COLUMBIA — After years of fostering mostly infants and younger children, Greenville nurse Jennifer Tice and her husband, Benjamin, knew that some foster kids, especially teenagers, were forced to sleep overnight in Department of Social Services offices.

About two years ago, when they agreed to take one of those teenagers as an emergency placement, they learned just how tough it can be.

The 15-year-old girl the Tices took into their home one weekend told them of sitting in a cubicle for hours as her case manager desperately tried to find a home for her, Jennifer Tice recounted. Finally, the girl fell asleep in the chair, only to awake to her traumatic story being retold over the phone time and time again and hearing families say they couldn’t take her in.

Jennifer Tice soon learned more.

Many offices don’t have beds, so they use air mattresses. One office told her they would have “upwards of six” children sleeping on mattresses in a conference room. Other department employees said they just wished they had a table kids could eat on during the long waits.

What Tice was hearing about was the beginnings of a surge in children forced by an acute shortage of foster homes to sleep in state offices or be shuttled around South Carolina to a succession of temporary homes.

As The Post and Courier reported this week, the problem of children staying overnight at state offices began to emerge in earnest around the time Tice learned more about it — in late 2021 and early 2022. After initially tamping down the problem, it’s soared since the beginning of this year.

In March, 16 children spent 49 nights in offices. By May, just over 50 children spent 144 nights in offices. In June, 62 children spent 251 nights in offices, according to the independent monitors’ report. Foster kids spent 132 nights in offices in July, a sharp drop from the month before, said Emily Medere, deputy state director for child welfare services. The state said earlier this year it needs 2,000 more foster homes to meet demand.

“As a mama, I could not stand the idea of a child that’s already been through a traumatic experience separated from their biological family … and only having an air mattress to sleep on,” Tice said. “I can only imagine it makes them feel like, ‘Who’s thinking about me?’ ”

Report points to mental health crisis

The foster home shortage and the kids sleeping on office floors that result are problems all over the country, not just South Carolina, and have been building for years.

About half of U.S. states have only half the foster families they need, said Serita Cox, co-founder and CEO of iFoster, a national group that provides support to foster families.

North Carolina has seen the number of licensed foster homes fall from about 7,000 to 5,500 since the COVID-19 pandemic, leading counties and community organizations to buy property to keep kids in while they wait for a home, Gaile Osborne, the executive director of the Foster Family Alliance of North Carolina, told The Post and Courier.

Experts and state officials agree it was the pandemic that pushed the system beyond the brink.

“When schools closed down, all of a sudden foster parents are homeschooling their foster children, which they didn’t sign up to do,” Cox said. “You can’t just call up a babysitter. To take care of a foster child, you need another licensed foster parent to come in and take care of the kids just for you to go on a date night.”

The burnout thinned the ranks of foster parents significantly, and because the pandemic also impeded recruitment efforts, their places often went unfilled.

“We’re just constantly chasing our tails trying to get these foster care homes up and running,” said Cindy Bogan-Baber, president of the Berkeley County Foster Parents Association. She is currently fostering three children.

Cindy Bogan-Baber (center) laughs while sitting on the couch and talking to her two adopted sons, Josiah Baber, 7, and Jeremiah Baber, 10, at their home on Aug. 1, 2023, in Summerville. File/Gavin McIntyre/Staff

By Gavin McIntyre gmcintyre@postandcourier.com

At the same time, the children coming into the department’s care are increasingly teenagers with mental and behavior health challenges who require intensive support that many foster families are unable to provide. Those are also the children most likely to end up on an air mattress in a conference room.

Of the 109 children that slept overnight in an office from April to June this year, 79 percent had a mental health diagnosis, 31 percent had a history of suicidal thoughts and 15 percent had active substance abuse problems, the monitors’ report found.

The key cause of the latest instability in the foster care system, the report concluded, is South Carolina’s dearth of mental health care for children.

“Finding a child psychiatrist is like finding a leprechaun,” one department case manager told the monitors. South Carolina is the lowest-ranked state in the country for youth diagnosed with major depression who do not receive treatment, the report found.

The pandemic accelerated trends of declining mental health among youth, which plunged headlong into the Palmetto State’s treatment void.

There are not enough mental health care specialists in the state, especially in rural areas. South Carolina has only one 24-hour crisis stabilization unit, but it is only open to adults, and the state has had a moratorium on developing new rehabilitative behavioral health services since 2015, according to the report.

The state’s leaders have said improving mental health services is a key priority, and the state’s new 988 crisis hotline is showing promise.

Yet parents’ desperation has become so great, they are increasingly refusing to take their children back into custody after they are hospitalized for a mental health crisis because they cannot care for them, leaving them in the care of the department, the report found.

“Some of these parents are willing to submit to allegations of child neglect because they are desperate for help for their child,” the report said.

Those children, with acute mental health needs, are very difficult to place with foster families and are more likely to bounce from home to home when they are placed, leading to the current crisis.

Troublingly, the monitors found the crisis feeds on itself: The longer children don’t have a stable home, the worse their mental health and behaviors become, making them ever harder to place.

“Though DSS leadership has been rallying staff in a collective effort to stem the crisis for months, a severe insufficiency of services and supports for families is fundamentally preventing progress,” the report states.

Department searches for solutions

S.C. Department of Social Services Director Michael Leach. File/Provided

Provided

Michael Leach, director of the Department of Social Services, told The Post and Courier this month he is well aware of the problems, and the department is doing its best to address them.

The department is providing families with the most-challenging children 24/7 crisis support, extra training and a behavioral specialist; began providing day services in the Midlands; resumed directly recruiting foster parents and contracted with a third-party organization to work on keeping children in a consistent home, officials said.

The department has begun building out its own youth mental health support system to tackle the problem at its root, he said.

“I think it’ll take time for us to be able to expand all of those before we see a marked impact,” said Medere, the deputy director.

Monitors urged the department to go further. It should pay full-time professional foster parents, redouble their already successful efforts to place foster children with relatives and work with law enforcement to reduce unnecessary child removals. It calls on the rest of state government to act swiftly to improve the state’s mental health care system.

In May, Gov. Henry McMaster signed a bill that allows the department to provide relatives who care for foster children with the same reimbursements foster families receive. That could play a crucial role in alleviating the crisis by making it easier for relatives to take in children, said Cox of iFoster.

But Jennifer Tice wasn’t willing to wait. In March 2022, she and her husband resolved to do something.

Working with the support of the Upstate business community and the department, they began renovating department offices, adding couches, rocking chairs, tables, TVs, Nintendo Switches, books and beds — real ones.

In March 2022, Jennifer and Benjamin Tice, foster parents from Greenville, founded a nonprofit called Lily Pad when they learned that foster kids were sleeping on air mattresses in conference rooms when they couldn’t find a stable home. Since then they’ve been renovating county Department of Social Services offices to make them more comfortable. At left is a “before” picture of the Anderson County office, and at right is an “after” photo. Lily Pad/Provided

“They go from just having an air mattress in a cubicle to having an entire room that doesn’t even look like they’re in an office,” she said.

They’ve renovated eight county offices, all in the Upstate, but have an aggressive plan to reach the rest of the state. But it’s a problem Tice said she’s sad it even needs to be solved in the first place.

“If we ever get to a point where these rooms aren’t used for overnights, then praise the Lord,” she said.

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Michigan’s air quality is generally pretty good.

But Canadian wildfires in Quebec last week created hazy, smoky conditions that brought the air quality index (AQI) to levels not generally seen in the state and other parts of the America’s Midwest.

“When it comes to the air quality index the lower the number the better. Normally, we’re probably in the 30s and 40s. That’s not bad,” Dr. Devang Doshi, an allergist with Corewell Health Royal Oak said. “But last week we were in the 160s and unfortunately that created problems for a lot of people with respiratory ailments and heart conditions.”

Other allergists and physicians at area hospitals and emergency rooms reported slight increases in the number of asthma and exacerbation and respiratory issues, possibly caused by the fires but also extremely high pollen conditions.

“People were just miserable,” Doshi said.

A satellite image taken Wednesday, June 7, 2023, provided by CSU/CIRA & NOAA, shows a broad view of smoke from Canadian wildfires drifting across Michigan and other parts of the Midwest prompting an air quality alert. Photo courtesy of CSU/CIRA & NOAA via AP

How bad was it?

Elevated levels in parts of southeastern Michigan prompted the Michigan Department of Environment, Great Lakes, and Energy to declare an air quality alert for June 8-9.

“It was the first air quality alert that we’ve done in the last decade,” said Kyle Klein, a meteorologist with the National Weather Service in White Lake Township.

The unusually poor conditions prompted the cancellation of numerous outdoor activities.

In Major League Baseball, a Detroit Tigers game at Philadelphia was called off,  as was the Belmont, which is the final leg of horse racing’s Triple Crown.

Areas of Macomb and Oakland counties also saw outdoor events canceled due to the poor air quality alert.

“I wouldn’t be surprised if we see these alerts issued again,” Klein said, noting with the first day of summer next week will come hot and dry conditions that are expected to last.

During July, August and September temperatures throughout Michigan are predicted to be high while remaining below average for precipitation. Klein said what we will be experiencing here in the next three months is likely to be the same as conditions in Canada.

The numbers

In the past six weeks, wildfires in Canada have not only impacted air quality but sparked a great deal of discussion about current conditions across the U.S., where air quality has been poor for some time.

According to an analysis by QuoteWizard.com, the five most polluted states based on air quality and drinking water quality are:

• New Mexico

• Oklahoma

• Mississippi

• Arizona

• New Jersey

Michigan was ranked 22nd overall for air and drinking water pollution while Hawaii and North Dakota were found to have the lowest pollution levels.

In determining the rankings QuoteWizard analysts evaluated the Environmental Protection Agency’s (EPA) Air Quality Index (AQI) measurements for 2022. In determining the percentages of good days the team analyzed data related to five pollutants covered by the AQI including: Ozone (O3), Particulate matter (PM10 and PM2.5), Carbon monoxide (CO), Nitrogen dioxide (NO2) and Sulfur dioxide (SO2).

Other key findings showed:

• Air quality is the worst in California, followed by New Mexico and Arizona.

• In 2022, California had a total of 67% “good” air quality days, while Hawaii had 99%.

• West Virginia, New Jersey and Mississippi have the most polluted water.

• Over 10% of the population in West Virginia was affected by drinking water violations.

• Thirteen states had zero drinking water violations in 2021.

Canada’s wildfires

There are currently more than 400 wildfires burning across Canada, according to a report by the Guardian.

“The ‘fire season’, when weather conditions are ripe for conflagrations, has only just begun. A third of the fires are in the boreal forest in the eastern province of Quebec, a place not used to dealing with large blazes,” according to the report.

Michigan experienced a good dousing of rain on Thursday — but Quebec did not get enough to douse the flames.

Fires are now burning in every Canadian province and territory except for Prince Edward Island and Nunavut, a frigid northern region where trees cannot survive. The amount of land consumed is also striking – more than 5.4 million acres have burned so far this year (since the start of the worst fire season in decades).

About 5,000 firefighters from other countries, including the U.S. and France, have been deployed across Canada, while teams from Chile and Costa Rica are expected in the coming days.

Dr. Devang Doshi, an allergist at Corewell Health Royal Oak examines Julian Bright. Both Julian and his mother, Jessica Bright of Shelby Township have asthma and are among those most vulnerable during poor air quality conditions. Photo courtesy of Corewell Health

Health risks

Poor air quality is especially difficult for individuals with cardiovascular and respiratory conditions like asthma or chronic obstructive pulmonary disease (COPD).

Last week’s conditions forced many people indoors, where air quality can be controlled and even improved with air purifiers and filtration systems.

Among the companies that specialize in air quality is C & C Heating and Air Conditioning in Roseville. Dayna Hottle, a company spokesperson, whose grandfather and great uncle started the business in 1948, said they saw their numbers doubled at the start of COVID-19 but have not seen a huge increase due to the fires. However, that could change during the summer months if the conditions persist.

Of those who ventured outdoors while the orange haze engulfed Michigan many experienced a variety of symptoms including throat irritation, coughs, watery eyes and a runny nose.

Doshi said the best course of action in the coming months is to be mindful of the conditions in your area and consider a few healthful measures:

• Check the weather or AirNow app on your phone to determine the AQI count for the day

• If you have respiratory issues make sure it’s safe to be outdoors

• When poor air quality conditions exist minimize your time outdoors

• Also be mindful of bringing pets indoors

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LADSON — Before the first patient walks through the door, Live Oak Mental Health and Wellness is already on the radar of families across the state, activist Kelly Troyer said.

She is fielding calls from Greenville, Rock Hill and Myrtle Beach from parents like her who are checking their insurance to see if they can get their child in the first free-standing behavioral health hospital to open in the Lowcountry in more than 30 years.

“Is it open yet?” Troyer is asked. It will be June 6, and officials with Trident Health System are already eyeing plans to expand from 60 beds to 84, and have space behind to build more.

The need is readily apparent at Trident Medical Center, where the inpatient behavioral health unit of 25 beds is constantly full, said Trident Health CEO Christina Oh. It is why this $47.5 million investment now is so important, she said.

In the decades since a new facility opened, “we know mental health needs haven’t gone down as the population has grown and become more stressed out,” Oh said.

That is particularly true since the pandemic and the shortage of mental health beds has become worse, especially for children and adolescents, said Mark Binkley, executive project manager for the South Carolina Department of Mental Health.

“Even children with insurance, a lot of times there are not enough adolescent beds because of the really dramatic surge recently in kids getting into behavioral health crises,” he said. “They wind up in community hospital emergency departments. It’s a national issue.”

Living quarters feature a common area and large windows at Live Oak Mental Health and Wellness, part of Trident Health System, in Ladson. The center, pictured May 31, 2023,  focuses on the safety and comfort of all residents and employees. Laura Bilson/Staff

Laura Bilson/lbilson@postandcourier.com

Since the pandemic began, 37.1 percent of high school students reported worse mental health, 44.2 percent had persistent feelings of sadness or hopelessness, nearly one in five thought seriously about suicide and 9 percent actually tried it, according to the Adolescent Behaviors and Experiences Survey in 2022.

Some of those kids who seek help wind up in emergency departments for days or weeks seeking a mental health bed, Binkley said. It’s one reason the state mental health department, working in partnership with the Spartanburg Behavioral Health Coalition, is creating a resource for kids in crisis that would serve Spartanburg, Cherokee and Union counties. It would serve as a kind of Crisis Stabilization Unit where kids could be referred for assessment, crisis intervention and therapy, and peer and family support.

One whole wing of Live Oak is dedicated to adolescents, children age 12 and up, because of the need, Oh said.

“It’s encouraging to me to see that young people in our community will have that access so they are not waiting in a hospital emergency department or having to travel across multiple state lines to get care,” she said.

And it will be able to serve as a statewide resource, as it will have a crisis intake team available around the clock to assess patients, not only in the Lowcountry, but also by telehealth for those farther away, Oh said. 

Live Oak Mental Health and Wellness in Berkeley County will help fill a gap in beds. Provided

“(The goal is) to help patients get a bed quickly,” she said. “People are not getting better as they are (waiting) in an ER holding area.”

Once they get to Live Oak, they will find a very different facility, said Rick Paczkowski, regional vice president in the behavioral health service line for HCA Healthcare, Trident’s parent company. The goal was to get away from the institutional, cinder block-heavy look and provide a “softer” look to the interior, he said.

Art supplies are pictured at Live Oak Mental Health and Wellness, part of Trident Health System, in Ladson on May 31, 2023. The center will be the first behavioral health hospital to open in the Lowcountry in more than 30 years. Laura Bilson/Staff

Laura Bilson/lbilson@postandcourier.com

Troyer, the mother and health advocate, notes the rounded edges on hard surfaces like desks and a lack of plexiglass separating staff and patients that is often seen in other hospitals. 

“It makes people who are here feel like patients instead of criminals,” said Troyer, whose son has been institutionalized multiple times. “I think that is so important. And it helps in people’s recovery, that they are getting help and they’re not being taken to jail. Having it here is a breath of fresh air.”

It is something HCA has been developing in this arena to move from a feel of a psychiatric hospital to one that is focused on, as the name says, mental health and wellness, Paczkowski said. 

“The wellness part of that is so important,” he said.

Central to the facility in both design and feel is a large inner courtyard that can be used by patients for exercise and group therapy sessions or just getting outside for sunshine, which aid the healing, Troyer said. Her son was in a facility that had an inner courtyard but it was surrounded by a 14-foot fence.

“It looked like a prison yard,” she said. “And this looks like a recreation space.”

Outdoor spaces add to the therapeutic feel of Live Oak Mental Health and Wellness, part of Trident Health System, in Ladson on May 31, 2023. The center will be the first behavioral health hospital to open in the Lowcountry in 30 years. Laura Bilson/Staff

Laura Bilson/lbilson@postandcourier.com

Many patient rooms look out on woods or the inner courtyard. But they are also designed for safety — doors swing both ways on the bathrooms and patient rooms, to prevent patients from barricading themselves in, said Melissa Camp, director of clinical operations at Live Oak. Hinges and door handles are designed to foil hanging attempts. The hallways have a good line of sight from the nursing stations.

But the emphasis is on working with patients, said David Was, chief operating officer for Live Oak.

“We are focused on proactively engaging with our patients,” he said. “We truly want them to get well.”

Patients are also engaged in their care. When appropriate, they will go to the cafeteria for meals instead of passively having meals brought to their rooms, Paczkowski said. The idea is to build a sense of community.

“What says community more than breaking bread together?” he said.

Randy Gaspard chops bell peppers in the kitchen of Live Oak Mental Health and Wellness, part of Trident Health System, in Ladson on May 31, 2023. The center will be the first behavioral health hospital to open in the Lowcountry in more than 30 years. Laura Bilson/Staff

Laura Bilson/lbilson@postandcourier.com

In the units, patients will go up to a pharmacy to get their medications and talk with staff about them, instead of having them brought to their rooms under the passive old system, Camp said.

“This is very active,” she said, gesturing toward the counter, and more like the real-world pharmacy they will have when they are discharged. “So when they leave here, they know how to continue” their medication routine.

Live Oak will actually provide a spectrum of care that includes outpatient treatment, including intensive outpatient treatment, that can give patients another level of therapy, Paczkowski said.

Melissa Camp, director of clinical operations, and Kelly Troyer chat during a tour of Live Oak Mental Health and Wellness, part of Trident Health System, in Ladson on May 31, 2023. Laura Bilson/Staff

Laura Bilson/lbilson@postandcourier.com

“Having this continuum (of care) under one roof is an important thing, a one-stop-shop for keeping them under a single umbrella, following through on a consistent care plan,” he said.

That lessens the strain on patients and families of going from provider to provider, having to repeat stories and start over with new personnel, Troyer said. And it is less expensive not to redo it, she said.

“When I talk to legislators, I say, ‘That saves money,'” Troyer said. “That is going to save not only dollars but lives and the quality of life for so many people.”

Word about the innovations has already gotten out across the Palmetto State.

“That’s why everyone is calling me about this hospital, because they know it is different,” Troyer said.

But even after it opens, the area and the state will still be short of beds, Was said. By switching some private rooms to private, for two patients, the hospital will be able to go to 84 beds without any new construction Camp said.

That may happen sooner rather than later, Oh said.

As the referrals come in, “we’ll be reaching capacity quickly,” she said. But there is also land behind the facility.

“We certainly have the room to expand beyond 84,” Oh said.

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The airlines that will stand out during the upcoming busy spring and summer travel season are those that are ready to support today’s most frequent travelers.

According to a survey by Teleperformance Business Insights Lab, Millennials and Gen Zers are increasingly opting for a variety of digital channels such as instant messaging, video and text to negotiate air travel.

The changing face of business

Calling, email and web forms continue to be the customer service channels used most by airline travelers.

Notably however, nearly 70% of travelers who have contacted airline customer service before and after the pandemic say their interactions with airlines have changed since the ‘new normal’.

Almost a quarter of travelers (24%) now say they’re branching out and trying new channels to contact the airlines, and a quarter (26%) report using more self-help options to get the support.

Photo Credit: Jan Vašek from Pixabay

These findings derive from the Teleperformance Business Insights Lab Survey, in which 87,000 consumer interviews were conducted across 20 sectors and 16 countries.

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Now in its ninth year, the survey queried consumers across topics ranging from customer service channel preferences and metrics, including more than 4,800 airline customers.

Specifically, the online survey was conducted on 4,803 airline customers across 16 countries between August and September 2022.  

Survey participants had booked their flights and completed travel within the 12-month period preceding the survey date.  

For reliability, the survey was conducted in accordance with ICC/ESOMAR guidelines, with a sample population representative of general population for age and gender. 

The Business Insights Lab looked into travelers’ use of airline support channels and their preferences.

It aimed to help airlines understand how travelers want to be served and just what customer channels airlines should consider adding to their contact options.

Digital support channels are getting busier

One of the strong findings which came through from the survey was the increasing use of mobile apps and instant messaging facilities to contact airlines for customer support

Contacting airlines for help through an airline’s mobile app rose 29% since 2019.  Instant messaging with airlines’ customer service was up 71% since before the pandemic, and texting airlines grew 105%.

Travelers told Teleperformance they are also using other digital ways to seek help from airlines including automated chat and video.

These trends are more pronounced across younger demographics.  You can read additional findings from the survey here.  

“One of the most significant changes in the travel industry since the pandemic is the growing demand for flexibility among travelers,” said Rahul Jolly, President of Global Travel and Hospitality, Teleperformance.

“This includes a demand for more diverse contact options and travelers’ rising preference for digital channels that provide flexibility in how they receive help and support.”

“Building out and enhancing support capabilities across emerging digital channels can help airlines differentiate themselves, provide positive experiences and help customer retention.”

About Teleperformance GroupTeleperformance isa global leader in digital business services, serves as a strategic partner to the world’s largest companies in many industries.

It offers a One Office support services model including end-to-end digital solutions, which guarantee successful customer interaction and optimized business processes, anchored in a unique, comprehensive high touch, high tech approach.

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