State Seeks Solutions To Foster-Care Crisis

Difficulties in accessing or paying for mental health services in the community are driving thousands of parents in Virginia to relinquish custody of their children to obtain treatment for them, according to a report released in November by a task force of the State Executive Council.

The report, which was commissioned by Virginia's General Assembly, found that almost 1 in 4 children in Virginia's foster care system is there to receive mental health treatment for serious emotional disturbances.

Task force members analyzed the state's Department of Social Services database and found that of 8,702 children in foster care as of June 2004, 2,008 were placed there to receive treatment for mental health problems.

The report also documented the experiences of six families who encountered substantial barriers while trying to access mental health services for their children with mental illness.

“Families are exhausted from dealing with the behavior of their mentally ill child, and most lack the energy, time, and knowledge to battle a complicated system to obtain services,” one parent said in the report.

Some of the services needed by the families were nonexistent or, if they were available, “exceeded caps set by their private insurance,” according to the report. And while Medicaid covers many of these services, the majority of the children in the six families were not eligible for Medicaid while living at home due to their parents' incomes.

In addition, “in the experience of these families,” the report stated, “the system often made negative assumptions that families were the cause of the children's mental health problems.”

Families also said they faced financial crises triggered by loss of employment or income due to attending court sessions or treatment sessions during the day or needing to stay home to supervise their children.

The report made a number of recommendations to be implemented by the State Executive Council.

Among them: to explore the use of private insurance funds for home-based treatment and crisis stabilization services, review “alternative” models of child-serving systems, and develop a statewide parent and family resource and advocacy program that is affiliated with the Federation of Families for Children's Mental Health, a family-run organization dedicated to helping children with mental health needs and their families achieve a better quality of life.

The report also endorsed the expansion of funding for Virginia's Comprehensive Services Act, which was designed to provide money for mental health services for children.

Yaacov Pushkin, M.D., president of the Psychiatric Society of Virginia, Inc., told Psychiatric News that “without adequate allocation of public funding toward the state mental health system, the social costs will be incalculable.”

He also said it is incumbent upon providers, advocates, policymakers, and the general public to “work cohesively and forcefully to confront and remedy these issues.”

The problem of relinquishing custody of children so they can obtain mental health treatment is by no means unique to Virginia. A 2001 study of the General Accounting Office found that approximately 12,700 children were placed in the child welfare or juvenile justice system in the United States for this reason (Psychiatric News, June 6, 2003).

“It is cruel public policy to expect parents to turn over custody of their child to the state to get health care,” said Dorothy O'Keefe, M.D., president of the Virginia Council of the American Academy of Child and Adolescent Psychiatry. She counts stigma as chief among the reasons that parents are placed in such a difficult position.

“Can you imagine the public reaction if kids with cancer had to be placed in foster care to get treatment?” she asked.

In response to the report's findings that almost 1 in 4 was placed in foster care solely to obtain mental health services, O'Keefe pointed out,“ The other three-quarters of kids in Virginia's foster care system are there because of abandonment or abuse” and also need mental health services.

“When a large number of kids who need intensive treatment enter the foster care system expressly to access services,” she said, “it moves kids who have entered the system in the usual way further back in priority.”

Charles Devitt, M.D., medical director of the Barry Robinson Center, a 72-bed residential treatment facility based in Norfolk, Va., noted that parents sometimes have the option of entering into a“ noncustodial” agreement, under which parents don't transfer full custody of their children to the state, but place the child in foster care for a limited period. In that time, the child can receive Medicaid benefits supervised by the Department of Social Services. However, parents are subject to scrutiny by the state before their child is returned to them.

“Parents are “desperate” to avoid giving up custody of their children in order to get treatment for them, he said. “As if the difficulty of that decision was not enough of a problem, the various background checks required before full custody is returned to them sometimes frightens families into sending their children to the juvenile justice system.”

A copy of the “Report of the State Executive Council Workgroup on the Relinquishment of Custody for the Purpose of Accessing Behavioral Health Treatment” may be obtained by contacting Irene Scott at (804) 786-3921. ▪