Child Welfare

A national survey in 2003 found that 48 percent of children who had a completed child protective investigation suffered from significant emotional or behavioral problems.[i] The Child Welfare League estimates that mental health services are the number one health care need of children in foster care.[ii] It is estimated that 80% of these children live with mental illness.[iii] Research has shown that the frequency and severity of these problems are directly related to the history of deprivation, neglect, abuse, and lack of permanence and security that many of these children in foster care experience.[iv]

Child Welfare in Texas

In Texas, the Texas Department of Family and Protective Services (DFPS) is responsible for providing protection and regulatory services for children living at home or in state facilities, licensing group day-care homes, day-care centers, and registered family homes. In addition, DFPS is charged with managing community-based programs aimed at preventing child delinquency, abuse, neglect and exploitation.

There are three main programs under DFPS that directly relate to the mental health and well-being of children. First, to help protect and ensure the physical well being of children, Child Protective Services (CPS) is charged with investigating reports of abuse and neglect. Second, to help provide living arrangements for children is adoption and foster care. Adoption is a lifelong commitment to a child, while foster care is meant to be a temporary situation until a permanent living arrangement can be obtained. Third, prevention and early intervention (PEI) focuses on managing community-based programs to help prevent child maltreatment and juvenile delinquency. PEI programs are administered through contracts with local community agencies or organizations. It is important to note that these services are not available in every Texas community.

Ensuring children and youth's mental health is an important component within each of the three program areas listed above. Children are provided health care coverage under Medicaid when they come under conservatorship of the state of Texas due to abuse or neglect by parents or legal guardians. Children in foster care, however, have access to STAR Health, a statewide health care program that includes, among other things, behavioral health care coverage.

Child Custody Relinquishment

In 2003, a Government Accountability Office report found that, in 2001, 3,700 families relinquished custody of their children to the child welfare system solely for the purpose of gaining mental health services for them through Medicaid and other federal funds.[v] Private health insurance benefits may be depleted after just a few months and services for the treatment of mental disorders in children is extremely expensive, leaving parents unable to afford the out-of-pocket cost. Moreover, children often remain ineligible for Medicaid because their parents' income and assets keep them from qualifying for assistance. Therefore, with no other way to get their children treatment, parents are many times forced to choose custody relinquishment.[vi]

In Texas, DFPS estimates that 82% of the children in its custody are due to parents relinquishing custody in order to obtain for their children access to mental health services. [vii] In 2002 alone, 244 children were given to the State for this reason. [viii] In order to resolve this problem, Texas is working to develop a 1915(c) Medicaid Waiver. If approved by the federal government, the program, called Youth Empowerment Services (YES), could demonstrate a greater flexibility in the funding of intensive community-based services and supports for children with emotional disturbances and their families.[ix] Through making services available without the typical funding restrictions, it is believed that parents may have an option beyond custody relinquishment to get their children the mental health care they need.

Focus on Families

Although responsibilities for children's mental healthcare is dispersed across multiple systems, including schools, primary care, the juvenile justice system, child welfare and substance abuse treatment, the first system is the family.[x] There are several 'renewal' programs that are being instituted around Texas through the DFPS "Family Focus Initiative." One such program, called the Family Group Decision Making model, defines "family” as one that includes extended family members, friends, neighbors, and others identified as potential sources of support. The Family Group Decision Making model has so far benefited many families encountering the child protective, juvenile justice, and mental health service fields.11[xi]

RELATED REPORTS

CASA (Court Appointed Special Advocates) published an article explaining the mental health challenges that foster children face and contains resources for those involved in child welfare, Mental Health Needs of Youth in Foster Care: Challenges and Strategies: http://www.casanet.org/library/foster-care/mental-health-%5Bconnection-04%5D.pdf

The American Academy of Pediatrics released a policy statement in 2002 on the need for comprehensive health screening, assessment, and plans for children entering foster care: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;109/3/536

The UCLA Center for Healthier Children, Families and Communities has made available a policy brief, Mental Health Services for Children in Foster Care: http://www.healthychild.ucla.edu/PUBLICATIONS/ChildrenFosterCare/Documents/Mental%20health%20brief%20final%20for%20distribution.pdf