Judges Endorse Principles On Foster-Care MH Services
The national organization representing judges who preside over child foster-care placement has given its stamp of approval to a statement of principles on mental health and substance abuse services for children in foster care and their families.
The statement was developed by the American Academy of Child and Adolescent Psychiatry (AACAP) and the Child Welfare League of America (CWLA), as part of an ongoing collaborative initiative to meet the mental health needs of children in the foster-care system.
The initiative has grown to include more than 70 organizations, including APA.
Now, the National Council of Juvenile and Family Court Judges has passed a resolution endorsing the collaboration, and the statement of principles and values, during its annual conference in San Antonio in July.
The council’s resolution urges the values and principles embodied in the AACAP-CWLA statement to be used “whenever possible. . .to guide reform and innovation as we work collaboratively to improve the outcomes and well-being of these children and their families.”
The council’s resolution endorses an initiative that leaders of AACAP and CWLA say is a groundbreaking effort to bring together mental health experts and the full range of people involved in foster-care placement. And it bestows on the initiative the imprimatur of pivotal decision makers in the foster-care system.
“The family court judges are the arbitrators for all the decisions that get made about children and their families,” said Steve Hornberger, M.S.W., director of behavioral health at CWLA. “They preside over hearings before there is a placement and periodically throughout the child’s stay in foster care to make sure everyone is working in the interest of the child.
“Nothing in foster care happens without the judges,” Hornberger added.
The AACAP-CWLA initiative is an effort to address in a comprehensive way the mental health needs of approximately 570,000 children in foster care and their families.
Hornberger said studies suggest that mental illness or substance abuse affects 40 percent to 85 percent of children placed in foster care, but definitive data are lacking since state agencies do not collect information on the mental health status of children or families.
But he said the burden of mental illness is apparent to all who are closely involved in foster care.
Systems Operate in Separate Silos
“The prevalence, intensity, and severity of the mental health needs of foster children have been more than the child welfare system has been able to address,” Hornberger said. “Historically, the mental health and child welfare systems stayed separate in their silos and fragmented.”
Led by AACAP President Marilyn Benoit, M.D., the initiative has grown to include more than 70 groups, meeting six times and including representatives from virtually every constituency involved in foster care.
Benoit told Psychiatric News that the group is seeking funding to continue as a permanent, multidisciplinary body. “We are going to government and nongovernmental funding agencies so that we might become the first entity addressing foster care that is national in scope and broadly multidisciplinary,” she said. “We really have the leaders to form a major national constituency.”
Child-Centered Perspective Urged
An overriding theme of the values and principles developed by the collaborative group and endorsed by the Council of Family Judges is the need for a “child-centered” approach to foster-care placement and treatment for the trauma that accompanies such placement.
“We think the child has been forgotten in the system,” Benoit told Psychiatric News. “It is designed to protect children, but it has become so bureaucratized and so inflexible that the child has become lost, and things get done to serve the purposes of the system, not the child.”
She cited an example of a child who had been placed in the care of an aunt, who had “worked very hard to understand” and respond to the child’s needs.
Later, another family member got in trouble and needed a place to stay. The aunt invited the family member in, but the added household member upset the official person-per-square-foot ratio, requiring a new placement for the child, according to the system’s regulations.
“Instead of trying to work with the family, they yanked the child because there was no longer the proscribed square footage of space in the house,” Benoit said.
She and other initiative leaders reported that several new documents are being prepared by work groups for a “tool kit” that can be used by “frontline staff”—the child welfare workers who first respond to a crisis situation—and others in the foster-care system.
Still in draft form, the documents highlight the group’s focus on what psychiatrist Francine Cournos, M.D., called “the inner, subjective life of the child” who is invariably traumatized by the experience of placement in a strange family—even when the placement may be lifesaving.
Firsthand Experience Shaped Views
Cournos, who was herself a foster child and has written about her experience in a memoir titled City of One, said the child welfare system is focused on “rescue” of the child—frequently from an abusive family situation.
But that singular focus, she said, can cause social service workers and others to lose sight of the fact that the placement process itself is a frightening and traumatic experience for the child. “It is so hard to keep in mind the inner subjective experience of the child,” she said, “because from the system’s point of view the most important thing is being physically safe.”
The appearance of strange people in the household and the sudden move to a strange family—in addition to the fact that many foster children may have multiple placements over a period of years—can be a terrifying, disorienting, and alienating experience.
It was so for Cournos, who was not removed from her family of origin because of abuse. “I felt like a piece of furniture,” she said. Cournos is part of a work group that is developing a document specifically for the foster child, “First 30 Days Guidebook: A Guidebook for Foster Children.”
The document would be presented in book form to a child at the time of placement and is intended as a kind of “memory book” wherein the child may record his or her own feelings about the experience as it happens. The book will also include questions and exercises that allow the child to record information about him or herself: favorite foods, colors, playthings, television shows.
“It’s a way to help the child make sense of the experience, and something for the child to take from one placement to another,” Cournos said. “It’s also a way for the kids to communicate with their foster parents and express their needs in a systematic way.”
A second document for the tool kit, also in draft form, is called “First Responder Guidelines for Initial Screening of Emergency and Urgent Mental Health/Alcohol and Other Drug-Related Issues in Children Being Removed From Their Homes.”
Benoit said the guidelines will be specific, offering what amounts to a script for first responders. She notes that many of the personnel who are first responders to a crisis may be called “social workers,” but may actually have limited social-work training—so that some fundamental skills in responding to the child’s subjective experience may be lacking.
“The child can have no idea what it means when strangers come into the house saying they want to take him or her to a safe place,” Benoit said. “So we have focused on the nitty-gritty, really scripting for first responders what they should say—little things like introducing oneself and explaining to the child why this is happening.”
The statement on values and principles is posted on the AACAP Web site at www.aacap.org/publications/policy/collab01.htm. The “Policy Statement on Mental Health and Substance Use Screening and Assessment of Children in Foster Care” is posted at www.aacap.org/publications/policy/collab02.htm. ▪
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Published online: 5 September 2003
Published in print: September 5, 2003
Notes
A collaboration led by the American Academy of Child and Adolescent Psychiatry and the Child Welfare League of America promotes a child-centered approach to placement of children in foster care.
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