In a small basement classroom of the Christ Child Institute for the emotionally disturbed in Rockville, teacher Dena Baker and six young children held a junk sale last Friday morning.
"We're trying to save our school," said one blond-haired boy. "If we don't save it, at least we can say we tried."
The 40 cents they made was enough for a trip to the 7-Eleven for a Coke, but it was not enough to save the school. The program at Christ Child, which provided residential treatment for 23 emotionally disturbed children and day treatment for 12 more, will end June 29.
The problems that led to the school's demise are typical of the confused state of care for 3,500 emotionally disturbed children in Maryland. The children, of normal or above-normal intelligence, require special education programs with psychiatric support; the severely disturbed youngsters need residential treatment. The object of most programs is to prepare children to enter or return to normal schools.
Staff members at Christ Child are trying to find other programs in which to place the students before the June closing. Last month, the Prince George's school board decided to withdraw its support for Cheltenham, the largest facility for emotionally disturbed children in that county. Montgomery County delegates are now protesting a state health department plan to reserve 24 beds in the Regional Institute for Adolescents and Children (RICA) in Rockville for emotionally disturbed children from Prince George's.
In the meantime, a plan for a new institution in Prince George's and another for the emotionally disturbed children of Calvert, Charles and St. Mary's counties has foundered. Existing institutions are faced with decreasing funds and long waiting lists. Rockville RICA Administrator John Gilden estimates more than 60 adolescents, now in institutions and programs that do not adequately serve their needs, are waiting to get into his facility.
Jurisdictional squabbles and rivalries are at the root of many of the problems, say experts. State departments of health, education and human resources all deal with the children, as do several county-level departments and agencies. If an emotionally disturbed child runs into trouble with the law, Juvenile Services officials and the court system also become involved.
"There are so many different planning groups. If you take them seriously you're doing a disservice" to the emotionally disturbed, said Dick Dunn, president of the Prince George's Coalition for the Disabled. Dunn said he resigned "in protest" from his position as state coordinator of services to the handicapped in February because he was so disgusted.
In an October 1980 letter to Gov. Harry R. Hughes, the director of the state's Office for Children and Youth, Howard Bluth, described care for emotionally disturbed children as a "patchwork system that cannot help but fragment the child." He wrote that the "labeling game" is typical: "Armed with numerous labels available for categorizing the child, or the child's problem, a resource-deficient agency will do everything possible to screen out a case by labeling it in a way that another agency or program has to assume responsibility."
So varied are methods of classification that it is impossible to get a clear idea of the number of children involved. According to statistics compiled a year ago, for instance, 587 children and adolescents were classified as emotionally disabled in Montgomery County. In Prince George's, which had almost 25 percent more children and adolescents in the total population, only 278 were so classified.
Sanford Bienen, assistant director of the Department of Health and Mental Hygiene in Southern Maryland, says the worst outcome of overlapping responsibility "is that kids don't get the services they need, or they have to wait a long time to get them, or they get sent to agencies that are inappropriate. Kids have often been hurt in the process."
Christ Child Director Kathy M. Brown said that without treatment, emotionally disturbed children "can't make it in a job. Some are going to end up in state institutions the rest of their lives. Some will get into criminal activity. The cost is pretty great in terms of dollars -- and the waste of lives."
William C. Litsinger Jr., assistant director of the state's Juvenile Services, an agency that deals with hundreds of emotionally disturbed children each year, said "resources are desperately needed." Juvenile Services lost $230,839 through budget cuts this year, including $140,714 earmarked to pay for residential treatment for 10 children. Next January, regulation changes in the federal "right to education" law, which provides about 10 percent of Maryland's special education funds, are expected to cut funding for special education programs, including those for the emotionally disturbed.
The limited facilities mean that some children must be placed in institutions outside the state, although specialists agree that it is in the youngsters' best interests to be cared for nearer home. Last year more emotionally disturbed children from Prince George's were receiving residential treatment in facilities spread from nearby Virginia to faraway Texas (76) than in-state (69).
Brown, of the Christ Child Institute, said lack of coordination by controlling organizations has added to the high cost of care that is bringing her program to a close.
She names no fewer than 10 organizations and agencies, ranging from the state Department of Health and Mental Hygiene to assorted local departments of education, that inspect the institute. She says she doesn't disapprove of scrutiny but "all this adds to the cost."
Last February, Brown said, representatives from the Joint Commission on Hospitals made a three-day inspection. They recommended a particular type of window for the "quiet room" (a room where children go when they need to calm down).
"Two weeks later two people from CHAMPUS (a medical program for children of military personnel) came and made different recommendations about the same window," she said. "Last month, the fire marshal had recommendations about the same window. They were not the same recommendations."
Brown already had changed the window once. So she ordered it changed again.
Conflicting aims of controlling organizations led to the Prince George's school board's decision to withdraw educational support from Cheltenham next June. The Department of Health and Mental Hygiene, without providing additional funds, had directed Cheltenham to accept children ordered to special facilities by a court.
State Sen. Julian L. Lapides (D-Baltimore), chairman of the legislative commission on the emotionally disabled, said he was shocked to learn of inadequate and unequal treatment of emotionally disturbed children, especially in preventive and day care.