White Papers

MENTAL HEALTH
Mental Health Services to Children in Child Welfare
Updated 2011

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Purpose:
It is the intent of this document to outline a variety of concerns with regard to how mental health and substance abuse services are delivered to children and families of Kansas; to initiate a dialogue on the relevance of the current system of mental health care upon which children and families of Kansas must rely; to explore approaches for resolving problems in the system and to continue to improve a system of effective care in Kansas. Common to these families are the need for safety, permanency and well being.

The Children’s Alliance believes the time has come to review closely the availability and effectiveness of mental health services to children and families in Kansas. Moreover, this review needs to broadly address family-centered practices that are necessary before, during, and after a family may have been formally engaged in the child welfare system. The challenge of stabilizing and assuring successful reintegration once a youth has returned home can best be achieved with responsive, family-centered mental health care.

Background:
The need for mental health services for youth and families when a youth has been removed from her or his family are even more clearly demonstrated. More than 80% of children in foster care have developmental, emotional, or behavioral problems. Mental health services are repeatedly identified as their number one health care need, and according to the U.S. Department of Health and Human Services. These findings reflect national estimates on the mental health needs of foster children according the Child Welfare League of America.

Currently the mental health centers are the primary provider of mental health care for children in the child welfare contracts. In addition they are the gatekeepers of services for youth in psychiatric residential treatment facilities (PRTF). Important challenges remain for assuring proper and expeditious mental health care for all youth in the child welfare system. Concerns continue to surface in the areas of timeliness of access to enter care, extent of care being provided, relevance of current community mental health center treatment approaches, and uniformity of services across the state network of community mental health centers.

Child Welfare Perspective:
There is no question that children in the child welfare system, and their families, should receive both appropriate and timely mental health and substance abuse services. We must find ways to make certain that the proper services can be delivered to families in a timely manner. It is in this area of consistent service delivery statewide that our system is most likely to fail this population of youth.
We recommend the following service components be included with more traditional forms of therapy to assist the care giver in developing tools to manage a child’s behaviors:
• Clinically assess the capacity of parents to effectively parent in a safe manner.
• Service protocols that are consistent with the need for families to meet permanency in a   timely manner.
• Utilize properly licensed and credentialed staff.
• The needs of family members as well as the need of the family unit must be addressed.
• Support resource families and birth parents in the treatment process.
• Crisis intervention services for both birth and resource families.
• Provide training and counseling to birth and resource families to assist in managing             behaviors of children with whom they live.
• Licensed and/or credentialed staff provides thorough and timely reports to the court on   treatment progress and recommendations for permanence and the safety of the child.
• Recognition of the valuable role of the psychiatric residential treatment facilities (PRTF)   programs in the continuum of mental health services available to children and families.
• Treatment services should be provided in the most appropriate setting, ideally in the         home.
A second step necessary to guarantee the services being delivered to Kansas families is that those services be independently monitored. We need to know who is receiving services, the appropriateness of the service, and the timeliness by which that service is being provided. This provides the basis not only for quality assurance, but also to guarantee the cost effectiveness of the treatment plan being provided.

Families must have a full range of mental health and substance abuse services available to them regardless of whether they live in Lawrence or Lakin. Because of the nature of the work involved in reunifying or building families, the range of services available across the state must include; assessment, respite and attendant care, individual, group and family therapy, case conferencing, and targeted case management. These services should be available and provided by a properly licensed and credentialed provider.

Traditional services have not been geared toward serving a child who often belongs to two families. This presents complexities not anticipated in the model of care that has traditionally been provided in Kansas. The child welfare community based service providers have developed and are experienced in providing family-centered approaches that effectively combine mental health and substance abuse intervention with family-centered self-directed problem solving to meet the needs of families they serve. These distinctions represent cultural differences between traditional mental health service provision and the child welfare community based providers.

Finally, it is essential that expectations for accountability for the provision of mental health and substance abuse services be consistent and enforced. Providers must be held accountable in areas of service effectiveness and collaborate with all people involved in the life of the client.

Recommendations:
While KDHE is now in the midst of preparing the RFP for Medicaid services it seems the time is right to bring the values discussed in this paper to your attention.
The Children’s Alliance and its member agencies are prepared to work with administrative or legislative bodies to further engage this discussion.