John William Tuohy lives in Washington DC

News about your foster care system (You own it)

Fostering Kids Together seeking Christmas gifts, necessities for foster children
The holiday season is fast approaching, and a local organization wants to ensure happy holidays for the 170 to 190 foster children in the area.

Hannibal, Mo.
The holiday season is fast approaching, and a local organization wants to ensure happy holidays for the 170 to 190 foster children in the area.
Fostering Kids Together – an organization that helps connect area foster children and foster families with the items and services they need – is seeking necessities and Christmas gift items for foster children in the area.
Items needed for children include: diapers (various sizes), underwear (various sizes, for boys and girls), socks (various sizes), toothbrushes, tennis shoes (various sizes, for boys and girls), deodorant (for boys and girls) car seats, booster seats and pajamas (for ages eight and up, boys and girls).
For Christmas, Fostering Kids Together prepared a list of common Christmas gifts. Group volunteers usually spend between $20 and $25 per child. The gift items include: Walmart gift cards (most common gift, especially for children six years of age or older), action figure toys, princess and Barbie dolls, clothing, infant toys, stuffed animals and books.
For more information or to donate an item, please visit http://www.fosteringkidstogether.com or call Jona at (573)822-8627.

Miami law firm helping foster children
MIAMI (AP) -- A Miami law firm is helping foster children get legal representation or volunteer guardian advocates.
Akerman LLP is partnering with the National Court Appointed Special Advocates, pledging $1 million to the organization and working to create a model that can be replicated with other philanthropic businesses.
A significant portion of the money will go to the organization and its local guardian ad litem programs to strengthen its network of court-appointed advocates and volunteer training programs.
Funds also will be used to establish a scholarships or college-bound youth who have aged out of the foster care system.

Experts: Kinship Care Better Alternative To Foster Care
By Jenifer Abreu, Weekend Anchor/Reporter

Caught up in everyday life, it may be easy to take family for granted. One organization is spreading the importance of kinship.
September is Kinship Appreciation Month and on Monday, the Allen County Children Services spoke at the Exchange Club's meeting.
Kinship care is a better alternative to foster care, according to experts. It's when children are placed with a relative or someone they already have a relationship with, like a family friend or a coach.
In 2014, Allen County Children Services helped 71 families and one 118 children .
"The children that are in kinship care experience a lot less difficulties, they are usually able to stay with family members who they know. It's a lot less traumatic for them. They are usually able to stay in the same school system," said Shelly Conrad, Family Stability Supervisor. 
If you'd like donate, or get involved with the kinship program, contact the Allen County Children Services. 

Florida’s Foster Children Are Still Being Medicated without Proper Oversight
–Margie Menzel, News Service of Floeida

Despite an outcry in 2009 over a 7-year-old’s apparent suicide, a draft report from the research arm of Florida’s child-protection system shows that foster children are still being put on psychotropic medications without caregivers following proper procedures.
As of July, 11 percent of the children in state foster care — 2,434 of 21,899 children — had active prescriptions for at least one psychotropic drug, according to the Florida Institute on Child Welfare at Florida State University.
But a review of 140 children’s files showed that just 20 percent met all the key requirements for administering such medication. In particular, the study showed that consent forms were incomplete or completed late in the great majority of cases.
“It suggests an important disconnect between a good policy and real-world practice,” Jeffrey Lacasse, one of the study’s authors, said earlier this month.
The state’s current policy for using psychotropic drugs on foster kids followed a tragedy. It was updated after the 2009 death of 7-year-old Gabriel Myers, who was found hanging from a shower fixture in his foster home in Margate. He had been on two “black box” medications intended for adults. A subsequent Department of Children and Families review of the files of all foster children showed that in more than 16 percent of cases where kids were medicated, it was without the consent of a parent or judge.
But the updated policy isn’t always followed today, according to the institute’s draft report, which is expected to be finalized this fall. While the state sets the policy, privatized community-based care agencies are responsible for caring for foster children.
“We’re largely concerned with overuse of those medications,” Lacasse said. “But it’s a balancing act, because it’s seen as a very integral part of normal care.”
Lacasse presented the findings that he and Angela Lieber had compiled at the annual Child Protection Summit, sponsored by the Department of Children and Families. It was the first such presentation for the Florida Institute on Child Welfare, which was created by the Legislature last year to conduct research. The report showed what Lacasse called a “marked increase” in the numbers of children taking psychotropic meds such as mood stabilizers and anti-psychotics. That’s been a national and state trend for years, just as it has been a trend for children in the foster-care system to be medicated more heavily.
In 2005, for instance, it was estimated that 14 percent of youths nationwide were prescribed one or more psychotropic drugs after contact with the child-welfare system. By 2010, 22 percent of youths receiving child-welfare services also received psychotropic meds over a three-year period.
That’s a problem because the drugs can have adverse effects, Lacasse said, and tend to exclude the use of long-term models such as therapy for trauma the children have endured.
“I hear story after story from my colleagues about court-ordered therapy that never happens,” said attorney Robin Rosenberg, deputy director of the advocacy group Florida’s Children First.
Rosenberg sat on a task force that studied the use of psychotropic meds after the Myers child’s death. She said children in foster care shouldn’t be medicated until other methods of addressing the underlying causes of their misbehavior have been tried and found wanting.
“The fact of being in the child-welfare system means that something pretty bad happened in your life,” Rosenberg said. “And common, normal reactions to bad things happening to you look like behavior problems — that’s a normal response.”
But while Florida has good policies in place, she said, it needs to monitor them more closely — and ensure that front-line DCF staff members, who turn over rapidly, stay current in their training.
The Florida Institute on Child Welfare draft report reached similar conclusions. It also recommended that children’s files be kept current, especially given “consistent reports” that information is missing on the dates when children begin taking certain medications.

 Sharp rise in the number of children in foster care means more kids at risk

The disturbing headlines and heartbreaking stories of children failed by foster care continue to fill newspapers and websites. The tragedies are also likely to become even more common if the strain on America’s foster care system isn’t alleviated, as the number of children in foster care in the U.S. rose sharply, for the first time in nearly a decade. According to the Department of Health and Human Services’ (HHS) annual report, the foster care population in Fiscal Year 2014 rose to 415,129 children from just under 401,000 children in Fiscal Year 2013.
Sometimes the stories are about one unfortunate child, like Eric Dean, a three-year-old Minnesota boy killed by injuries caused when his stepmother threw him across a room, after fifteen separate abuse reports by day care workers failed to get authorities to intervene.
And sometimes the stories show system-wide problems, like the 184 children who were abused or neglected while in state custody in Massachusetts last year. According to the Boston Globe, the Massachusetts Department of Children and Families (DCF) “investigated and substantiated about 630 allegations of abuse and neglect,” meaning many of these children were the victims of multiple incidents of abuse or neglect. Even more troubling, these numbers represent “an 18 percent increase from 2013, when 538 allegations of mistreatment were substantiated, and a 36 percent increase from 2012, when 465 allegations were found to be valid.”
Jeremiah Oliver sadly didn’t even survive his time in foster care. The Massachusetts Department of Children and Families “lost track” of him after failing to conduct regular home visits, and his body was found on the side of a road. In August, a two-year-old girl died and a 22-month-old baby was found in “dire condition” in one foster home, just three days after a DCF worker had visited.
Arkansas is another state that has reported problems, with reports showing troubling signs of how overburdened the Arkansas Division of Children and Family Services (DCFS) is. DCFS had such a shortage of available foster homes, that during January and April of this year, 22 children slept in the DCFS offices.
These disturbing real life examples of a failed system should signal the need for serious reforms. But, all too often, the response to negative headlines about tragedies within the child welfare system calls for more social workers to be hired, more training programs, and more taxpayer dollars dumped into a broken system with terrible outcomes. While things like providing improved training and decreasing caseloads for front line workers are necessary, the implementation of reforms too often fail, resulting in a repeat of the same problems year after year. Children deserve better than the status quo, and it’s time that policymakers to do the hard work necessary to ensure that no child becomes a cautionary tale.
The problem is nationwide. Arkansas is far from the only state to report overburdened case workers, and Massachusetts is not the only state with spiking rates of abused and neglected children in foster care. Seven years ago, the Mississippi Department of Children and Family Services was ordered to implement reforms to its foster care system as part of a lawsuit over the state’s failure to adequately protect the children in its care. In July, the agency publicly admitted in a filing with the court that they had failed to implement the required reforms. In Minnesota, after the death of little Eric Dean, the three-year-old who was the subject of 15 ignored reports of suspected abuse, a special task force recommended a complete overhaul of the state’s child welfare system, over 100 reforms in all.
Voters have seen too many of these headlines to trust government to properly care for at-risk kids. The Foundation for Government Accountability recently commissioned a multi-state pollthat showed voters across all demographic and ideological groups strongly prefer – by a 70% majority – private, community-based options like charities and churches over government programs for responding to the needs of children and their families.
One of the most successful programs with a strong track record of not only protecting children, but ensuring that they never enter foster care, is a national charity called Safe Families for Children.
Since 2002, Safe Families chapters, which exist in 27 different states, have handled more than 20,000 placements. According to the Lydia Home Association, 90 percent of these placements successfully achieved reunification without ever entering foster care. In contrast, government-run foster care successfully returns only 51 percent of children to their biological families.
Even better, children hosted through Safe Families spend, on average, only 29 days away from their families, while children in foster care languish there for over 700 days.
These incredible results are achieved at little or no cost to taxpayers as most Safe Families chapters are funded through private charity donations. While government-run foster care costs taxpayers $25,000 or more per child each year, Safe Families costs only $1,500 per child in mostly private funds.
It is all too easy to feel despair when there are so many tragic headlines about vulnerable children being abused, neglected, and even dying while in foster care. But we can turn that despair into hope by seizing this opportunity to make life better for families and reduce the number of children entering a broken system. Those who care about our kids and our families can encourage policymakers in their states to commit to prioritizing innovative, community-based solutions, like Safe Families, that give states another tool in the toolbox to help children realize their basic right to a family.
Kristina Ribali is the Senior Coalitions Director for the Foundation for Government Accountability. Follow her on Twitter, or contact her at kristina@thefga.org.

Children In Foster Care Aren't Getting To See The Doctor

On any given day, about half a million children are living in foster care. They've been removed from violent or abusive households; many suffer physical and mental health problems that have gone untreated.
Their need is acute but the response is often dangerously slow, according to a policy statement from the American Academy of Pediatrics. The recommendations, published Monday in the journal Pediatrics, are intended as a wake-up call for pediatricians who care for foster kids.
According to the report, more than 70 percent of these children have a documented history of child abuse or neglect, and 80 percent have been exposed to significant violence, including domestic violence. Almost all are further traumatized by being removed from their families, says author Moira Szilagyi, a professor of pediatrics at the David Geffen School of Medicine at UCLA.
Foster care becomes a "window of opportunity for healing," Szilagyi says, often the first chance these children have to get the help they need.
And the need is great. Thirty to 80 percent of these children have an untreated medical condition. That can be as simple as eczema or asthma or far more severe and complicated, such as cerebral palsy or neurological damage from shaken impactinjuries.
"We see the spectrum," Szilagyi says, including teenagers who have multiple mental health conditions such as conduct disorder, bipolar disorder, depression, ADHD — "a laundry list of diagnoses."
The problem is that many of these children face barriers to care, starting with the permission to treat them in the first place. The process for foster parents to get consent from a family member or guardian can be cumbersome and often stops before it even begins.
And if foster parents do obtain consent, medical providers typically face an incomplete if not invisible medical history.
"Often these children have gone from one relative to another," says Szilagyi, adding it's often not clear how many caregivers the child had prior to foster care. There's no record of treatment, no history of vaccinations, no information about psychosocial development, behavior or mental health problems. The children have a very high prevalence of dental problems.
While the report finds that the number of children in foster care has decreased over the past few decades, the number labeled as "emotionally disturbed" has increased. Szilagyi says these findings should serve as a heads-up for health care providers to refer children to get the care they need, be it from dentists and pediatric mental health providers.


Abby Sewell
Jesse Opela hunched on a plastic chair in the "music room" at Central Juvenile Hall, a cramped space with no air conditioning, an old CD boombox, a keyboard and a bookshelf filled with aging bestsellers. Tears rolled down the sturdy 17-year-old's face as he apologized to his probation officer.
"I messed up everything," Jesse said. "I had so many chances and I messed all of them up."
Not too long ago, Jesse had dared to dream that he would be one of the lucky ones — not like most of the other kids in the probation-run foster care system.
For some of the most troubled young wards of the state, the chance of being adopted, or even placed in a foster home, once they've broken the law is near zero.
Jesse's chances looked even smaller.
When he was 12, he said, he broke down a door and tried to kill the middle-aged woman who had adopted him when he was a toddler. He was sent to a residential treatment facility for teens with severe psychological or behavioral issues. Jesse said he was later diagnosed with bipolar disorder.
 Jesse Opela, 17, at a group home in Altadena in June, says he knows that many adults see him as a threat. But he said he’s “just a lost kid asking for help.”
 (Mel Melcon / Los Angeles Times)
When he was 13, he said, he punched a police officer who was trying to detain him, leading to a charge of battery on a police officer. It was his first stay in juvenile hall — and the beginning of his years under the Los Angeles County probation system.
"I just said … "F— it, 'I have nothing to live for anyways — might as well act a fool. I guess this is my destiny to just be in jail all my life,'" he said.
I guess this is my destiny to just be in jail all my life.- Jesse Opela
Then, when he was 15, he landed at Dorothy Kirby Center, a probation facility for youths with mental health issues. He befriended Dwain Miller, a volunteer chaplain who had a grown adopted son and had sometimes opened his home to other children who had nowhere to go.
During one of his talks with Miller, Jesse asked whether the chaplain might be willing to adopt him. "Anything's possible," Miller said.
Jesse choked up.
"I took it to heart, thinking I finally have someone, I finally have somebody in my life, hoping that it might come true."
Jesse is one of a small subset of foster children whose cases are overseen by probation officers rather than social workers.
They've landed in the Los Angeles County Probation Department because they've been both neglected or abused and committed a crime. Most of them bounce back and forth between group homes and juvenile lockups until they turn 18.
Few are placed in foster homes, and adoptions are even rarer: Only seven such children have ever been adopted in California, despite stepped-up efforts by some probation agencies to find more permanent homes.
"We know that young people rehabilitate and heal in families. They don't do that in institutions," said Jennifer Rodriguez, executive director of the Children's Law Center and herself a former "crossover kid." "When we put children in this situation, it becomes impossible to expect that their behavior is going to do anything but get worse."
The Times received unusual court permission to interview Jesse and track his often rocky trajectory through the system. In seven months, he will turn 18, and he will probably make his passage to legal adulthood in one of the same institutions where he has spent most of his adolescence.
Born to a drug-addicted mother, Jesse was taken from his birth parents when he was 2. He went to live in a foster home in Lancaster with a woman whose own children were grown. After several prospective adoptions fell through over the course of the next year, his foster mother adopted him.
But his new family unraveled when he neared his teens.
Jesse knows that many adults see him as a threat. But he said he's "just a lost kid asking for help."
Jesse said that his adopted mother was abusive and deprived him of basic childhood rites such as birthday parties and Christmas presents.
His adopted mother, Melodina Opela, a diminutive 68-year-old originally from the Philippines, denied that she had hit her son. She said she'd tried to give him a normal upbringing with family parties and snowball fights in the nearby mountains with her grandchildren and other foster kids, but that he had anger issues and she had lived in fear of his outbursts.
Opela said she won't take her adopted son back — even if he wanted to return — because she's worried about her safety and that of her young grandchildren. But she feels the loss.
"I miss him," she said. "I still cry about him."
About a decade ago, the county Probation Department began a push to find more permanent homes for youths like Jesse. At first, skeptical probation officers joked about printing bumper stickers that would say, "Adopt a criminal."
But over the years, attitudes have started to change, along with a larger shift in thinking about juvenile justice that puts more emphasis on rehabilitating youths who have gotten in trouble.
"There's much more of a shift in people seeing probation foster youth as having the same needs as foster youth that haven't committed crimes," said Lisa Campbell-Motton, who oversees the Probation Department program that searches for placements for the teens. "Those kids are very similar."
As of July 31, 808 youths were in the probation foster system. Some started out as foster children and then committed a crime, earning them the nickname "crossover kids." Others were first arrested and then landed in the foster system because officials found they didn't have a safe home — or a home at all — to return to. Of those youths, 756 were living in group homes. Fifty-one more were placed with relatives, family friends or other adults who had been part of their lives. Only one was in a foster home.
By contrast, children in the normal foster-care system run by the Department of Children and Family Services are far more likely to be living with relatives or in foster homes.
A recent report by the California Department of Social Services emphasized the need to shift kids away from group home care, which it described as "not in the best interest of children and youth."
An organization representing group home providers took issue with that characterization, saying that many youths have been helped by caring group home staff and placement decisions should be made based on each child's circumstances, not on "general idealistic beliefs that do not always equate with reality or with the desires of the impacted youth."
Jesse bonded more deeply with Miller after the chaplain told the boy he might be willing to adopt him.
Miller recalled, "It sort of blossomed — or maybe erupted would be a good term for it — from there."
Jesse began calling Miller "Dad." On Jesse's 16th birthday, they had a party with root beer floats at Dorothy Kirby. Miller went through a home check and background check necessary for Jesse to visit him and perhaps eventually come to live with him. Jesse spent that Thanksgiving with Miller's extended family.
But the arrangement began to unravel after Jesse left Dorothy Kirby and moved to a group home in Altadena. Jesse met a girl in school, and their relationship quickly became all-consuming. He became less interested in spending time with Miller. And then Miller's adult son moved back in with him, taking the room that would have been Jesse's.
With the potential adoption on the skids, probation officials began looking for other places to put Jesse.
At a court hearing in June, the judge decided that Jesse would stay at the group home in Altadena. But within a week, Jesse ran away with his girlfriend — twice. He got picked up by police in July — Jesse said he'd turned himself in after his girlfriend broke up with him — and was sent back to Central Juvenile Hall.
The return to the lockup threw Jesse into a depression. He hated seeing other kids get letters and visits from their families, while the only visits he got were from his probation officer.
"It hurts to have nobody, to look outside the room and see families just visiting, and all I can do is look outside and watch," he said.
One day, Miller came to see him at the juvenile hall's chapel. Miller's son was still living with him, but he said he wanted to continue being part of Jesse's life as a mentor. Jesse asked his probation officer whether he would be able to resume visiting with Miller upon his release back to the group home.
In part, Jesse's fate may depend on where he is when he turns 18. If he's in a group home or foster care placement, state law allows him to remain a foster youth until he turns 21, providing extra support and money. But the benefits won't be available if he's in juvenile hall on his 18th birthday.
Jesse insisted that this time he's ready to start taking the steps to stay out of trouble. He said he wants be a police officer — or maybe a probation officer.
"All my life has pretty much been wasted. Nothing I can do about it, really," he said. "I know five years from now I'll look back at it and say, 'I'm glad I'm in a better place right now.'"

A Hole in the Safety Net Offered by the Affordable Care Act

By Ray Glier

Kayla VanDyke, 23, was on her way in a career as an advocate for foster youth in Oregon. She had a college degree in human physiology and she was working for Foster Club, an advocacy organization, counseling foster children who had traumatic experiences with sexual abuse and attachment issues. In and out of foster homes herself since she was 5 years old, VanDyke was looking at graduate schools in Oregon to strengthen her skills in child welfare and have more impact.
Instead, she had to return to her home state of Minnesota because of recurring health issues. The Affordable Care Act will cover foster youth who age out of foster care until they are 26 — unless they move into certain states. A provision in the Medicaid law allows Oregon to refuse health coverage to foster youth if they move in from out of state.
Just like that, VanDyke’s dreams were hijacked. Only 13 states allow foster youth to travel into their state with their federal health insurance, an obvious hole in the safety net of ACA.
“The bureaucrats and government and the state, they all talk about wanting foster kids to succeed and make it on their own, and here I am, someone who graduated from college with good grades and with independent research, and I was on a path to graduate school — and here is this roadblock,” VanDyke said. “I am doing things to be successful in the community and overcoming challenges and then, all of a sudden, a core support is being pulled out from under me. It didn’t make a lot of sense.”
When VanDyke’s stomach and intestinal issues grew more severe this past spring, she had to give up the job and move back to Minnesota to seek health care.
According to Shadi Houshyar, the vice president of child welfare policy for First Focus, an advocacy organization that lobbies in Congress on issues involving children and families, the 13 states that allow foster youth to leave their home state and use their health insurance in another state are California, Georgia, Kentucky,  Louisiana, Massachusetts, Michigan, Montana, New Mexico, New York, Pennsylvania, South Dakota, Virginia and Wisconsin.
So far, 37 states will not allow the Medicaid coverage to travel with former foster children. However, the Center for Medicaid and Medicare Services (CMS) said in a December 2013 memo to state Medicaid offices that it will approve any state that offers an amendment to its Medicaid policy covering people who were in foster care and getting Medicaid when they “aged out” in other states.
Section 2004 in the Affordable Care Act added a new mandatory group to the law: former foster care children. Former foster care children now had to be covered by health insurance under one section of the Affordable Care Act. Another section said states must cover people under age 26 who were both enrolled in Medicaid and in foster care under responsibility of the state when they turned 18 (or a higher age such as 21 in some states).
In a statement Dec. 13, 2013, CMS, which is part of the U.S. Department of Health and Human Services, interpreted the law to mean that states had the option to cover foster youth from another state, regardless of income.
In a 2009 speech on the Senate floor, then-Sen. Mary Landrieu, D-La., the primary sponsor of the provision to allow foster youth to travel from state to state, said all eligible former foster youth should be covered.
The 400,000 foster youth in the nation are a highly transient population who seek jobs, education or long-lost family. Landrieu intended to secure a protection for them, said Tricia Brooks, a research assistant professor at the Georgetown University Health Policy Institute and senior fellow at the Center for Children and Families.
“The simple drafting error of using ‘the state’ versus ‘a state’ has been interpreted in the proposed rules to require states to cover youth who aged out in ‘the’ state, but make it an option to cover youth who aged out of foster care in ‘a’ different state,” Brooks said. “This is concerning because it is not uncommon for a child to be placed in foster care in another state, particularly in metropolitan areas that span multiple states. Moreover, former foster youth are often a transient population, and covering them regardless of their current residency is critical to assuring that they have continuing access to health care.”
Brooks said she and Georgetown colleague Sophia Duong are writing a brief for Congress to try to amend the law. They expect to file it in the fall.
In the meantime, Sen. Robert Casey, D-Pa., introduced a bill in Congress on July 23 called Health Insurance for Former Foster Youth Act of 2015. It seeks to ensure insurance continuity for foster youth who move to one of the 37 states that does not now permit Medicaid benefits to travel to that state.
“Why states aren’t picking up the option isn’t completely clear,” Brooks said. “I’m sure that some states simply want to avoid costs that are not mandated under Medicaid law. But I also think there is not widespread awareness of the issue.”
Brooks said CMS is taking another look at the issue to see if it has the statutory basis to require states to cover youth regardless of the state where they were in foster care.
A spokesperson for the Oregon Health Plan (OHP), the state’s Medicaid provider, said in an e-mail that Oregon’s decision was “part of a State Plan option that Oregon chose not to take. As with most State Plan options there are budgetary impacts that influence decisions.”
Walker Blevins, 20, was in foster care in Washington and Montana until she was 18. She lives in Niobrara, Neb., with her husband, Will. They are expecting a baby in September. When she aged out of foster care at 18, Walker expected to be covered by her own Medicaid. Nebraska said she was not.
“Nebraska cut me off from everything,” said Blevins, who was in foster care from age 15 to 18 in Montana. “They said if you are not staying in Montana, you don’t get anything. If you’re leaving Montana, you’re done. The only reason they gave me for their decision was that I moved and that I was only eligible for health care as a foster youth in Montana.”
Blevins said she had the same issue when she moved back to Washington state briefly to take care of a sick aunt. Because she had aged out of foster care in Montana when she was 18, Washington said she was ineligible for her Medicaid under the Affordable Care Act. While she cared for her aunt, she had no health insurance.
When Blevins married and moved to Nebraska, she applied for Medicaid from the state of Nebraska because of her low income. That’s how she finally secured health care coverage, not through her rights as a former foster youth.
“At first it was frustrating,” Blevins said. “I had health care my senior year in high school, then it all crashed on me. I’ve picked myself up and learned how to handle these things on my own.

Making Health Care Access Easier for Young People Leaving Foster Care

By Elizabeth Mertinko and Christine Tappan

“My transition out of [foster] care was difficult. Probably the most difficult part out of foster care was losing health insurance. I didn’t really think that would be very hard, but it definitely was because it seemed like right after I transitioned out I got sick with a sinus infection … [I didn’t know] where to go or have the money upfront to pay for it. I didn’t realize how expensive health care is until it had to come out of my own pocket.”
—Faith, from the U.S. Department of Health and Human Services Administration for Children and Families video, “Spotlight onNational Youth in Transition Database,” from February 2014.
Health care is a basic necessity for all young people. For some of our most vulnerable — those aging out of the child welfare system — health care coverage is particularly vital. Young people who have experienced neglect and/or abuse often have significant health care needs, including physical health issues, behavioral/mental health diagnoses and developmental challenges. While most have coverage while in foster care, like Faith, once they leave, they lack the resources to support their ongoing health care needs. That changed with the passage of the Patient Protection and Affordable Care Act (ACA), which is creating new pathways to health care for current and former foster youth.
Each state manages the health care benefits system for children in and leaving foster care. The majority of young people in foster care, however, are eligible for Medicaid, a program jointly funded by federal and state governments to provide health care coverage to low-income citizens who meet certain eligibility criteria. Most young people in care are eligible for Medicaid through Title IV-E of the Social Security Act, which provides funding to support safe and stable care for children who are removed from their homes.
Once young people leave care, however, maintaining health coverage becomes much more difficult. Unlike young people who grow up in their biological families’ homes and can remain on their parents’ health insurance policies until age 26, for the most part, young people who leave foster care have no such safety net. To help remedy this situation, the ACA created new health insurance eligibility options for youth formerly in foster care so they could more easily maintain coverage into adulthood. The ACA provides for:
•           Medicaid eligibility for the adult group: States have the option to cover the “adult group” added by the ACA (nonpregnant individuals ages 19 through 64 whose household income is no more than 133 percent of the federal poverty level). Because youth who have aged out of foster care are often considered for Medicaid eligibility as a household of one, they can obtain coverage through this provision in the 28 states that currently offer it.
•           Youth formerly in foster care and under age 26: The ACA provides a new, mandated Medicaid eligibility pathway for former foster youth who are no longer in care. Youth are eligible for their state’s full Medicaid coverage regardless of income and regardless of whether their state opted to provide coverage for the “adult group” as described above.
•           Youth who age out of foster care in states that offer the Chafee option: The Chafee Foster Care Independence Act of 1999 provides services and supports to assist youth who are aging out make successful transitions to adulthood. The Chafee Act authorizes states to extend Medicaid coverage to certain youth who age out of foster care. Currently, 30 states offer Medicaid to former foster youth who are not eligible for the mandatory Medicaid groups; 26 of those states do not apply an income limit for them.
Helping young people understand the importance of health insurance and maintaining their physical, mental, emotional and behavioral wellness is a key step in ensuring that those exiting care are best equipped to tackle the opportunities of adulthood. The ACA provides youth leaving care with a health insurance safety net on par with what is available to their peers who did not grow up in the system — and more importantly, helps provide access to necessary health services.

•           Know your state’s laws and policies regarding Medicaid eligibility. Help young people determine how they might access health insurance and guide them — or link them to someone who can guide them — in applying for and maintaining health care coverage.
•           Talk to young people and help them understand the importance of health care coverage. Educate them about health care costs and the potentially devastating health and financial consequences of not maintaining health coverage.
•           Encourage young people to plan early, so there is no gap in care due to lapses in health insurance coverage as they leave foster care.
•           Assist young people in locating health care providers who will accept Medicaid. Health insurance is only one piece of the puzzle: Finding providers who accept young people’s coverage is critical to their ability to access the care they need.

•           More information on Title IV-E eligibility.
•           Links for information on health insurance and out-of-home care, see also “Health Care Coverage for Youth in Foster Care – And After.”
•           Information designed to help youth manage their mental/emotional wellness.
Elizabeth Mertinko, MSW, is a senior project manager at ICF International, where she is operations manager for Child Welfare Information Gateway, the information service of the Children’s Bureau, U.S. Department of Health and Human Services.
Christine Tappan, MSW, is also a senior manager at ICF International, where she is deputy project director for Child Welfare Information Gateway and has worked extensively with youth-serving programs across human services.

Many Former Foster Youths Don’t Know They Have Health Care
By Ray Glier, NPR

Laticia Aossey was flat on her back in an Iowa hospital bed with a tube up her nose, a needle for a peripheral IV stuck in one arm and monitors pasted to her body. It was early June 2014, a week after her 18th birthday, when a friend brought Aossey’s mail from home — including one ominous letter. Aossey’s health insurance was about to be discontinued.
“My heart dropped. I just wondered to myself, ‘Are they going to pull this tube out, unhook me from everything and roll me down to the street?’ ” Aossey said. “Could I get the medicine I needed?”
When children “age out” of foster care at age 18 in Iowa, they are eligible to receive Medicaid under the Affordable Care Act until they turn 26. But Aossey, a ward of the state as a foster child, had not filled out the necessary paperwork. Then she fell ill with stomach ulcers, acid reflux and cyclical vomiting.
She was in college at the University of Northern Iowa in Cedar Falls, and instead of using her dormitory address she had used a friend’s home address. The state Medicaid office sent the paperwork to complete her health care enrollment to her friend’s address in Iowa City, so she did not receive it right away.
“The first call I made from the hospital to get it straightened out, the woman said, ‘Your parents need to call,’ ” Aossey said.
“My parents? I was in foster care. I had no parents. Then she said my caseworker, an adult, my boss, somebody … [other than] me had to call. She wouldn’t talk to me. I was 18.”
Aossey’s doctors finally calmed her fears, and a couple of days later, she said, a caseworker arrived to help her complete the paperwork. She realized she could have managed that before things became complicated in the hospital.
“Be an adult,” Aossey advises other foster youth. “Find a way to do your paperwork. Do not rely on other people for something you should do.”
Aossey is one of 400,000 foster youth in the nation, and one of approximately 23,000 per year who age out of foster care when they turn 18 (or 21 in some states). They are all eligible for Medicaid, regardless of income, under the Affordable Care Act until 26.
Federal law requires states to cover former foster youth, and the federal government provides Medicaid matching funds to pay for it. But 21 states chose not to expand their Medicaid programs under Obamacare. And some states make enrollment for former foster youth easier than others.
“In some states, where the state is not embracing ACA in general, there wouldn’t be a particular incentive for them to inform young people of their eligibility,” says Celeste Bodner, founder and executive director of Foster Club, a national advocacy organization for foster youth. “If you want to call that a hostile environment, I don’t think that is a stretch.”
In California and New York, youth who age out of foster care are automatically enrolled in Medicaid. But even then, social services providers say they often need help figuring out health care.
The Jewish Child Care Association, which serves 750 foster youth of all faiths and backgrounds in New York City, puts significant resources into getting teens in foster care ready to be independent. A state-funded program includes guidance on filling prescriptions and managing health care.
“Navigating anything as a 20-year-old under the best of circumstances is tough and anxiety-provoking,” said Ronald E. Richter, CEO of the JCCA and a former commissioner of New York City’s Administration for Children’s Services. “Not all 20-year-olds come in for help with a smile on their face. Systems are not built for an anxious, stressed out 20-year-old.”
California automatically enrolls foster youth in Medi-Cal, its Medicaid program, but even that seemingly foolproof method has its glitches.
The Covered til 26 campaign, run by the advocacy organization Children Now, has tried to canvass the foster youth population, yet some slip through the safety net because of coding issues or questions about eligibility, changing addresses, incarceration, health issues and the sheer complexity of the system.
And in states without automatic enrollment, “What tends to happen when kids age out of foster care is that nobody tracks them, nobody keeps in touch with them,” said Bodner, of Foster Club. “It is extremely difficult to get word out to kids age 18 to 26 who are eligible. It can be an issue because that 18 to 26 population is really tough to find, there is no master list or a mailing list. This group is particularly transient.”
Many former foster children also would qualify for Medicaid based on income, but they may not be aware that they are eligible because of their foster status.
“It’s a complete maze,” said Bodner. “They get tracked into an income-qualification category as opposed to the automatic eligibility.”
Medicaid coverage for former foster children takes the place of insurance coverage that other young adults are eligible for through their parents, according to Jessica Haspel, a senior associate who handles welfare policy for Children Now in California.
“These are youth that have experienced abuse and neglect and the state has become their parent,” Haspel said. “It is giving them an equal protection other youth have had. It is about equity.”
Ray Glier writes from Atlanta. This story was produced by Youth Today, the national news source for youth-service professionals, including child welfare and juvenile justice, youth development and out-of-school-time programming.

Lander man sentenced for raping two of his foster children

This morning, a Lander man who earlier this year pleaded guilty to the forcible rape of two foster children who were in his care, was sentenced to what will effectively be the rest of his life in prison.
Thomas Passey, 67, was sentenced to 25-50 years in prison for two counts of First Degree Sexual Abuse of a Minor. The two victims were 8 and 10 at the time of the assaults. That is the maximum sentence allowable under the statute that was in place at the time the crimes occurred about 7 years ago.
Fremont County Deputy Attorney Dan Stebner argued this morning for the maximum because it will mean Passey will likely serve the rest of his life behind bars because of his age and failing health. Stebner argued that due to abhorant nature of Passey’s actions, he deserved to draw his last breath as a free man today.
Passey’s attorney, Terry Martin encouraged Judge Norman E. Young to take into account that Passey owned up to his actions and pleaded guilty, thereby not requiring the victims to have to speak during a trial. He asked for a 10-50 year sentence, so that Passey might have an opportunity for parole at age 73 or 74, at which time he wouldn’t be of harm to anyone.
When asked if he had anything to say, Passey’s only statement was, “I do not want to die in prison.”
As required by state statute, Young said he considered probation in the sentencing, but due to the “extreme, extreme nature” of the crime, he found it inappropriate.

AAP: Evaluate Children in Foster Care 'Early and Often'
Frequent visits encouraged due to mental and developmental health risks
by Molly Walker

Because most children in foster care have mental and developmental health issues, frequent medical evaluations are essential, according to a new policy statement from theAmerican Academy of Pediatrics (AAP).
The AAP Council on Foster Care, Adoption and Kinship Care, its Committee on Adolescence, and the Council on Early Childhood recommended that children in foster care should be evaluated "early and often" after placement. The report appeared Monday in Pediatrics.
The first visit should be within 72 hours of a child's placement into foster care, and within 24 hours for children with chronic medical or developmental conditions or who are the suspected victims of abuse. After this initial screening, children should be seen every 6 months, at a minimum. These visits should be more frequent for younger children, with monthly evaluations for babies 6 months or younger, and every 3 months for children ages 6 to 24 months.
"Ideally, children should have at least three health encounters over the first 3 months of foster care, as they adjust to their new circumstances. This schedule allows the pediatrician to monitor the child's adjustment to placement, to identify emerging needs, and to support the caregiver in helping the child," the report said.
The committee also recommends a full mental health evaluation after the child enters foster care, including screening for suicide risk and acute mental health needs.
Children should also be screened for signs of physical and sexual abuse, as well as signs of neglect, including:
•           Scanning body surfaces for burns, bruises, scars, and deformities
•           Anal and genital examination by an expert in childhood sexual abuse, especially for pre-verbal children
•           Height and weight (and head circumference for children <3 and="" measured="" o:p="" plotted="" years="">
•           BMI calculated beginning at age 2
Treatment should include appropriate therapy and trauma-informed care, including education and support to the child's caregivers and caseworker.
"This is a time of great emotional turmoil for children and a time during which children and caregivers need much support," lead author Moira Szilagyi, MD, PhD, of the AAP Council on Foster Care, said in an email to MedPage Today. "Developmental and mental health assessments are a crucial part of primary care as is connecting children with needs to needed services."
In fact, a number of studies have shown that up to 80% of children and adolescents in foster care have some type of "mental health need," while 60% of those younger than 5 years experience developmental health issues, 40% have educational difficulties, and almost 40% have significant oral health issues.
The AAP had previously issued a statement about caring for children in foster care, but Szilagyi characterized it as a "very old" recommendation. She said that the new information in the updated statement relates to research on "toxic stress and impact on the developing brain."
The authors noted the adverse effects of early childhood trauma on the neurobiology of a child's brain. They cited a correlation between this trauma and a variety of behavioral difficulties, such as aggression, hyperactivity, impulsivity, as well as insecure attachment disorders.
These struggles continue through adolescence and even into adulthood. The authors note that foster care children are more likely to be in special education classes and have a history of grade repetition. Only a little over half of adolescents in foster care graduate high school, and the dropout rate is nearly three times higher than low-income children. Only 6% of former foster care children have "some college education" and only 1% to 2% graduate with a 4-year degree.
Because of these lifelong risks, communication with the child's case worker is a critical part of the process. The authors recommend disseminating information from the child's "personal health record" (part of the electronic health record) to help improve care coordination for children in foster care. The report recommends enrolling children the state has moved into foster care in Medicaid until age 21, and reminding patients even when they age out of the foster care system, the Affordable Care Act allows them to be covered under Medicaid until 26 years of age.
Another update to the report is the recommendation that clinicians become involved with advocating for foster care education and resources at the policy level. The authors suggest that pediatricians attempt to coordinate with policy makers when legislation is developed for children in foster care. They also recommend interfacing with state and local child welfare to develop healthcare coordination and oversight plans to help connect children in foster care with pediatric medical homes.
"There is a role for pediatricians in advising states around this and advocating for states to follow AAP guidelines for their care," said Szilagyi.

Head of foster care agency accused of misusing millions of dollars

Officials said the head of a local foster care agency misused millions of dollars while needy children went without. Now, the organization has been shut down.
The agency called Give Us This Day has been caring for foster kids in group homes and placing them with foster families in the Portland area for years.
Organizers relied on state funding, but investigators said the money was mishandled and one former employee told FOX 12 she can back that up.
"We had to go on our own to food banks and churches and places that donated food to pick that up on our own time. When we weren't getting paid. Just to make sure the kids had food to eat, or we'd bring our own lunches and they'd beg us for our own lunches. So it was difficult," said Rachel Rosas.
Rosas used to work for Give Us This Day, caring for foster kids in group homes. She said not only were the living conditions sub-par, with very little money for groceries, linens and clothes, but she said her paychecks were late on a regular basis.
When she asked managers about it, they told her the state wasn't giving them their funding.
Mary Holden ran the agency and had several foster parents working for her. Several of them have also complained to FOX 12 that they didn't get paid on time and are still owed money.
Court documents show thousands of dollars were spent on travel, dining out, Las Vegas Casinos and clothing at Victoria's Secret and Louis Vuitton.
Rosas testified before a senate committee about the agency and how money was appropriated.
Just this week, the State Department of Justice signed a settlement agreement with Mary Holden, saying she will dissolve the agency, her insurance company will give $500,000 back to the state and she is not allowed to work for a non-profit for 7 years.
Rosas feels that a lot of neglected children are finally getting a voice.
"The foster kids will contact me. They've aged out of the program or they're homeless or they've been in jail and they just feel like, what did they do wrong? Or why didn't they get a chance? And it's just showing them that it wasn't their fault. Somewhere the system failed them," said Rosas.
FOX 12 was not able to locate Mary Holden to get her side of the story.
FOX 12 asked state officials if she could face criminal charges and they said they can't comment on that at this time.

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