I apologize for the intermission in my blog entries... I've been in California on a family vacation. During that time, I met with three wonderful people who are each working in their own ways to make a positive difference in foster care. It was definitely one of the best trips I've ever taken, but I'm sorry to be silent for so long!
I'd like to begin this blog entry by inviting readers to share specific cases of psychotropic drugging of California foster children. KCBS investigative producer Karen Foshay is very passionate about this subject, and your insights would add to her current research.
I have already passed on this request to several other sources, but I figured one more "shout-out" wouldn't hurt.
Historical prospective
In light of unresolved nationwide issues in drugging foster children, I wanted to turn back the pages of time to share another atrocity: Hundreds of foster children received experimental AIDS drugs in the 1990s without the oversight of medical advocates.
Yes, you read that correctly: Foster children who were HIV-infected were used to test potent AIDS drugs by federally funded researchers.
Using foster kids as guinea pigs
Testing took place in seven states: Texas, Colorado, New York, North Carolina, Maryland, Lousiana and Illinois. This research was funded by the National Instititutes of Health.
The guidelines for the "Protection of Human Subjects" require researchers to inform the subject of possible side effects and obtain parental consent.
Due to the lack of parental involvement, researchers initially promised NIH in writing that they would appoint medical advocates for each child, in accordance with federal law.
Where were the advocates?
Between 600-1300 foster children, ranging from infants to teenagers, participated in the HIV experiments. Many suffered side effects, such as rash, vomiting and plunging levels of infection-resisitant blood cells.
In some cases, medical advocates were promised but not provided. In others, research oversight boards later determined that medical advocates where not necessary.
-The Columbia Presbyterian Medical Center in New York provided advocates for 142 of the 465 foster children used by researchers to test AIDS drugs in their state. Approximately two-thirds of subjects did not receive advocates, which was in violation of state policy.
-Illinois officials reported that foster children tested at the Chicago Memorial Hospital received no medical advocates.
-At the John Hopkins University in Baltimore, medical advocates were also absent.
Where was the informed consent? What about a guardian at litem?
Did the end justify the means?
During the investigation led by the U. S. Office for Human Research Protections, medical researchers asked that the experiments be viewed within the context of the late 80's and early 90's, when a million Americans were estimated to be HIV-positive.
The Maryland medical oversight board claimed that, according to state policy, in trials where the child patients face minimum risk or are expected to draw direct benefit from the research, no medical advocate is required to oversee medical experimentation.
The ethical paradox was that foster children were recieving costly, life-extending care from the world's most eminent doctors, at a time when no other viable treatments existed.
John J. Farley, associate professor of pediatrics at the University Maryland School of Medicine said, "I join with my colleagues in feeling that they weren't exploited and probably a number of those children are alive today because they had access to those medications."
It would be difficult to verify or nullify the truth to his statement, since no further information was forthcoming about the subjects of the research. After denying medical advocacy to foster children, medical officials now claim to be protecting their confidentiality.
Foster children deserve medical advocacy
The staff of the Houston Chronicle wrote that, "Few members of society are more vulnerable than children without permanent parents. Foster care kids with dire illnesses are more fragile still."
They concluded that, "Because of their vulnerability, each of these foster children should have had a medically qualified advocate. It is a high standard of legal protection - but not too high for children with so few defenses."
As Representative Fortney Stark, from California pointed out that prisoners involved in medical research have advocates to oversee all participation in medical trials. Similar protections should be offered to foster children.
He said, "I think we'd all sleep a little better at night if we put in a requirement that children have sufficient advocacy."
Sources
Brainard, Jeffrey. Report faults studies using foster children. Chronicle of Higher Education, May 27, 2005, Vol. 51, Iss. 38, p.A23.
Editorial: Put child advocacy before science. Atlanta Journal, Constitution, Atlanta, GA, May 13, 2005, p.A14.
Hopper, Leigh. AIDS study of foster kids scrutinized: No advocates were provided for children given drugs in trials that included Baylor. Houston Chronicle, Houston, TX, May 5, 2005: p.B6.
Otto, Mary. Drugs tested on HIV-positive foster childre: Hill investigates ethical questions raised by 1990s trails in Md., elswhere. The Washington Post, Washington, DC, May 19, 2005: p.B1.
Spencer, Jim. Lack of informed consent dulls good news in kids' study. Denver Post, Denver, CO, May 9, 2005, p.B5.
Standards of caring: Legal protections for foster children should be at least as high as they are for kids with parents. Houston Chronicle, Houston, TX, May 14, 2005, p.B8.
Walters, Ron. Minority foster children used as guinea pigs in HIV tests. Tri-State Defender, Memphis, TN, June 4-June 8, 2005, Vol. 54, Iss. 23, p.4A.
Sunday, July 30, 2006
Friday, July 21, 2006
Making the most of every opportunity
As mentioned in a previous post, I have been chosen to help design the Ohio chapter of FCAA. As co-founder with my friend Gayle, my first challenge will be getting in touch with foster alumni throughout the state, and inviting them to help positively influence nationwide policy.
History of Foster Care Alumni of America
In 1999, the Casey Foundation conducted the largest ever retrospective study of foster alumni. Their research was based on extensive interviews with 1400 foster alumni, who had aged out of care between 1966-1986.
Because this study was the first of its kind, they had no idea what to expect. One thing that they didn't expect was that every participant, whether their ultimate placement had been positive or negative, wanted to change the foster care system.
They were actively engaged on all levels. One woman who was destitute, spent hours talking on a calling card, in the hopes that her experience could be used to positively impact others.
As a result of their findings, the Casey Foundation founded an Alumni Relations Board in 2000. Two years later, the board recommended the need for a national organization. Why? Because foster alumni needed to have a collective voice.
FCAA achieved national 501 3c status in 2004. In May of 2006, representatives from seven states (including yours truly) attended the summit in Seattle.
The need for a collective voice
Foster care alumni are an invisible population. If you met me, you wouldn't know I grew up in foster care unless I told you. There is no scarlet "F" label on my chest.
Because of the stigma and stereotyping that most foster youth experience growing up, alumni are often reticent to identify themselves as former foster children. We have experienced firsthand the low expectations and lack of credibility that foster youth are often afforded.
It has been a conscious choice on my part to identify myself with my past. I do it because of my passion to speak up for those who cannot speak for themselves.
But, a national foster alumni organization takes this idea one step further: It empowers foster alumni to speak for themselves.
Connecting with other foster alumni
Many challenges are inherent in trying to arm the passion and power of former foster children. We have learned not to connect, not to commit, not to trust. We have learned to be individuals, and to stand on our own. We have experienced feeling "different," which often leads to self-isolation.
So, how can we connect with one another? Trust one another? Work with one another, when our first impulse will be to tackle problems individually?
Obstacles exist, but I believe the outcome is worth the effort. Before leaving for my trip to California, I printed out 200 fliers, inviting adults who grew up in group homes, foster homes or with a relative (kinship care) to contact me and be a part of Ohio FCAA.
My initial plan was to visit every Krogers in town and post fliers on the bulletin boards. Unfortunately, Krogers have replaced their bulletin board with plastic display cases, and wire shelves designed specifically for Krogers-approved publications.
My back-up plan was to post fliers all over the local college campus, with the help of my oldest stepdaughter. I also visited every store downtown in the Short North area. This is an area frequented by people of all backgrounds, from professionals to college students, to homeless individuals.
I posted fliers in college coffee shops, tattoo parlors, downtown restaurants, laundrymats and car repair establishments.
Opportunity for a television appearance?
I have recently been in contact with Michael Bloom, the associate producer of the Dr. Keith Ablow Show. He is looking for a foster child or alumni who is struggling.
Here is the dilemma, as I see it:
Mr. Bloom has a deadine to deal with... He seems to be sincere in his belief that Dr. Keith Ablow is a reputable and sensitive doctor. He cannot understand why different agencies that he has contacted, including Foster Care Alumni and the California Youth Connection, appear to be stonewalling him.
The way he sees it, this could be a great opportunity for someone. Free counseling, and the show would pay for their follow-up care. The reason that Mr. Bloom works for the Dr. Keith Ablow Show is because he believes that it positively changes lives.
However, I can also understand why organizations might hesitate to respond. When I received Mr. Bloom's email, my first instinct was to feel protective...
My concerns:
1.) Not to betray anyone's trust. (I will not give out contact information for the foster youth / alumni that I am in contact with without their permission).
2.) What I call the "Drew Barrymore syndrome:" If you take an emotionally raw person and they air their experiences publicly, that is very sensitive information that they are putting out there. It could potentially follow them throughout their life.
Foster children already grow up with a case file, which is not always permanently closed when they reach adulthood. They don't need to be haunted by anything else.
3.) Not to waste an opportunity to give a voice to someone in/from foster care. There are many emotional issues affliction foster children that can and should be brought to life. Post-traumatic stress disorder is one of them.
Foster alumni often don't have medical insurance. If the show provided follow-up therapy, that would be a generous and helpful gift. It might lead to greater emotional health and healing...
I think that the two biggest challenges that Mr. Bloom faces in trying to find foster youth/alumni willing to appear on the show are:
1.) We as foster youth don't want to come across as weak, needy or broken. Not allowing us to talk about our successes and progressive healing is a turn-off. We need to be able to say how far we've come, before we risk the vulnerability of sharing an area or two wherein we might still need to heal.
2.) The television format is "now, now, now." If you really do want to contact someone straight off the streets, homeless due to aging out of foster care without proper resources and/or emotionally raw, you have to put in some time.
You will have to earn their trust. Work at it. Foster alumni have often been exploited in the past, and they will be ultra-sensitive to being exploited in the future.
For you, it's a show. For them, it's their life. Because deep-down, underneath the tough exterior that we might put on, foster care alumni are vulnerable.
History of Foster Care Alumni of America
In 1999, the Casey Foundation conducted the largest ever retrospective study of foster alumni. Their research was based on extensive interviews with 1400 foster alumni, who had aged out of care between 1966-1986.
Because this study was the first of its kind, they had no idea what to expect. One thing that they didn't expect was that every participant, whether their ultimate placement had been positive or negative, wanted to change the foster care system.
They were actively engaged on all levels. One woman who was destitute, spent hours talking on a calling card, in the hopes that her experience could be used to positively impact others.
As a result of their findings, the Casey Foundation founded an Alumni Relations Board in 2000. Two years later, the board recommended the need for a national organization. Why? Because foster alumni needed to have a collective voice.
FCAA achieved national 501 3c status in 2004. In May of 2006, representatives from seven states (including yours truly) attended the summit in Seattle.
The need for a collective voice
Foster care alumni are an invisible population. If you met me, you wouldn't know I grew up in foster care unless I told you. There is no scarlet "F" label on my chest.
Because of the stigma and stereotyping that most foster youth experience growing up, alumni are often reticent to identify themselves as former foster children. We have experienced firsthand the low expectations and lack of credibility that foster youth are often afforded.
It has been a conscious choice on my part to identify myself with my past. I do it because of my passion to speak up for those who cannot speak for themselves.
But, a national foster alumni organization takes this idea one step further: It empowers foster alumni to speak for themselves.
Connecting with other foster alumni
Many challenges are inherent in trying to arm the passion and power of former foster children. We have learned not to connect, not to commit, not to trust. We have learned to be individuals, and to stand on our own. We have experienced feeling "different," which often leads to self-isolation.
So, how can we connect with one another? Trust one another? Work with one another, when our first impulse will be to tackle problems individually?
Obstacles exist, but I believe the outcome is worth the effort. Before leaving for my trip to California, I printed out 200 fliers, inviting adults who grew up in group homes, foster homes or with a relative (kinship care) to contact me and be a part of Ohio FCAA.
My initial plan was to visit every Krogers in town and post fliers on the bulletin boards. Unfortunately, Krogers have replaced their bulletin board with plastic display cases, and wire shelves designed specifically for Krogers-approved publications.
My back-up plan was to post fliers all over the local college campus, with the help of my oldest stepdaughter. I also visited every store downtown in the Short North area. This is an area frequented by people of all backgrounds, from professionals to college students, to homeless individuals.
I posted fliers in college coffee shops, tattoo parlors, downtown restaurants, laundrymats and car repair establishments.
Opportunity for a television appearance?
I have recently been in contact with Michael Bloom, the associate producer of the Dr. Keith Ablow Show. He is looking for a foster child or alumni who is struggling.
Here is the dilemma, as I see it:
Mr. Bloom has a deadine to deal with... He seems to be sincere in his belief that Dr. Keith Ablow is a reputable and sensitive doctor. He cannot understand why different agencies that he has contacted, including Foster Care Alumni and the California Youth Connection, appear to be stonewalling him.
The way he sees it, this could be a great opportunity for someone. Free counseling, and the show would pay for their follow-up care. The reason that Mr. Bloom works for the Dr. Keith Ablow Show is because he believes that it positively changes lives.
However, I can also understand why organizations might hesitate to respond. When I received Mr. Bloom's email, my first instinct was to feel protective...
My concerns:
1.) Not to betray anyone's trust. (I will not give out contact information for the foster youth / alumni that I am in contact with without their permission).
2.) What I call the "Drew Barrymore syndrome:" If you take an emotionally raw person and they air their experiences publicly, that is very sensitive information that they are putting out there. It could potentially follow them throughout their life.
Foster children already grow up with a case file, which is not always permanently closed when they reach adulthood. They don't need to be haunted by anything else.
3.) Not to waste an opportunity to give a voice to someone in/from foster care. There are many emotional issues affliction foster children that can and should be brought to life. Post-traumatic stress disorder is one of them.
Foster alumni often don't have medical insurance. If the show provided follow-up therapy, that would be a generous and helpful gift. It might lead to greater emotional health and healing...
I think that the two biggest challenges that Mr. Bloom faces in trying to find foster youth/alumni willing to appear on the show are:
1.) We as foster youth don't want to come across as weak, needy or broken. Not allowing us to talk about our successes and progressive healing is a turn-off. We need to be able to say how far we've come, before we risk the vulnerability of sharing an area or two wherein we might still need to heal.
2.) The television format is "now, now, now." If you really do want to contact someone straight off the streets, homeless due to aging out of foster care without proper resources and/or emotionally raw, you have to put in some time.
You will have to earn their trust. Work at it. Foster alumni have often been exploited in the past, and they will be ultra-sensitive to being exploited in the future.
For you, it's a show. For them, it's their life. Because deep-down, underneath the tough exterior that we might put on, foster care alumni are vulnerable.
Monday, July 17, 2006
Fathers & Daughters
My favorite scene from the movie, "Good Will Hunting," is the one wherein Robin Williams assures Matt Damon that he (Matt) is not to blame for the abuse he suffered as a child. "It's not your fault... It's not your fault... It's not your fault."
Robin keeps repeating this phrase, until finally Matt bursts into tears and reveals the feelings of guilt and shame that he has been carrying.
Running from a feeling of shame
Sadly, children often internalize traumatic events. Part of being a child is sometimes viewing self as "all-powerful." Also, feelings of loyalty toward the parent can cause children to shift the burden of blame onto themselves.
Shame can be a depressing, disturbing and deadening experience. Dr. Norman Wright describes it this way: "Shame is like a hole in the cup of our soul. Since the child in the adult has insatiable needs, the cup cannot be healed."
What do insatiable needs look like?
Shame often demonstrates itself in the form of compulsive behavior. Workaholic, sexaholic, money hunger, eating disorders, substance abuse... Take your pick.
Alan Jones describes it this way, "I consume things - to stop myself from being consumed... trying to gratify an immediate hunger, without accepting that hunger is part of being human and so cannot be dealt with or understood by an endless succession of leakplugging operations."
Compulsions can be self-destructive in the long-run, but in the present, they serve a specific purpose. They distract us from fear, worry, loneliness, anger and pain.
Father loss & daughter reaction
A father might die, abuse or abandon his child or be present physically, but not emotionally. In the case of divorce, he might want to see his children more often, but be unable to do so...
Regardless for the reason for paternal absence, the impact on a child can be astrononical.
Abandonment and neediness
When I was in college, my roommate was father-hungry. She feared abandonment, and reacted to that fear by clinging to her boyfriends.
Her behavior was not always endearing. One night, when her boyfriend said he needed space and was about to drive off to his apartment, Andi took his keys and through them into the bushes, so that he couldn't leave.
Deep inside Andi was the little girl she once was... The little girl who stood at her bedroom door, counting cars and telling herself that one of them would be her father coming to visit her.
Insatiable needs can be difficult for others to deal with...
Achievement as a substitute for intimacy
After living in foster care from age 12-16, I was also father-hungry. But my father hunger manifested itself in a different way than my roommates. I experienced the same fears, the same anxiety as Andi -- but my conclusion at the time was that it would be better to rely on myself.
A father's absence teaches a young woman the precariousness of love. One response is to invest emotions in activities, rather than people. There is often an underlying desire for paternal approval.
Living under a father's shadow
For any experience, there can be a myriad of reactions. Why did Andi and I react so differently? One factor can be the role that the father plays in a child's life prior to his absence. Before his absence, how did the daughter perceive her father?
Dr. Wright describes weak fathers as unreliable, undependable and having no strength to offer. Weak fathers do things like ending their relationship with their daughter because their new wife asks them to choose.
Daughters of weak fathers worry that they might overwhelm others with their emotional needs. They have been disillusioned by witnessing their father's ineffectiveness.
My father was a weak father. I can say that now, after having married a strong man.
Source
Jones, Alan W. SoulMaking.
Wright, H. Norman. Always Daddy's Girl.
Robin keeps repeating this phrase, until finally Matt bursts into tears and reveals the feelings of guilt and shame that he has been carrying.
Running from a feeling of shame
Sadly, children often internalize traumatic events. Part of being a child is sometimes viewing self as "all-powerful." Also, feelings of loyalty toward the parent can cause children to shift the burden of blame onto themselves.
Shame can be a depressing, disturbing and deadening experience. Dr. Norman Wright describes it this way: "Shame is like a hole in the cup of our soul. Since the child in the adult has insatiable needs, the cup cannot be healed."
What do insatiable needs look like?
Shame often demonstrates itself in the form of compulsive behavior. Workaholic, sexaholic, money hunger, eating disorders, substance abuse... Take your pick.
Alan Jones describes it this way, "I consume things - to stop myself from being consumed... trying to gratify an immediate hunger, without accepting that hunger is part of being human and so cannot be dealt with or understood by an endless succession of leakplugging operations."
Compulsions can be self-destructive in the long-run, but in the present, they serve a specific purpose. They distract us from fear, worry, loneliness, anger and pain.
Father loss & daughter reaction
A father might die, abuse or abandon his child or be present physically, but not emotionally. In the case of divorce, he might want to see his children more often, but be unable to do so...
Regardless for the reason for paternal absence, the impact on a child can be astrononical.
Abandonment and neediness
When I was in college, my roommate was father-hungry. She feared abandonment, and reacted to that fear by clinging to her boyfriends.
Her behavior was not always endearing. One night, when her boyfriend said he needed space and was about to drive off to his apartment, Andi took his keys and through them into the bushes, so that he couldn't leave.
Deep inside Andi was the little girl she once was... The little girl who stood at her bedroom door, counting cars and telling herself that one of them would be her father coming to visit her.
Insatiable needs can be difficult for others to deal with...
Achievement as a substitute for intimacy
After living in foster care from age 12-16, I was also father-hungry. But my father hunger manifested itself in a different way than my roommates. I experienced the same fears, the same anxiety as Andi -- but my conclusion at the time was that it would be better to rely on myself.
A father's absence teaches a young woman the precariousness of love. One response is to invest emotions in activities, rather than people. There is often an underlying desire for paternal approval.
Living under a father's shadow
For any experience, there can be a myriad of reactions. Why did Andi and I react so differently? One factor can be the role that the father plays in a child's life prior to his absence. Before his absence, how did the daughter perceive her father?
Dr. Wright describes weak fathers as unreliable, undependable and having no strength to offer. Weak fathers do things like ending their relationship with their daughter because their new wife asks them to choose.
Daughters of weak fathers worry that they might overwhelm others with their emotional needs. They have been disillusioned by witnessing their father's ineffectiveness.
My father was a weak father. I can say that now, after having married a strong man.
Source
Jones, Alan W. SoulMaking.
Wright, H. Norman. Always Daddy's Girl.
Sunday, July 09, 2006
Delayed Health Care for Foster Children
Drugging foster children unnecessarily is not good.
Denying foster children medical services due to citizenship concerns is equally disastrous.
Deficit Reduction Act of 2005 Revisited
Due to recent concerns about illegal immigration, the federal government is now implementing a provision of the DRA which requires that all U.S. citizens who apply for, or renew, their eligibility for Medicaid coverage must document their citizenship.
This ruling was effective on July 1, 2006. It is intended to prevent illegal immigrants from receiving benefits through Medicaid, the government program of health care for the poor.
What About Foster Children Receiving Medicaid?
Therein lies the rub. All children who eligible for Title IV-E funds can be enrolled in Medicaid. Up until now, the very fact that they receive federal foster care payments has been accepted as proof of citizenship.
Likewise, low-income children and children with disabilities within the foster care have had access to Medicaid as well.
Well... not anymore.
New regulations are requiring the documentation of citizenship for every child entering foster care. Without the proper documentation, foster children will remain uninsured.
Approximately 300,000 children enter foster care each year. How many of them will be carrying their birth certificates with them? Many of these children are coming from abusive and neglectful homes, and their families might not have (or be willing to relinquish) vital information.
Due to the circumstances surrounding the emergency removal of children from their homes, state agencies frequently use electronic birth records to establish case files. Now, only the original document, or a copy certified by the issuing agency will be considered acceptable.
Will foster parents be given enough information to apply for birth certificates on children's behalf?
What about the waiting period? Obtaining a birth certificate can take weeks or months.
Denying Foster Children Access to Health Care
Upon entry into foster care, a child might be developmentally delayed or underweight. They may never have visited a dentist or lack up-to-date immunizations.
It is for all these reasons that the American Academy of Pediatrics Committee on Early Childhood recommends a comprehensive medical screening upon entry into foster care.
Children who enter foster care are at high medical risk. How long should they wait to receive treatment?
I agree wholeheartedly with this quote from Robert Greenstein, Executive Director of the Center on Budget and Policy Priorities:
"These children are among the most vulnerable members of our society. To deny them health care coverage for beaurocratic reasons that readily could be resolved, and refuse them coverage while their documents are being located is not defensible."
Kudos to Montana for coming up with a creative solution
Montana's Motor Vehicle Division will issue state identification cards to nearly 2000 foster children.
Casey Family Programs contacts the Department of Health and Human Services
The following agencies joined Casey Family Programs in voicing (and documenting) their collective concern over this issue:
Association of Jewish Family & Children's Agencies
Arkansas Center for Health Improvement
Bazelon Center for Mental Health Law
California Mental Health Directors Association
California State Association of Counties
Child Welfare League of America
County Commissioners Association of Pennsylvania
County Welfare Directors Assocaition of California
Familes USA
Foster Care Alumni of America
Illinois Department of Children and Famiyl Services
Jim Casey Youth Opportunties Initiative
National Advocacy Center of the Sisters of the Good Shepherd
National Association of County Human Services Administrators
National Association of Social Workers
National Education Association
NETWORK, a National Catholic Social Justice Lobby
Pennsylvania Children and Youth Administrator's Association
Public Children Services Association of Ohio
Safe Place: Center for Child Protection and Health
Alliance for Children and Families
Arc of the United States
Children's Health Fund
Vermont Department for Children and Families
Voices for America's Children
United Cerebral Palsy
Wisconsin Counties Association
Sources
Kids in foster care receive state cards. Montana News Station, Great Falls, MT: July 2006.
National organizations warn HHS that citizenship-verification rules could lead to denial of critical medical services to foster children. Casey Family Programs press release: June 30, 2006.
Redmond, Pat. Children in foster care may have to delay health care because of federal regulations on citizenship requirement. Center on Budget and Policy Priorities: July 7, 2006.
Spillane, Shannon. Changes in Medicaid rules 'commendable,' but further changes needed to precent loss of health coverage by poor children and parents. U. S. Newswire: July 7, 2006.
Denying foster children medical services due to citizenship concerns is equally disastrous.
Deficit Reduction Act of 2005 Revisited
Due to recent concerns about illegal immigration, the federal government is now implementing a provision of the DRA which requires that all U.S. citizens who apply for, or renew, their eligibility for Medicaid coverage must document their citizenship.
This ruling was effective on July 1, 2006. It is intended to prevent illegal immigrants from receiving benefits through Medicaid, the government program of health care for the poor.
What About Foster Children Receiving Medicaid?
Therein lies the rub. All children who eligible for Title IV-E funds can be enrolled in Medicaid. Up until now, the very fact that they receive federal foster care payments has been accepted as proof of citizenship.
Likewise, low-income children and children with disabilities within the foster care have had access to Medicaid as well.
Well... not anymore.
New regulations are requiring the documentation of citizenship for every child entering foster care. Without the proper documentation, foster children will remain uninsured.
Approximately 300,000 children enter foster care each year. How many of them will be carrying their birth certificates with them? Many of these children are coming from abusive and neglectful homes, and their families might not have (or be willing to relinquish) vital information.
Due to the circumstances surrounding the emergency removal of children from their homes, state agencies frequently use electronic birth records to establish case files. Now, only the original document, or a copy certified by the issuing agency will be considered acceptable.
Will foster parents be given enough information to apply for birth certificates on children's behalf?
What about the waiting period? Obtaining a birth certificate can take weeks or months.
Denying Foster Children Access to Health Care
Upon entry into foster care, a child might be developmentally delayed or underweight. They may never have visited a dentist or lack up-to-date immunizations.
It is for all these reasons that the American Academy of Pediatrics Committee on Early Childhood recommends a comprehensive medical screening upon entry into foster care.
Children who enter foster care are at high medical risk. How long should they wait to receive treatment?
I agree wholeheartedly with this quote from Robert Greenstein, Executive Director of the Center on Budget and Policy Priorities:
"These children are among the most vulnerable members of our society. To deny them health care coverage for beaurocratic reasons that readily could be resolved, and refuse them coverage while their documents are being located is not defensible."
Kudos to Montana for coming up with a creative solution
Montana's Motor Vehicle Division will issue state identification cards to nearly 2000 foster children.
Casey Family Programs contacts the Department of Health and Human Services
The following agencies joined Casey Family Programs in voicing (and documenting) their collective concern over this issue:
Association of Jewish Family & Children's Agencies
Arkansas Center for Health Improvement
Bazelon Center for Mental Health Law
California Mental Health Directors Association
California State Association of Counties
Child Welfare League of America
County Commissioners Association of Pennsylvania
County Welfare Directors Assocaition of California
Familes USA
Foster Care Alumni of America
Illinois Department of Children and Famiyl Services
Jim Casey Youth Opportunties Initiative
National Advocacy Center of the Sisters of the Good Shepherd
National Association of County Human Services Administrators
National Association of Social Workers
National Education Association
NETWORK, a National Catholic Social Justice Lobby
Pennsylvania Children and Youth Administrator's Association
Public Children Services Association of Ohio
Safe Place: Center for Child Protection and Health
Alliance for Children and Families
Arc of the United States
Children's Health Fund
Vermont Department for Children and Families
Voices for America's Children
United Cerebral Palsy
Wisconsin Counties Association
Sources
Kids in foster care receive state cards. Montana News Station, Great Falls, MT: July 2006.
National organizations warn HHS that citizenship-verification rules could lead to denial of critical medical services to foster children. Casey Family Programs press release: June 30, 2006.
Redmond, Pat. Children in foster care may have to delay health care because of federal regulations on citizenship requirement. Center on Budget and Policy Priorities: July 7, 2006.
Spillane, Shannon. Changes in Medicaid rules 'commendable,' but further changes needed to precent loss of health coverage by poor children and parents. U. S. Newswire: July 7, 2006.
Friday, July 07, 2006
Drugging Foster Children
If I hadn't read these articles, I (a former foster child) would have thought that drugging foster children was an urban legend.
It is the stuff of a science fiction novel:
-States such as Texas, Florida and Minnesota discover an alarming number of foster youth on behavior-altering drugs.
-California state regulations provide financial incentive for group home staff to request and administer psychotropic drugs to children in their care -- because rates are based on mental-health treatment services per child.
-A seventeen-year old foster child in California is threatened that if she doesn't take the drugs she was prescribed, she will not receive transitional housing.
Unfortunately, all these things are happening - and it is time for them to stop.
Medicating wounds, rather than healing them
Medications have their place in helping members of society. But foster youth who experience grief, fear and sadness are simply displaying normal reactions to their living situations.
Consider this scenario:
Girl's mother dies - Girl feels sad - Staff recommends Zoloft - Group home receives more money.
What's wrong with this picture? It creates a system that is ripe for abuse.
In Texas, 12,000 foster youth received psychotropic drugs in 2004. Each child averaged 21 psychotropic drug prescriptions a year.
In Massachusetts, two-thirds of 17-year-old foster children have recieved inpatient or outpatient medical treatment (as opposed to only 37% in Illinois, Iowa and Wisconsin). State Representative Marie Parente believes that state reimbursement checks from the federal government might be a financial incentive to misdiagnose and overmedicate foster children.
In California, the use of drugs remains unchecked and unregulated. The California Psychiatric Assocation blocked the passing of a 2004 bill by then-Senator Mountjoy to analyze the administration of drugs to children in foster care.
Judges approving dosages
According to the California rules of court, Rule 1432.5: "Once a child is declared a dependent child of the court and is removed from the custody of parents or guardian, only a juvenile court judicial officer is authorized to make orders regarding the administration of psychotropic medicine to the child."
Is the judge now considered a medical expert? Does he or she even meet the child in question? Often, all that judge has to go by are the reports handed in by social workers and group home staff.
In 1999, when Governor Gray Davis gave final approval to the law requiring judges to sign off on medication requests, many juvenile judges said that they didn't know much about medications, nor the doctors prescribing them.
One judge reported that he simply trusted that the 'doctor knows best.' While Los Angeles Juvenile Court had the funding to screen requests through the county's medical health unit, other judges lacked the money for such a review.
Also, according to California rules of court: "In emergency situations, psychotropic medications may be administered to a dependent with or without court authorization..."
This is both disturbing and vague.
What constitutes an emergency situation? Is it only that the child is sad, and the group home will recieve more money? California group homes receive anywhere between $2000 and $6000 per foster youth, depending on what medications they are on, according to Jennifer Rodriguez, legal representative for the California Youth Connection.
Foster youth are not informed of their right to refuse medication. Foster youth reported being punished for refusal by losing privilges and threatened that they will be evicted from the group home.
Risks of overmedicating
Attorney Andrea Moore, of Florida, is currently representing several children who began lactating after taking antipsychotics .
One of her clients is also a twelve-year-old whose heart condition was exacerbated by the Geodon she had been prescribed. According to Moore, the doctor who prescribed Geodon did not even have the child's medical history. The drug's label clearly states that patients with heart problems shouldn't take it.
Actions being taken in California:
-Assembly members Noreeen Evans and Karen Bass, both members of the Select Committee on Foster Care, have requested a public hearing in August, focusing on medication, foster care and the lack of communication (and accountability).
-Attorney General Bill Lockyer is investigating the amount of tax dollars being spent to overmedicate foster youth.
-State Comptroller Steve Westly has called upon Governor Schwartznegger to take immediate action on this issue "in order to ensure that no one profits by forcing kids to take mind-altering drugs."
Nationwide concern
Paul Vincent, of the Child Welfare and Policy Group, believes that the number of foster children being prescribed antipsychotics has risen over the past few years.
Children as young as four-years-old are being prescribed antipsychotics. And, who is doing the prescribing? Vincent says, "They aren't even psychiatrists or counselors. I have considerable worry over the accuracy of these diagnoses."
According to USA Today:
-There was a 77% increase in Med-Cal prescription claims in California between 2001-2005.
-Illinois had a 39% increase betwen 2003-2005.
-In Florida, the number of Medicaid children taking antidepressants jumped from 9,500 to 17, 000 over the past five years.
Sources:
For foster kids, oversight of prescriptions is scarce. USA TODAY. McLean, Va.:May 2, 2006. p. D2
Hayasaki, Erika. Teens speak out about foster care; Thirty young people attend a summit at Occidental College to tell policymakers about problems they face and suggest some solutions. Los Angeles Times Los Angeles, Calif.:Jun 6, 2006. p. B2
To our children's defense. San Francisco Chronicle San Francisco, Calif.:Jun 14, 2006. p. B8
Vascellero, Jessica. Prevalence of drugs for DSS wards questioned. Boston Globe Boston, Mass.:Aug 9, 2004. p. B1
Weber, Tracy. California and the west: Foster children on medication get protections; Health: Davis signs measure to prevent youths in state care from getting improper or unmonitored doses of psychiatric drugs. Los Angeles Times Los Angeles, Calif.:Sep 30, 1999. p. 3
It is the stuff of a science fiction novel:
-States such as Texas, Florida and Minnesota discover an alarming number of foster youth on behavior-altering drugs.
-California state regulations provide financial incentive for group home staff to request and administer psychotropic drugs to children in their care -- because rates are based on mental-health treatment services per child.
-A seventeen-year old foster child in California is threatened that if she doesn't take the drugs she was prescribed, she will not receive transitional housing.
Unfortunately, all these things are happening - and it is time for them to stop.
Medicating wounds, rather than healing them
Medications have their place in helping members of society. But foster youth who experience grief, fear and sadness are simply displaying normal reactions to their living situations.
Consider this scenario:
Girl's mother dies - Girl feels sad - Staff recommends Zoloft - Group home receives more money.
What's wrong with this picture? It creates a system that is ripe for abuse.
In Texas, 12,000 foster youth received psychotropic drugs in 2004. Each child averaged 21 psychotropic drug prescriptions a year.
In Massachusetts, two-thirds of 17-year-old foster children have recieved inpatient or outpatient medical treatment (as opposed to only 37% in Illinois, Iowa and Wisconsin). State Representative Marie Parente believes that state reimbursement checks from the federal government might be a financial incentive to misdiagnose and overmedicate foster children.
In California, the use of drugs remains unchecked and unregulated. The California Psychiatric Assocation blocked the passing of a 2004 bill by then-Senator Mountjoy to analyze the administration of drugs to children in foster care.
Judges approving dosages
According to the California rules of court, Rule 1432.5: "Once a child is declared a dependent child of the court and is removed from the custody of parents or guardian, only a juvenile court judicial officer is authorized to make orders regarding the administration of psychotropic medicine to the child."
Is the judge now considered a medical expert? Does he or she even meet the child in question? Often, all that judge has to go by are the reports handed in by social workers and group home staff.
In 1999, when Governor Gray Davis gave final approval to the law requiring judges to sign off on medication requests, many juvenile judges said that they didn't know much about medications, nor the doctors prescribing them.
One judge reported that he simply trusted that the 'doctor knows best.' While Los Angeles Juvenile Court had the funding to screen requests through the county's medical health unit, other judges lacked the money for such a review.
Also, according to California rules of court: "In emergency situations, psychotropic medications may be administered to a dependent with or without court authorization..."
This is both disturbing and vague.
What constitutes an emergency situation? Is it only that the child is sad, and the group home will recieve more money? California group homes receive anywhere between $2000 and $6000 per foster youth, depending on what medications they are on, according to Jennifer Rodriguez, legal representative for the California Youth Connection.
Foster youth are not informed of their right to refuse medication. Foster youth reported being punished for refusal by losing privilges and threatened that they will be evicted from the group home.
Risks of overmedicating
Attorney Andrea Moore, of Florida, is currently representing several children who began lactating after taking antipsychotics .
One of her clients is also a twelve-year-old whose heart condition was exacerbated by the Geodon she had been prescribed. According to Moore, the doctor who prescribed Geodon did not even have the child's medical history. The drug's label clearly states that patients with heart problems shouldn't take it.
Actions being taken in California:
-Assembly members Noreeen Evans and Karen Bass, both members of the Select Committee on Foster Care, have requested a public hearing in August, focusing on medication, foster care and the lack of communication (and accountability).
-Attorney General Bill Lockyer is investigating the amount of tax dollars being spent to overmedicate foster youth.
-State Comptroller Steve Westly has called upon Governor Schwartznegger to take immediate action on this issue "in order to ensure that no one profits by forcing kids to take mind-altering drugs."
Nationwide concern
Paul Vincent, of the Child Welfare and Policy Group, believes that the number of foster children being prescribed antipsychotics has risen over the past few years.
Children as young as four-years-old are being prescribed antipsychotics. And, who is doing the prescribing? Vincent says, "They aren't even psychiatrists or counselors. I have considerable worry over the accuracy of these diagnoses."
According to USA Today:
-There was a 77% increase in Med-Cal prescription claims in California between 2001-2005.
-Illinois had a 39% increase betwen 2003-2005.
-In Florida, the number of Medicaid children taking antidepressants jumped from 9,500 to 17, 000 over the past five years.
Sources:
For foster kids, oversight of prescriptions is scarce. USA TODAY. McLean, Va.:May 2, 2006. p. D2
Hayasaki, Erika. Teens speak out about foster care; Thirty young people attend a summit at Occidental College to tell policymakers about problems they face and suggest some solutions. Los Angeles Times Los Angeles, Calif.:Jun 6, 2006. p. B2
To our children's defense. San Francisco Chronicle San Francisco, Calif.:Jun 14, 2006. p. B8
Vascellero, Jessica. Prevalence of drugs for DSS wards questioned. Boston Globe Boston, Mass.:Aug 9, 2004. p. B1
Weber, Tracy. California and the west: Foster children on medication get protections; Health: Davis signs measure to prevent youths in state care from getting improper or unmonitored doses of psychiatric drugs. Los Angeles Times Los Angeles, Calif.:Sep 30, 1999. p. 3
Tuesday, July 04, 2006
Distancing Self From Relationships
In upcoming postings, I will continue to explore the issue of drugging foster children and the need for medical advocacy. However, in this posting, I want to address why survivors of foster care might seem to distance themselves from relationships.
I've been editing the second half of my book, and as I read through old journals of mine from college and graduate school, it seemed so obvious what my peers were trying to tell me.
The messages had a common theme:
-"Connect with us."
-"Take a risk and date me."
-"All men aren't bad or dangerous."
-"Slow down and let people love you."
-"Take a break from saving the world, and play a game of volleyball."
Time to mourn
One thing that I believe foster care survivors need is time to mourn. Even more than the initial loss experienced upon entry into the foster system, the denial of that loss and inability to mourn it can impede personal development.
As Joanne Bernstein wrote, "If in the face of trauma, mourning remains absent or delayed throughout childhood, it can interfere with normal adult life. Children who will not allow their emotions direct expression are in effect saying, This event hurt me so much that I can never again let anything touch me."
Walled off from pain - and from love
Remaining fearful of rejection and abandonment, those who cannot mourn as children often shy away from relationships as adults.
As long as the initial losses remain unprocessed, new attachments will be difficult to form and internalize. As Fynn noted, "The soul is imprisoned, protected. Nothing can get in to hurt it, but then it can’t get out either."
What's the cure? No magic bullet to be sure, but there are several factors which can help:
1.) Time plays an enormous factor. Time to be nurtured, time to heal, time to wait before taking big risks again.
2.) Emotional expression within a context of acceptance and a caring community is also very important. Learning to react to losses as they occur also helps survivors reconnect with their core emotions. (I found my 'second home' in my college dorm).
3.) Reaffirming personal identity is vital. Foster care survivors often disassociate from past trauma in order to survive. Much of their emotional energy is spent on adjusting to each new placement.
To quote from Heineman, "For children whose histories are littered with separation, loss and abandonment, time with a past, present and future is anything but linear. Many of these children have little sense of self through time.
Consider it from the point of view of the foster child:
1.) No time to mourn initial loss of family; the child (or teen) must adjust to foster care.
2.) At each placement is a new environment with different expectations. In a sense, at each new placement, the child is forced to prove themselves.
3.) By going from one placement to another, the child learns the tenuousness of relationships and the inevitability that people will fail them.
Risking intimate relationships
Once a foster alumni has aged out of foster care, adult relationships pose a tremendous risk. Paradoxically, what they fear most is also often what they need most. However, it is their choice as to whether or not to receive it.
Speaking from my personal experience, I had a bad dating experience in college - and reacted to it by not dating again for eight years. An overreaction? Yes, most certainly. (I was reacting less to the young man I dated, and more to earlier experiences with men in my life. The breakup was a trigger that forced me to reexamine them).
Yet, looking back, I don't regret the time I took to heal. Those eight years before I met my husband were among the most productive in my life. I needed that time:
- To reflect, and process through the events in my past.
- To immerse myself in a caring community, and spend carefree time with friends.
- To build positive memories of friendships with many "good" men.
- To finish college and graduate school, and start my career.
I believe that the time that it took me to be ready for a serious relationship was well-spent. I wouldn't be as stable as I am today without it.
Sources
Bernstein, Joanne. Books to help children cope with separation and loss, Vol. 2, p. 11-12.
Fynn. Mr. God, This is Anna. Ballantine Books; 1985.
Heineman, Toni and Diana Ehrensaft. Building a home within: Meeting the emotional needs of children and youth in foster care. Brookes Publishing, 2006.
I've been editing the second half of my book, and as I read through old journals of mine from college and graduate school, it seemed so obvious what my peers were trying to tell me.
The messages had a common theme:
-"Connect with us."
-"Take a risk and date me."
-"All men aren't bad or dangerous."
-"Slow down and let people love you."
-"Take a break from saving the world, and play a game of volleyball."
Time to mourn
One thing that I believe foster care survivors need is time to mourn. Even more than the initial loss experienced upon entry into the foster system, the denial of that loss and inability to mourn it can impede personal development.
As Joanne Bernstein wrote, "If in the face of trauma, mourning remains absent or delayed throughout childhood, it can interfere with normal adult life. Children who will not allow their emotions direct expression are in effect saying, This event hurt me so much that I can never again let anything touch me."
Walled off from pain - and from love
Remaining fearful of rejection and abandonment, those who cannot mourn as children often shy away from relationships as adults.
As long as the initial losses remain unprocessed, new attachments will be difficult to form and internalize. As Fynn noted, "The soul is imprisoned, protected. Nothing can get in to hurt it, but then it can’t get out either."
What's the cure? No magic bullet to be sure, but there are several factors which can help:
1.) Time plays an enormous factor. Time to be nurtured, time to heal, time to wait before taking big risks again.
2.) Emotional expression within a context of acceptance and a caring community is also very important. Learning to react to losses as they occur also helps survivors reconnect with their core emotions. (I found my 'second home' in my college dorm).
3.) Reaffirming personal identity is vital. Foster care survivors often disassociate from past trauma in order to survive. Much of their emotional energy is spent on adjusting to each new placement.
To quote from Heineman, "For children whose histories are littered with separation, loss and abandonment, time with a past, present and future is anything but linear. Many of these children have little sense of self through time.
Consider it from the point of view of the foster child:
1.) No time to mourn initial loss of family; the child (or teen) must adjust to foster care.
2.) At each placement is a new environment with different expectations. In a sense, at each new placement, the child is forced to prove themselves.
3.) By going from one placement to another, the child learns the tenuousness of relationships and the inevitability that people will fail them.
Risking intimate relationships
Once a foster alumni has aged out of foster care, adult relationships pose a tremendous risk. Paradoxically, what they fear most is also often what they need most. However, it is their choice as to whether or not to receive it.
Speaking from my personal experience, I had a bad dating experience in college - and reacted to it by not dating again for eight years. An overreaction? Yes, most certainly. (I was reacting less to the young man I dated, and more to earlier experiences with men in my life. The breakup was a trigger that forced me to reexamine them).
Yet, looking back, I don't regret the time I took to heal. Those eight years before I met my husband were among the most productive in my life. I needed that time:
- To reflect, and process through the events in my past.
- To immerse myself in a caring community, and spend carefree time with friends.
- To build positive memories of friendships with many "good" men.
- To finish college and graduate school, and start my career.
I believe that the time that it took me to be ready for a serious relationship was well-spent. I wouldn't be as stable as I am today without it.
Sources
Bernstein, Joanne. Books to help children cope with separation and loss, Vol. 2, p. 11-12.
Fynn. Mr. God, This is Anna. Ballantine Books; 1985.
Heineman, Toni and Diana Ehrensaft. Building a home within: Meeting the emotional needs of children and youth in foster care. Brookes Publishing, 2006.
Saturday, July 01, 2006
Texas Foster Care System
Ongoing investigations into the Texas foster care system
Comptroller Carole Keeton Strayhorn's current allegations should not come as a surprise to Texas officials.
What is surprising is that she is still being stonewalled and her efforts are still being resisted after three years.
Comptroller Strayhorn and her staff have been investigating the Texas foster care system and publishing their negative findings since 2003.
In 2004, due to deficient services and inadequate oversight, a complete overhaul of the Texas foster care system was recommended by Strayhorn.
At that time, Strayhorn called for accountability:
1.) Accountability for service providers: Strayhorn recommended that direct services be outsourced, and that DPRS conduct unannounced site visits and financial audits.
Direct services providers would be assessed based on:
- Safety
- Placement stability
- Maintenance of familial connections
- Shorter stays in foster care.
2.) Financial accountability: Money was to be directed toward funding programs for foster youth.
3.) Accountability for facilities: If a facility compromised the health and safety of foster youth through noncompliance to standards, their license was to be revoked.
4.) Accountability for DPRS*: (which is now DFPS)
- Caseworker visits were to be thoroughly documented.
- Comprehensive background checks were to be conducted.
- Complaints were to be thoroughly reviewed.
- Minimal number of foster placements.
- Children were not be placed with peers who had a history of violent crimes and /or juvenile sexual predators.
- A crisis management team was to be created, in order to decrease the number of child fatalities in foster care.
*Texas Department of Protective and Regulatory Services is now Texas Department of Family and Protective Services.
Let's Not Forget Medical Accountability
Comptroller Strayhorn's 2004 investigation uncovered that:
- 60% of children in the Texas foster care system were being given psychotropic drugs that were not been approved for children.
- Physicians had prescribed mind-altering drugs to children as young as three years old.
- Two Texas doctors who weren't psychiatrists were prescribing mental health medications to foster children.
- It was not uncommon for some foster children to have up to 14 different prescriptions.
- Many of these drugs were labeled "not for use by children," and listed as having serious side effects such as diabetes, cardiac arrhythmia, suicidal tendencies.
In 2004, as is currently happening in 2006, Texas health officials cited "privacy concerns" and patient confidentiality as reasons for their reluctance to share information.
Sources:
Garrett, Robert. Drug fraud alleged in foster care: Strayhorn believes kids are getting unnecessary psychiatric medication. Dallas Morning News, November 12, 2004.
Hughes, Polly Rose. Strayhorn will probe drug use on children: Comptroller asks for medical data on children in foster care. Houston Chronicle, Austin Bureau, Novemver 12, 2004.
Lilliedoll, Wendy. Texas Comproller says state foster care in crisis; "appalled" by conditions; called for "massive overhaul." Youth Law News, April-June 2004.
http://www.youthlaw.org/publications/yln/2004/april_june_2004/texas_comptroller_says_state_foster_care_in_crisis/
Comptroller Carole Keeton Strayhorn's current allegations should not come as a surprise to Texas officials.
What is surprising is that she is still being stonewalled and her efforts are still being resisted after three years.
Comptroller Strayhorn and her staff have been investigating the Texas foster care system and publishing their negative findings since 2003.
In 2004, due to deficient services and inadequate oversight, a complete overhaul of the Texas foster care system was recommended by Strayhorn.
At that time, Strayhorn called for accountability:
1.) Accountability for service providers: Strayhorn recommended that direct services be outsourced, and that DPRS conduct unannounced site visits and financial audits.
Direct services providers would be assessed based on:
- Safety
- Placement stability
- Maintenance of familial connections
- Shorter stays in foster care.
2.) Financial accountability: Money was to be directed toward funding programs for foster youth.
3.) Accountability for facilities: If a facility compromised the health and safety of foster youth through noncompliance to standards, their license was to be revoked.
4.) Accountability for DPRS*: (which is now DFPS)
- Caseworker visits were to be thoroughly documented.
- Comprehensive background checks were to be conducted.
- Complaints were to be thoroughly reviewed.
- Minimal number of foster placements.
- Children were not be placed with peers who had a history of violent crimes and /or juvenile sexual predators.
- A crisis management team was to be created, in order to decrease the number of child fatalities in foster care.
*Texas Department of Protective and Regulatory Services is now Texas Department of Family and Protective Services.
Let's Not Forget Medical Accountability
Comptroller Strayhorn's 2004 investigation uncovered that:
- 60% of children in the Texas foster care system were being given psychotropic drugs that were not been approved for children.
- Physicians had prescribed mind-altering drugs to children as young as three years old.
- Two Texas doctors who weren't psychiatrists were prescribing mental health medications to foster children.
- It was not uncommon for some foster children to have up to 14 different prescriptions.
- Many of these drugs were labeled "not for use by children," and listed as having serious side effects such as diabetes, cardiac arrhythmia, suicidal tendencies.
In 2004, as is currently happening in 2006, Texas health officials cited "privacy concerns" and patient confidentiality as reasons for their reluctance to share information.
Sources:
Garrett, Robert. Drug fraud alleged in foster care: Strayhorn believes kids are getting unnecessary psychiatric medication. Dallas Morning News, November 12, 2004.
Hughes, Polly Rose. Strayhorn will probe drug use on children: Comptroller asks for medical data on children in foster care. Houston Chronicle, Austin Bureau, Novemver 12, 2004.
Lilliedoll, Wendy. Texas Comproller says state foster care in crisis; "appalled" by conditions; called for "massive overhaul." Youth Law News, April-June 2004.
http://www.youthlaw.org/publications/yln/2004/april_june_2004/texas_comptroller_says_state_foster_care_in_crisis/
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