After a nine-year court battle, a landmark class-action settlement was preliminarily approved this week that would require the state to provide more effective mental health services for the children in or about to enter foster care.
Its reach is expected to be significant. California has 61,000 children in the foster care system, and it runs the nation's largest child welfare system at a cost of about $4.7 billion per year, half of which is covered by federal funds. The state said about 10,000 children would qualify for improved mental health services.
The suit was filed in 2002 against the state Department of Social Services, the Department of Health Services and several agencies in Los Angeles County, which had custody of a number of the plaintiffs in the case. Foster care and related mental health services are overseen by the state but are handled at the county level, and practices vary widely.
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The settlement would create state standards, training and monitoring for the provision of intensive and “medically necessary” mental health services as dictated by federal law. It also mandates the use of mental health approaches that have been widely accepted as effective by national experts and agencies. Foster care children who could be affected by the settlement will be notified beginning in early October.
Child advocates have hailed the settlement, saying California's abused and neglected children have historically wound up in incarceration-like settings because their mental health condition has not been diagnosed and they have not received effective care.
“The outcomes for children in foster care have been at risk in California,” said Kim Lewis of the National Health Law Program, which was one in a consortium of advocates that represented the foster children in the lawsuit. “If we don’t change the opportunities, they have to get the services that they are entitled to early on; what happens with the kids’ outcome is tragic.”
The lawsuit painted a dire picture of the system. Katie A., the named plaintiff, was 14 at the time the suit was filed, and she had been in foster care in Los Angeles County for 10 years. She was removed from the care of her homeless mother and incarcerated father, and she was assessed, at age 5, as needing trauma treatment. Although a foster parent requested mental health help, court documents say the girl never received therapeutic treatment. Instead, Katie A.’s condition worsened, and she was moved through 37 different placements, including 19 stays at eight psychiatric hospitals.
Other plaintiffs include Mary B., a blind 16-year-old who was 13 when she was removed from her home because she was physically and sexually abused. The lawsuit contended that she did not receive a comprehensive psychological assessment and did not begin receiving mental health treatment until two years after her first foster care placement. She had a total of 28 at the time the lawsuit was filed.
Attorneys representing Katie A. argue that a failure to systematically diagnose conditions or provide effective mental health care to this population early on creates a vicious cycle: Children with behavioral and emotional problems “fail” in traditional foster homes; they are moved to group homes with similarly challenged kids, which ultimately results in “needless psychiatric hospitalizations, and in many cases ‘graduation’ to the juvenile delinquency system,” according to court documents filed by child advocates. Similar concerns were raised by a 1991 Little Hoover Commission report on California’s foster care system.
“With the settlement, tens of thousands of children will remain in their homes every year in California, many of whom get stuck in a system that hasn’t been responsive to their needs and who actually grow up in foster care,” said the National Center for Youth Law's Patrick Gardner. “These are the neediest kids in the state: children who are neglected or abused, children who suffer from mental illness, and children who are often warehoused in inappropriate and insufficient settings.”
Los Angeles County settled the case in 2003, leaving the state agencies to continue the court battle. Overseen by a panel of national experts, Los Angeles County has since developed in-home mental health services, increased access to therapy, and created a system to monitor and track foster children who receive these services. Additionally, the MacLaren Children's Center, a much-criticized institution for troubled foster care youth, was closed.
Because it is still in the midst of implementing the settlement, Los Angeles County officials declined to comment. The California attorney general’s office did not return calls seeking comment. The state and LA County do not admit any wrongdoing by accepting this week's settlement.
The state Department of Social Services, which oversees child welfare programs, said that once the settlement is finalized, it will concentrate on implementation, which will improve the coordination among state agencies "in order to improve the mental health services for foster youth in California," said Michael Weston, a department spokesman.
In court documents, it appears that concerns about the cost of care to the financially strapped state were a stumbling block.
A report by the court-appointed special master, who oversaw the nearly two-year settlement talks, noted that the California social service delivery system was in the “midst of overwhelming system and social stress,” and it was experiencing “unprecedented economic difficulties that have created enormous challenges to the delivery of mental health and social services to children and families throughout the state.”
The special master’s July 2011 report notes that realignment, or the shifting of funds for services like mental health care to the county level, that begins Oct. 1 could create unanticipated costs to implementing the settlement agreement.
Child advocates acknowledge there will be a short-term increase in costs to the state and county, but the increased efficacy of the mental health programs prescribed in the settlement will result in long-term cost savings, they say.
“Anytime you try to transform a system, there are upfront costs, and it’s a small price to benefit children and reduce costs to the child welfare system and the juvenile justice system, because that’s another place where many children end up because we haven’t effectively met their needs,” said Gardner, who was one of the attorneys handling the case on behalf of the foster children. “If this is done well and right, then I firmly believe costs will go down.”
The settlement is expected to be finalized in December, but only one of the five foster kids named as plaintiffs in the lawsuit will benefit from improvements stemming from the lawsuit. In the course of nearly a decade of litigation, the other four have aged out and moved out of the state.
“Some have done well and some have not,” says the National Health Law Program’s Lewis. “It’s the tragic story of the foster care system, where kids get a lot of attention thrown at them, but not the right services. They age out, and as we know, foster care is not always a good prognosis for success if they don’t have a strong support network, some person behind them, or some place to call home.”