Needs of foster youth are not met

CALIFORNIA

Mental health care is more than medication

Children living in our foster-care system are all too often separated from their families, friends, schools, neighborhoods and everything that is familiar. For many, these separations take place without any warning. Add that to the abuse or neglect that precipitated their removal, and the outcome is that far too many foster children undergo psychological trauma at a young age. While our entire community undertakes to parent these vulnerable children when we remove them from their family, we simply are not doing enough to help attend to their most basic needs.

Indeed, most children living in foster care -- youngsters at greatest risk of emotional and mental upheaval -- often do not receive psychiatric care until their situation reaches a crisis point. Research shows that less than one-third of children received mental-health services during the year following contact with the child-welfare system, despite overwhelming evidence that early intervention may be an important element in reducing long-term negative consequences. Others are treated through administration of medication alone -- a critical tool in many instances, but one that isn't a panacea in all cases and that commonly needs to be accompanied by therapeutic remedies not available in a timely manner for most foster youth, based on reports from youth and caregivers.

As one foster youth aptly observed, "Medicating a kid for a heartache isn't the same thing as medicating them for a mental health issue." Yet many youth living in foster care experience more heartache than they can bear.

Post-traumatic stress syndrome occurs among foster children at a rate twice as high as among U.S. war veterans, 15 percent of foster youth attempted or contemplated suicide, and 29 percent spent some time in a psychiatric hospital, according to a 2006 study. These discouraging outcomes are not surprising in the face of the lack of coordination among the child-welfare system, mental health providers, schools and courts, resulting in fragmented "parenting" of youth who most need our collective best efforts. A shortage of available mental-health providers, poor record keeping and the absence of continuity of care further diminish children's odds for a stable adult future.

The consequences of making children who already have the fewest emotional defenses pay the price for an inadequate child-welfare and mental-health services system can be detrimental not just to the individual child, but to society as a whole. A recent study of California youth who crossed from the foster-care system into the juvenile-justice delinquency system indicates that 66 percent of the youth had a mental-health problem. Yet we continue to do little to turn this tide of societal neglect.

A report just released by the Los Angeles Foster Youth Mental Health Initiative (see www.clcla.org) outlines some of the difficulties encountered in providing better mental-health services for foster youth and proposes practical steps we must take if Californians hope to address this dismal situation. Key recommendations of the report include:

Ensure timely and quality screenings and assessments.
Institute early intervention and prevention programs.
Address practices relating to administration of psychotropic medication.
Improve access to services.
Facilitate foster-care system collaboration and communication among the many arms of the child welfare, mental health and court systems.
Enhance the voice of youth in all aspects of foster care and mental-health decision-making that will affect their lives.

Some efforts to improve our performance have already begun. In 2004, California voters passed Proposition 63, a measure that provided new funds to expand services and develop innovative programs and integrated service plans for mentally ill children, adults and seniors. Proposition 63 required California to develop mental health service programs including prevention, early intervention, education and training programs, and created a commission to oversee these programs and expenditures. In Los Angeles, litigation continues to focus attention on better screening and assessment for children in the foster-care system, or at risk of entering the system, along with providing the services to those who need it.

But there is much more work to be done. Proposition 63 resource expenditures are still in the formative stages and Californians need to work to ensure that the mental-health needs of one of our most at-risk populations -- foster youth -- are adequately addressed.

Our governor and Legislature must also continue the strong showing made on behalf of foster youth last year and pay particularly close attention to mental-health issues.

No area of a child's life remains untouched if the child has unmet mental-health needs. Our failure to intervene in a timely and appropriate manner can lead to tragedy both for individual children and for our community as a whole. The state of California oversees one of the largest foster-care systems in the nation. We must start to pay attention and change our approach to our most vulnerable children from "fail first" to "help first."

Darrell Steinberg, Miriam Aroni Krinsky
8 April 2007

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/04/08/EDGEBOSDP71.DTL

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