Category Archives: Health

Senate Roundtable Discusses Wide-Ranging Child Welfare Proposal

On Wednesday, July 30, the Senate Foster Youth Caucus hosted a “Discussion on Child Welfare Finance Reform.” For months, the caucus has been hosting a series of different presentations to update Senate staff on a range of child welfare topics. They issued an open invitation to organizations that wanted to offer varying proposals. For this roundtable approximately 17 different proposals were discussed by a number of different organizations. The proposals (Senate Foster Youth Discussion) ranged from ideas to change the current funding structure to more targeted reforms including ideas to better align and improve on Medicaid and mental health services, changing the current eligibility link to foster care, realigning funding such as SSBG to expanding funding to services such as post permanency and reunification support and the appropriate use of residential care.

CWLA, building on its earlier policy statement issued in April, Finance Reform & Child Welfare: A Balanced Approach submitted a proposal to realign the Social Services Block Grant (SSBG) to update the current definitions of programs and to highlight its significant role in funding child protective services, prevention and intervention services, other child welfare services as well as other vital human services including domestic violence and special services for the disabled. The $1.7 billion in SSBG funding has been targeted for total elimination under some House proposals.

During the various presentations there were some overlapping issues and concerns that were raised that offer potential incremental change such as the need to strengthen access to mental and behavioral health services, better coordination between state Medicaid and state child welfare agencies, there was also agreement on the desire to do away with the eligibility link between foster care and AFDC and the need to strengthen the child welfare workforce. There was no conclusion to the event but the series will continue to focus on key issues and issue areas. The forum is envisioned as a way to continue a policy education effort for congressional staff.

In light of the Senate’s inability to pass an adoption reauthorization bill later in the week, there appears to be little opportunity to enact anything comprehensive this year. It is still hoped by some advocates that an end of the year budget deal that may have to deal with a range of delayed policy issues could include a small child welfare piece such as the Administration proposal to incentivize coordination between Medicaid and child welfare that would improve health care access for children in foster care and also reduce the incidence of over-medication.

Briefing Focuses on Military Families With Infants and Toddlers

The Congressional Baby Caucus celebrated its 5th birthday with a briefing on veterans and families. The briefing was a follow up to the Caucus’s initial briefing five years ago which also focused on military families with young children. The briefing included a panel of three that included one program expert and two veterans to reflect on the current challenges of military families, especially those transitioning out of the military. Panelists included Katherine Rosenblum, Ph.D., Director, STRoNG Military Families Program, Melissa Hudson,, Veteran Parent, Brian Pate, Lieutenant Colonel USMCR.

The gathering also heard remarks from caucus co-chairs Congresswoman Rosa DeLauro (D-CT) and Congressman Duncan Hunter (R-CA). DeLauro highlighted a number of statistics in her remarks including, 42% of children of Active-Duty members are under the age of five, Active-Duty, Guard and Reserve families together have approximately 363,000 children under the age of three. She also outlined the general concerns that deployment itself created certain stress within the population and how that may be compounded if a veteran comes back with injuries and other challenges such as PTSD. She hopes to focus Congress’s attention on ways to look at policy in a way that might benefit these families and singled out potential changes to the child tax credit as a possible target for improvements.

Dr. Rosenberg talked about some projects through the University of Michigan that are targeted to service members, and veterans. In the coming years an average of 250,000 Active-Duty members will be transitioning out of service. She provided data from the state of Illinois that showed that this population of veteran families had an unemployment rate of around 13%, 7% were living below the poverty rate, and they tended to have younger children.

Brian Pate discussed his personal experience during deployment and highlighted four areas that need addressing: family-readiness when a member is ready to deploy, communication while on assignment in an effort to help keep families connected while away, post-deployment services that prepare the returning soldier with the family—particularly programs that prepare you for reunification with infants and toddlers, and understanding how past service continues to have an impact.

He also highlighted a need that is often overlooked, that services are lost to the family once a soldier transfers from active duty to veteran status. The veteran may have some limited services including health care but his or her family may lose many critical services including access to health care.

Commission on Child Fatalities Holds First Of Series of State Hearings Monday

The Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF) will hold the first of a series of local hearings starting today. The hearings will allow the Commission to examine the range of issues that have been raised so far. The first meeting is in San Antonio, TX followed by a hearing on July 10, in Tampa, FL and a third hearing on August 28 in Detroit, MI. Additional hearings may be held in the fall of this year. The meeting details for the San Antonio meeting is , Monday, June 2, 2014, from 1:00–5:30 p.m. CDT, and Tuesday, June 3, 2014, from 8:30 a.m.–1:00 p.m. CDT, held at the University of Texas at San Antonio, Downtown Campus, 501 W. César E. Chávez Blvd., Southwest Room, Durango Building 1.124, San Antonio, TX 78207. Although late, it may still be possible to register to phone in at https://www.surveymonkey.com/s/5WLJYWH. A call-in number is available upon registration. The first day will be dedicated to actions and policies in the state of Texas and will include policy and practice presentations from various Texas-based presenters including comments by commission-sponsor, Congressman Lloyd Doggett (D-TX). Tuesday will focus more attention on national policy and perspectives.

The state of Texas has had the highest number of child deaths in each of the past five years with 215 child fatalities in 2012 according to the 2012 Child Maltreatment report. According to rates, the fatalities rate at 3.08 per 100,000 children ranks the state lower than New Mexico, Colorado, Idaho, Louisiana, Florida and Arkansas with the last two states at approximately four and a half child deaths per 100,000.

The Commission is expected to have a website up and running by this week which should include tools to submit comments. You can also send comments via the mail to: Commission to Eliminate Child Abuse and Neglect Fatalities, c/o General Services Administration, Agency Liaison Division, 1800 F St., NW, Room 7003D, Washington DC 20006.

According to the enabling legislation, the commission’s work includes an examination of best practices in preventing child and youth fatalities that are caused due to negligence, neglect, or a failure to exercise proper care; the effectiveness of federal, state, and local policies and systems aimed at collecting accurate and uniform data on child fatalities; the current barriers to preventing fatalities from child abuse and neglect, how to improve child welfare outcomes; trends in demographic and other risk factors that are predictive of or correlated with child maltreatment, such as age of the child, child behavior, family structure, parental stress, and poverty; methods of prioritizing child abuse and neglect; and methods of improving data collection and utilization, such as increasing interoperability among state and local and other data systems.

House Hearing On Psychotropic Medication In Foster Care

On Thursday, May 29, the House Subcommittee on Human Resources of the Ways and Means Committee focused additional attention on the issue of the over-use of psychotropic medication for children in foster care. The hearing coincided with the annual “Shadow Day” a House event that arranges to have youth in or formerly in foster care to follow their member of Congress for the day. The issue of over-medication has attracted increasing attention over the past several years with a series of GAO reports, congressional hearings and a new Obama Administration proposal that would target the over medication issue through a coordinated incentive fund with Medicaid and the Children’s Bureau.

Witnesses before the panel included: Joo Yeun Chang, Associate Commissioner of the Children’s Bureau, Dawna Zender Hovenier, The Mockingbird Society, Phil McGraw, Talk Show Host, Dr. Phil, Michael Naylor, Associate Professor of Psychiatry, University of Illinois at Chicago, and Stephen Lord, Director, Forensic Audits and Investigative Services, Government Accountability Office. The star power of Dr Phil helped to draw a big hearing crowd including several of the foster youth as well as several members of the Subcommittee. The consensus was that there is an over-reliance on the use of medication and an agreement that much of it occurs due to a lack of proper health care screening for children and youth in foster care and then a lack of access to proper therapies for patients. As a result, the over-use of medication becomes a fall-back positions in many instances.
Commissioner Chang, highlighted the need for the Administration’s proposal based on current practice which fails to provide the needed therapies and screening for children in foster care. She said, “The existing strong evidence-base in the area of trauma-informed psychosocial interventions warrants a large initial investment to expand access to effective interventions. The ACF proposal for $250 million over five years would fund infrastructure and capacity building, while the CMS investment of $500 million over five years would provide incentive payments to states that demonstrate measured improvement.”

Ms Hovenier discussed her experiences in foster care and what led to her medical treatment and the overuse of psychotropic medications. She testified that she “was ordered into the psychiatric hospital after my social worker told the court I had Borderline Personality Disorder, Major Depressive Disorder and suicidal ideation. I was forced to take strong doses of psychiatric medications and told I could probably never live on my own. Only my CASA and the man who became my father agreed with me that I didn’t need the drugs. The seven months I was locked up and forced to take drugs against my will felt like being in jail.” Ms Hovenier also suggested that youth in care have a right to request a second medical opinion regarding their care.

Dr Phil repeated some of his remarks delivered earlier that afternoon before a luncheon of foster youth and members of Congress when he said, “Prescription psychotropic drugs can change and even save lives, but when it comes to these vulnerable children, these drugs are too often misused as ‘chemical straight jackets.’ This is a haphazard attempt to simply control and suppress undesirable behavior, rather than treat, nurture and develop these treasured young people.” He said it would be wrong to pour more money into the same system but that investment into a system that would provide better health care would be worthwhile and that we had to make a greater effort at supporting these children including making a better effort at reunification.

Michael Naylor, discussed some of the recent efforts and successes of the state of Illinois to monitor and reduce the overuse of medication for the foster care population in the state. Dr Naylor said, “The Illinois model of providing consent for psychotropic medications for foster children and monitoring the use of these medications is widely regarded as a pioneer and leader in this arena and has received considerable attention…a well-designed and implemented medication consent and oversight program that provides effective longitudinal oversight of a youth’s care and monitoring of prescribing patterns can improve the continuity and quality and increase the cost-effectiveness of care provided to foster children.” The GAO witness reiterated some of the findings of last week’s GAO report.

Dr Phil also indicated that he had signed onto a letter signed by more than 100 organizations in support of the Administration’s budget request for the joint ACF-Medicaid proposal.