The boy was a high school student, hyperactive and troubled, when he came into the state's foster-care system. At risk in his home, he needed a place to live, but he also needed special treatment that Maryland's foster-care system could not provide.
So the state sent him to a private institution in Virginia, at a cost of $97,800 a year. He became just one of the about 125 foster children annually whose special needs -- usually severe emotional problems -- force them out of state, at costs ranging from $40,000 to nearly $100,000.
Not only does out-of-state treatment rack up huge bills for the Department of Human Resources, it also makes it difficult for social workers to reunite the families, prolonging foster care -- and its costs.
The result is an expensive, vicious circle that affects up to 500 children, including those under agencies such as the Department of Health and Mental Hygiene, the Department of Juvenile Services and the Department of Education.
But DHR, working with four counties, Howard, Frederick, Montgomery and Prince George's, has decided to reverse that trend. In a pilot program underwritten with $200,000 from the state Department of Budget and Fiscal Planning, DHR is redesigning the way it provides services to such children.
Instead of making the youths fit existing programs, explained Steve Howe of DHR's Social Services Administration, social workers design one-of-a-kind service packages for the youths. The money spent on out-of-state care becomes a flexible checking account for the worker, whose only mandate is to bring the foster child back to Maryland at the same cost, or less.
"We think this is a critical effort that needs to be engulfing all of the [state] departments," said Nancy Grasmick, secretary for the Department of Juvenile Services and acting special secretary for the Office of Children, Youth and Families. All together, state agencies place about 500 children out of state.
"When you get a child out of state, there's a real mind-set that the child is going to be there year after year," she said. "There isn't the opportunity for reunification."
POP, as the program is known (Preventing Out-of-State Placements) dovetails with PUP (Preventing Unnecessary Placements), a DHR program that tries to keep children out of foster care.
"It's finally putting our money where everyone's mouth has been forever," Howe said of these new services.
Take the example of the Montgomery County teen-ager who had to be institutionalized in Virginia, he said. His social worker found a family willing to take on a foster child with special needs, arranged for therapy and enrolled him in vocational classes.
She also put him in a martial arts class, to help him with his concentration and impulse control.
"It works," Howe said. "He learned through martial arts how to focus his energy." The teen-ager ended up leaving the foster home at age 18 and is now living on his own.
Other success stories in the pilot program include:
* A child whose poor behavior was largely the result of a chemical imbalance had been placed in an out-of-state institution where his diet could be strictly controlled. His social worker found foster parents for him, then hired a nutritionist to consult with the family once a week. The cost for the boy's care dropped from $74,800 to $43,400.
* A 13-year-old who had been sent to Pennsylvania was able to return to Maryland with a package of services that included tutoring and summer camp, along with parenting classes for his mother. His cost to the state went from $47,000 a year to $37,600. "More importantly, we now have him back in state and our plan is [for him to] return home," Howe said.
So far, six foster children have returned to Maryland under the pilot program, all from Prince George's and Montgomery counties. By year's end, an additional eight are expected to return, Howe said.
In a department plagued by deficits, the money saved may seem to be the primary reason for PUP, Howe said. But it's not the program's sole focus.
"Yes, we may get 100 pennies back," he said. "We also get the child in closer proximity to the parents.
The program also gives power back to social workers, Howe said. "The caseworkers get real creative. They all know what their kids need."
Howe played with the analogy of taking services for foster children from one state-operated convenience store to a huge mall, where social workers can go from store to store, picking and choosing what the children need.
He said the workers can offer foster parents much larger stipends in these cases. Parents with special skills or knowledge -- along with what Howe calls "good old-fashioned patience" -- can be offered up to $14,000 annually to care for these foster children.
Howe hopes to expand the program statewide eventually, especially to Baltimore, which accounts for the majority of Maryland's out-of-state foster-care placements. But can the state realistically hope to prevent all out-of-state placements?
"I'd like to think we could," Howe said slowly. "I'm not ready to say no yet. They're being served somewhere, so why can't we serve them here?"