slight reduction of the
onset of sexual intercourse and students who are sexually active have continually
reduced the number of sexual partners and increased condom use. Still about
one third of all new HIV infections are among people 13-29 years of age, meaning
that many were infected in their teens and early twenties. Nationally, one
out of every four new HIV infection is believed to take place among adolescents.
1)
Continue to offer no cost “Programs that Work” HIV curriculum implementation
training to school and youth agency staff. Presently, 77% of public high schools
and 54% of middle schools have received training in these researched, skill-based
curricula. Plus, 60% of youth serving agencies have been trained. These curricula
have been proven to delay the onset of sexual intercourse and/or increase
HIV risk reduction behaviors (condom use).
2)
Design, implement and evaluate an HIV education program for young men who
have sex with men based on a need assessment and youth participation in the
planning process. There are no models nationally for this population.
3)
With the Centers for Disease Control, analyze the Youth Risk Behavior Survey
data to better understand Maine’s reported lower-than-national-average condom
use rate among high school students and low sexual responsibility rating.
Conduct a meeting of State-level program representatives to strategize how
to increase dual birth control and condom use messages for sexually active
youth.
1)
Lowest Condom Use Rate Among High School Adolescents in U.S. among 22 states
that conduct the Youth Risk Behavior Survey (YRBS): Maine high school students, specifically females,
report the lowest condom use rate in the country, due to the highest contraceptive
pill use. The message of dual protection of both pregnancy and sexually transmitted
infections must be incorporated into messages of sexual responsibility. Six
out of ten sexually active, senior class (12th grade) males used a condom
at last intercourse. The rate decreases, as students get older. Sexually transmitted infection rates continue
to be disproportionably highest among adolescent females. This indicates that
young females are at risk for HIV infection.
2)
Approximately one half of all new HIV infections in Maine are among men who
have sex with men. There continues to be limited HIV education
designed for young men who have sex with men. This population is at extreme
risk due to their isolation, a silence about sexual orientation and a lack
of support in schools and youth-serving agencies. One out of ten Maine high
school students reported being verbally harassed or attacked based on perceived
sexual orientation while in school or on their way to and from school. (YRBS
2001)
Children
are at risk if they live in homes built before 1978 and especially in pre-1950
homes. These homes are likely to contain lead-based paint that is the culprit
in most lead poisoning cases. Lead-based paint in good condition poses no
threat but when the paint begins to deteriorate it can generate paint chips,
flakes and dust. These chips of paint and the minute particles that settle
into house dust can be picked up on a young child’s fingers. Children’s hands
are frequently in their mouths where lead particles can be swallowed and absorbed.
Over time, this lead can accumulate in a child’s body and cause lead poisoning.
This is the source of the majority of lead poisoning cases in Maine. There
is another scenario commonly found in Maine. Many young families today are
purchasing older homes and renovating or remodeling them. If this work is
not done with a great deal of caution it can generate lead contaminated dust
that permeates the air throughout the house. This can lead to lead poisoning
in the children and even the adults who breathe it in. Children who are poisoned
by breathing in lead-contaminated dust get poisoned faster and at higher levels
than other children. Statistical
analysis of lead poisoning in Maine’s children revealed that children enrolled
in Medicaid are twice as likely to be lead poisoned. This probably happens
because these children are more likely to live in older, poorly maintained
homes. Furthermore, while the Centers for Medicaid and Medicare mandate that
all one-and-two year olds on Medicaid be screened for lead exposure, less
than 25% of these children are tested each year. On
a positive note, the annual rate of lead poisoning in all children who are
tested has declined in Maine over the past 7 years, from a high of 14.1% in
1994 to 4.9% in 2000. Since fewer children are poisoned, we are now challenged
to determine what populations of children, besides Medicaid enrolled children,
are truly at risk and target our efforts to those high-risk children. Medical
providers, in particular, need to know how to quickly and easily identify
at-risk children in need of testing for lead exposure. At
the same time, we must continue to work with our partner agencies at the Department
of Environmental Protection (DEP) and Maine State Housing Authority (MSHA)
to prevent lead exposures in the homes that are poisoning Maine’s children.
It is only by eliminating these sources of lead exposure that children in
Maine will be safe from the devastating, lifelong effects of lead poisoning.
1)
Identifying all lead poisoned children (blood lead levels > 10 ug/dl) in
Maine through reports from the Health and Environmental Testing Laboratory.
2)
Providing all families with lead poisoned children with information and education
through visits from Public and Community Health Nurses.
3)
Providing all families with children whose blood lead levels are 20 µg/dl
and higher with a complete environmental investigation and assistance with
accessing resources for lead remediation activities.
4)
Collaborating with a physician-directed project called “Kids Run Better Unleaded”
to educate health care providers about the need for lead screening in young
children.
5)
Collaborating with the EPSDT program to promote lead screening in the Medicaid
population.
6)
Collaborating with the University of Southern Maine, Muskie School, Institute
for Public Sector Innovation, to provide statewide public health education
on lead poisoning, including producing and maintaining a website and a periodic
newsletter, TV Public Service Announcements (PSAs), and numerous printed materials
and presentations.
7)
Collaborating with the DEP and MSHA on primary prevention efforts such as
offering “Lead Smart Renovator” classes to homeowners and contractors, and
offering federal grant money to low-income homeowners for lead abatement work.
8)
Maintaining comprehensive surveillance databases and epidemiological analyses
of blood lead screening results.
1)
To identify the target population of high-risk children for lead exposure
(beyond the Medicaid population).
2)
To identify and overcome the barriers to lead screening in the Medicaid enrolled
population.
3)
To continue funding to support current activities and to expand health education
efforts.
4)
To secure adequate funding in Maine to address the primary issue of lead-based
paint in older homes.
5)
To identify ways to partner with current community based initiatives. The
Department of Public Safety (DPS) is working to ensure the public safety of
children. Enhanced-911
is a data base that can be accessed with current addresses, and the right
Police, Fire and EMS agencies to call in case of an emergency. This system
is designed to have E-911 calls directed to a Public Safety Answering Point
(PSAP) and the dispatchers will direct the correct emergency responder to
the correct location. If a child who uses 911 is too young, scared or unsure
of what to say, the preprogrammed database will contain all the appropriate
information for a call taker to send the appropriate emergency responder.
DPS will undertake a educational project this year to inform young children
about E-911 with a "Red E. Fox" program which has been successfully
used nationwide. The
computerization of Criminal History Record Information (CHRI) is nearing completion.
There are hundreds of thousands of paper copies of criminal history records,
some supported by fingerprints and some not. This project allows criminal
history records to be built forward on all new requests, which can be disseminated
to criminal justice and non-criminal justice agencies in a timely manner.
The advantage of this for children is that companies, agencies and other employers
can then request a CHRI check and then can make informed decision as to whether
to employ, or hire a person or not. An employer who operates a business that
has children around could find out if any perspective employees have been
convicted of any crime that would make it unsafe for them to be around children.
1)
Implement E-911 in Aroostook and Hancock Counties.
2)
Complete the Criminal History Record Information program.
1)
Educate the law enforcement community with the best practices and training
involving Domestic Violence issues, School Resource Officer issues, Restorative
Justice issues and Community Policing issues.All of these issues intersect
with children in many ways.
2)
Increase our law enforcement first responder staff because of emerging issues
with drug and alcohol abuse, as well as other community safety issues. Overview 31
communities across the state have formed local Youth Advocacy Programs (YAP),
consisting of young people from a diversity of backgrounds and ranging in
age from 12-17. Most of these groups have gone through a weekend training
at Camp Kieve that focuses on teamwork and on helping them develop a plan
to reduce youth tobacco-use in their own communities. After being trained,
these groups returned to their communities to further develop and implement
their new programs. Local
YAP programs will include the issues of physical inactivity, and improving
nutrition, in addition to tobacco prevention. At
the State level, the Partnership For A Tobacco-Free Maine will collaborate
with the Maine Cardiovascular Health Program to develop regional training's
for both adults and youth working on Youth Advocacy Programs. Continuing Challenges
for 2003-2006 Recruitment
and retention of at-risk youth on local, as well as State-level, YAP boards.Respecting Children and Youth
Health Insurance For Children And Adults
Overview
Next Steps
for 2002
Continuing
Challenges for 2003-2006
Tobacco Use Reduction and Health Promotion
Next Steps 2002
Continuing Challenges 2003-2005
Substance Abuse Prevention, Intervention and Treatment
Overview
Development
of Comprehensive Prevention State System: to develop and implement a comprehensive,
long-range prevention program system to ensure that all State prevention resources
fill identified gaps in prevention services targeting youth ages 12-17 throughout
the State with science-based prevention programs.Next
Steps for 2002
Continuing
Challenges for 2003-2006
Teen Pregnancy Reduction
Overview
Next Steps for 2002
Continuing Challenges for 2003-2006
Infant Mortality
Reduction
Overview
Next
Steps for 2002
Continuing
Challenges 2003-2006
Determination
of those most likely not to receive early and adequate prenatal care and focus
interventions on them. Childhood Immunizations
Overview
Next Steps for 2002
Continuing Challenges for 2003-2006
Children’s
Mental Health Services
Overview
Next Steps for 2002
Continuing Challenges for 2003-2006
Reduce the need for families to seek out of
home treatment for their children by building an accessible system of community
based services in the State of Maine. A major ingredient in this strategy
is to assist families to become less reliant on the system and more reliant
on their own strengths and natural supports and, through supporting communities,
to become more responsible within their own environment. Learning
Results
Overview
Next Steps for 2002
Continuing Challenges for 2003-2006
Medicaid
Funding for Special Education Services
Overview
Next
Steps for 2002
Continuing
Challenges for 2003-2006
Reintegration
of Youth From Youth Development Centers
Overview
Next Steps for 2002
Continuing Challenges for 2003-2006
DOC Girls
Project
Overview
Next Steps for 2002
Continuing Challenges for 2003-2006
Education
of Youth Who Are Homeless
Overview
Next Steps for 2002
Continuing Challenges for 2003-2006
Expelled
Youth
Overview
Next Steps for 2002
Continuing Challenges for 2003-2006
Alternatives
in Education
Overview
Next Steps for 2002
Continuing Challenges for 2003-2006
Higher
Education Initiative
Overview
Next Steps for 2002
Continuing Challenges for 2003-2006
Maine Mentoring Partnership
Overview
Next Steps for 2002
Continuing Challenges for 2003-2006
Mentor Recruitment and Referral -- Targeting organizations from all sectors
to serve as mentors and continuing to create a statewide database of quality
mentoring programs.Services for Youth Who Are Homeless:
Overview
RCC I and the Portland Partnership for Homeless Youth provide oversight for
development and implementation of the Region I response for addressing needs
of youth who are homeless in Southern Maine. Hours have been expanded at the
teen day center and residential shelter so that youth have a safe place to
go off the streets, during the day and evening, seven days a week and can
connect with needed services. Linkages have been strengthened with the DHS
liaison position housed in the teen center. A new service approach was designed,
known as the HIP (Holistic Individualized Plan) Program, whereby youth obtain
intensive and coordinated guidance in setting and achieving life goals. Wraparound
funds are used to support these goals. RCC I created a community Service Review
Team that meets monthly to problem-solve challenging individual cases, and
developed a vocational model designed to engage youth in paid work experiences
and training.Next Steps for 2002
Continuing Challenges for 2003-2006
Adolescent
Suicide Prevention
Overview
Next Steps for 2002
Continuing
Challenges for 2003-2006
According to the 2002 Youth Risk Behavior Survey,
1 out of 10 Maine high school students reported attempting suicide, and 1
in 20 reported being treated medically for a suicide attempt. During the most
recent years for which data are available, Maine’s youth suicide rate has
come closer to the national average rate. Further progress will be directly
related to the program’s ability to maintain adequate support for program
activities including:Expanded Services For Youth Juvenile Offenders
Overview
Next Steps for 2002
Continuing Challenges for 2003-2006
Two Re-Designed Youth
Development Centers: Long Creek and Mountain View
Overview
Next Steps for 2002
Continuing Challenges for 2003-2006
HIV/AIDS/STIs
Overview
Next
Steps for 2002
Continuing
Challenges for 2003-2006
Childhood Lead Poisoning Reduction
Overview
Lead poisoning is still the most prevalent
environmental health disease among Maine’s preschool children, with one-and-two
year olds showing the highest rates of poisoning. Each year, almost 500 children
in Maine are identified with abnormally high levels of lead in their bodies
(> 10 µg/dl). Lead poisoning can lead to neurological problems such as
developmental delays, behavioral problems such as Attention Deficit Disorder
(ADD), and learning disabilities. Most children who are poisoned have no symptoms
initially. The only way to determine if a child is lead poisoned is through
a blood lead screening test. For this reason, it is recommended that all health
care providers routinely screen children at risk for lead exposures. Next Steps for 2002
Continuing challenges for 2003 - 2005
Ensuring the Public
Safety of Children
Overview
Next Steps for 2002
Continuing Challenges for 2003-2006
Youth
Advocacy Program
At the same time that the 31 YAP groups are working locally, together
they comprise a Statewide Youth Advocacy Network that can regularly share
ideas and successes, as well as look to coordinating efforts statewide in
the future. Next Steps 2002
[1] July 1999 report released by the Children’s Rights Council.
[2] Resolve 55. LD 2181. Resolve, to Help Homeless Young People Return to Home or Safe Living Situations.” Effective June 9, 1999.
[3] Chapter 778, LD 1623, An Act to Provide Services for Children in Need of Supervision. Effective May 10, 2000.
[4] For complete details on the development and work of the Children’s Cabinet, see the Cabinet’s 2001 Annual Report at the Children’s Cabinet website (see Appendix.)