State of Reform attempts to be an open forum for thoughtful engagement on health care issues and challenges. This email came unsolicited to us last week from a foster parent, which is an often unheard perspective. We’ve reposted this unedited, in its entirety.
To Whom it May Concern,
I am a therapeutic foster mom and work with teen girls that have mental health issues. All of them use psychotropic medications and need ongoing therapy, mainly for trauma, anxiety, and depression. These are challenging kids who tend to move often. I hear the average is about every three months!
We have run into the bad result of a well-meaning policy that was intended to keep foster youth in their home counties. The truth is, there is no way to keep kids in their home county, for a variety of reasons. It is an unrealistic expectation when kids are moved as often as they are, and there are never enough foster parents available anywhere.
The policy requires that OHP cards are only useful in the county for which they are registered. When a child moves the DHS caseworker must have it reassigned to the new county. It can take a month or longer to have this done, and then it is sometimes delayed even longer, so that the card can be enrolled with a different insurer.
We have had situations in which the youth needed a doctor, but essentially was not covered by OHP because DHS had not transferred the card yet, and we were threatened with having to pay the costs of care ourselves! We cannot count on DHS to cover it after the fact, since they state they will not reimburse for medical.
They need a statewide card, enrolled once, transferable to all counties, that just comes along with the child anywhere, any time. There are so many other frustrations inherent in providing foster care, this is one more headache we do not need. This should also cut administration costs, since there would be no need for DHS to have to do a thing with the health card when kids move.
Another frustration is that we can only use county mental health services for therapy. Sometimes a private clinic will offer more cutting edge therapies, such as EMDR, which is proven to be highly effective for PTSD. It can cut time in therapy to use a somatic therapy for PTSD. Our local county mental health doesn’t offer this effective therapy. I think if a county clinic doesn’t offer a needed type of therapy, we should be able to use an outside clinic that does. An alternative might be to require each clinic to train staff in more than CBT.
The other issue is a child arriving without enough medications to get them transitioned to new providers. It can take a long time to get an intake appointment, plus we cannot even call for an appointment until the OHP card is transferred. It is conceivable that it can take two months for a mental health visit, and if a kid arrives with only a few days worth of pills, it’s a crisis. Some of their former providers will not write extensions to get them covered during the interim. Former providers also should be required to ensure kids have plenty of refills, and it should not be left to the whims of each one to determine the policy.
There should be a policy that each youth comes with enough refills in their meds to cover three full months following a move. This would be adequate for all the time it takes for transitioning to the next provider.
Each child entering foster care should have full neuro-psych and sensory integration work ups within 30-60 days of entering care, and start appropriate therapies immediately, and then continuation of those therapies, no matter where they move. At the very least, every child in care must receive effective treatment for trauma. They ALL suffer effects of trauma, which interferes with attachment, trust, academic and social success, attention and focus, and stunts emotional development. If they can have the trauma healed, it releases them to develop and reach their potential. They all also seem to have sensory integration dysfunction, which is treatable and can reduce many behavior problems.
Foster parents seldom have any training about the effects of trauma on the brain, development, attachment, and behavior. They really need more training in these areas, so they better understand why these kids act the ways they do, and how to be more therapeutic in their approach to discipline and daily interaction. The kids are so hard to live with, without this understanding. In training foster parents, most of the time goes into how to do paperwork and follow rules, and little into how they are damaged and then how to repair them.
Please get my suggestions to someone who cares about ways to make transitions more seamless for these kids and their foster families. As foster parents, we are often undervalued, unheard, under-supported, , tired, taken advantage of, and underpaid. Most people do not last long. The problems the kids present with are increasingly more challenging and few are really equipped to handle them. The more the State can do to ease our burdens, the easier it is to focus on meeting needs of the kids, rather than nagging DHS, hauling them to therapies that don’t work, and begging clinics for medications.
We need a revolution in foster care, to keep up with the complexities of caring for these damaged kids. A revolution should not only focus on what the kids need. If foster parent needs are met, it automatically translates to better care for kids.
Thank you for listening.
To reach Jeryl, email her via firstname.lastname@example.org.