Effectively Addressing Mental Health Issues in Permanency-Focused Child Welfare Practice
Ornelas, Laura A., Silverstein, Deborah N., Tan, Sherylle, Child Welfare
Children and families built by adoption or relative caregiving have specialized needs. This paper proposes a rubric for the central elements of permanency-focused mental health services in child welfare practice. Kinship Center provides an innovative mental health service delivery system, weaving foster and adoptive placement programs, adoption specialty Wraparound1, and a relative caregiver support program into its permanency-focused children's clinics. Named a 'promising practice' in child behavioral health services (McCarthy & McCullough, 2003), Kinship Center's mental health clinics are publicly funded and are a significant contribution to a managed care behavioral health approach in three diverse California counties. Six years of clinical outcomes data provide promising preliminary information for the field.
Children and families built by adoption or relative caregiving have specialized, yet wide-ranging needs. The AFCARS Report (2006) indicates that in September, 2005, 513,000 children lived in foster care nationwide with a median age of 10.6 years. Thirty-two percent of these children were under six years of age. Three hundred eleven thousand children entered foster care in that year while 287,000 exited. The goal for 20% of these children was adoption; for 3%, guardianship was the permanent plan. One hundred fourteen thousand children were in foster care awaiting adoption (identified as having parental rights terminated and less than 16 years of age). Half of those children had been waiting 30 months or more for adoption. Fifty-two percent were boys and 48% girls. Thirty-two percent were African American; 18% Latino, and 41% were white. Ultimately, their foster parents adopted 60% of the waiting children. These statistics illustrate the broad range of children in the United States foster care system moving into permanence via adoption and guardianship with, because of their histories, a potentially critical need for services immediately or significantly after they are permanently placed.
In general, the mental health needs of foster children are grossly neglected in the current system, including the need for screenings and appropriate interventions based on specific knowledge of this at-risk population. Early Periodic Screening, Diagnosis, and Treatment (EPSDT/Medicaid), the federally mandated program designed to meet the health and mental health needs of this population, is greatly underused in caring for the health and mental health needs of foster children. Nationally, too few providers are trained (Sass & Henderson, 2000) and skilled in this area, and EPSDT/Medicaid providers are in short supply because of the low rates of reimbursement.
Furthermore, the lack of recognition or knowledge by professionals about whether or how adoption plays into one's mental health or treatment needs may account for the lack of specialty services. Henderson (2002) remarks, the "under-representation of adoption in mental health literature" (p.133) indicates a variety of reasons exist for the mental health community to avoid discussions around the possible mental health needs of foster and former foster children. Henderson (2002) cites possible biases including: the "feel-good" model (adoption should be a positive remedy); professional pride in the adoption solution; reluctance to pathologize a socially sanctioned outcome, and denial of the influence of race and privacy issues. Further, the child's preadoption experience, which is frequently unknown or misunderstood, clearly has an impact on the general outcome of the adoption, and, even more relevant for purposes of this paper, on the need for specialized mental health services upon permanent placement.
Development of the Need
Historically, as more and more children who otherwise might have grown up in the foster care system moved into permanent families, adoptive parents began reporting difficulties and requesting assistance. A lack of public responsiveness has occurred despite the fact that adoptive parents do request a variety of services (State of Illinois, 1989; Thomas, 1998), with mental health services being at or near the top of the list. …