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Audit found kids in Maryland's foster care system may not always get regular medical treatment

The Maryland Department of Human Services in Baltimore office.
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The Maryland Department of Human Services in Baltimore office.

A recent audit of the state agency responsible for the foster care system and protecting children from abuse found widespread deficiencies — from kids in foster care going without medical services to abuse allegations going unchecked.

WYPR reporter Rachel Baye joined Nathan Sterner to discuss some of these findings.


The focus of this audit is the Social Services Administration, which is part of the state Department of Human Services and oversees all of local social services agencies. I understand this audit is a follow up from an audit done last year?


Actually, the problems go back even further. The Office of Legislative Audits, which reports to the General Assembly, looked at the Social Services Administration back in 2017 and found 14 different problems. These ranged from inadequate monitoring of foster care providers to not making sure local social services departments were investigating allegations of child abuse in a timely fashion.

When the auditors went back last year, eight of those 14 problems still existed.

So this week, they released yet another audit looking at the six most significant remaining issues. Of those, the agency has still not fixed three, including the two you referenced: They are not making sure local social services agencies are following up on abuse allegations or are providing children in the foster care system with legally required services.


When you say children in the foster care system are not getting legally required services, what kinds of services are we talking about?


I spoke with Josh Adler, an assistant director with the Office of Legislative Audits. He offered this explanation:


Was there a medical exam within one year? Was there a dental exam within six months? Was the child attending school during the current year? Were there efforts to place the child with relatives? Was there a legal basis for the child entering foster care? Those are all the things that we look for during the audit, and many times, we just didn't — there was no evidence that happened.


According to the audit, the Social Services Administration routinely generated reports identifying children who were missing some of these services, but the agency did not follow up with the local social services departments to make sure the issues got resolved.

And to give you a sense of scale, as of the middle of March of this year, 254 children — roughly a third of the children in the foster care system — were overdue for medical exams.

Thirty children had not had a medical exam since 2019.


What was the Social Services Administration’s response to the audit?


A spokeswoman for the agency was not able to make someone available for an interview or answer questions before my deadline.

In their written response, the agency said that since October, it has been checking weekly to make sure children are going to school, and that it is in the process of making sure all of the children get their annual physicals.

The agency also seemed to blame poor record keeping for past issues related to both the foster care system and child abuse investigations.

But that explanation didn’t sit right with Adler.


“There are a couple of problems going on here. Number one … the record keeping is not that good. It's frequently inaccurate. So that's problem number one. Problem number two: So if they corrected the record keeping issue, then that would be one thing, but we, from our experience since 2017, it has not, it has absolutely not been a record keeping issue. It is an issue of the kids not getting these services.”


So what’s the next step here?


The audit report was sent to the legislature’s Joint Audit and Evaluation Committee, and next steps are really up to the lawmakers. I spoke with Senator Clarence Lam, the committee’s Senate chair. He said he expects the committee will want to see some kind of follow-through from the Department of Human Services. That could mean we have public hearings.

Lam also expressed frustration that some of the same problems continue to go unaddressed for years.


“We need to understand what the issues are. Are they just understaffed? Do they not have the right equipment? Do they have systems that can't talk to each other? What is at the core of all these problems that allow them to continue to fester on like this?”


The children who rely on the Social Services Administration often don’t have anyone advocating for them, and Lam said it’s really up to the legislature to make sure the state agency is properly caring for them.


Thanks, Rachel.


My pleasure.

After the radio story deadline, the state office offered further responses below.

Katherine Morris, spokeswoman for the Department of Human Services, provided additional written comments in an email Thursday evening.

Morris wrote that the audit investigated whether or not the agency documented services, not whether the services were provided. In August 2021, the state agency created an “internal audit compliance unit” to monitor local social services departments.

In the foster care system, “Children are receiving the legally mandated medical, dental and educational services,” she wrote. “In instances where services are not documented, there are a number of reasons that required documentation may not be in the child’s case file, for example, a youth refusing to go to a medical or dental appointment or a lack of providers in the area, preventing a caseworker from getting an appointment within mandated timeframes.”

And she said the agency “makes every effort” to conduct timely investigations into alleged abuse.

“The practice of child welfare is inherently complex, and there are a number of reasons why documentation may be incomplete,” she said. “For example, an alleged victim may have been seen, but other children in the household may be unreachable, or a caregiver may be at work when the caseworker conducts a visit and is not immediately reachable within the mandated timeframes.”

Read the recent investigative audit below.

Rachel Baye is a senior reporter and editor in WYPR's newsroom. @RachelBaye
WYPR's Morning Edition news anchor Ashley Sterner serves up the latest Maryland news and weather every weekday morning, delightfully interspersed with the occasional snarky comment.
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