Monday, February 18, 2008

For Oregon foster children, the psychotropic drugs are plentiful, but mental health services are few

Dr. Walter Shaffer, medical director for Oregon's medical assistance programs testified before the Senate Health and Human Services that:

*Between Jan. 1, 2004, and Dec. 31, 2006, children in the Oregon foster care system were three times more likely than other children to have been prescribed a psychiatric drug.

*Over that two-year period, nearly 4,700 Oregon foster children were prescribed an antidepressant, stimulant or other mood stabilizer.

*Meanwhile, less than a third of them received mental health assessments within 60 days as the law requires.

While the pharmaceutical industry might benefit from this all-too-common lack of oversight, it endangers the lives of these children.

As a former foster child and current youth advocate, I agree with Shaffer's recommendation that the state should:

1.) Hire a medical director for child welfare
2.) Build a network of nurses or mental health experts to consult with caseworkers
3.) Develop a better data system to track psychiatric medications used by children in foster care

It is important to note that this is a national problem, and it needs to be addressed. If the government is 'parenting' these children, then the government is accountable to regulate their medication, just as a parent would.

It is a crime when state laws are ignored, and hundreds of foster children prescribed multiple prescriptions with little or no state scrutiny.

Why? Because young children are three times as likely as adults to have adverse results to psychotropic drugs.

Drastic, damaging side effects can haunt their adulthood, as a result of this negligence, including lifelong medical problems and the inability to have children of their own.

Cole, Michelle. Testimony reveals foster care failings. Oregonian, Feb. 14, 2008.

Two great bills for foster care youth

Arkansas foster children driver's license passes
"Foster children would be able to obtain a driver's license more easily under legislation that passed the Senate on Thursday.

"Teenagers in foster care are unable to hold jobs, drive to school or visit friends without mobility, Madison and other bill supporters said. Foster parents usually are unable to afford liability coverage, and some teen-agers who are wards of the state live independently and have no foster parents.

"Under Senate Bill 247 by Sen. Sue Madison, D-Fayetteville, the state would assume liability for driving accidents by foster children.

"No other method would allow foster children old enough to drive but not to obtain their own liability insurance coverage to get valid driver's licenses, bill supporters told the committee.

"Although Madison said she had no figures available Wednesday, the financial impact on the state is expected to be less than the existing impact of teen-agers being unable to contribute fully to their own support through jobs.

"The bill passed 26-0 in the Senate and goes to the House."

Source: Legislative briefs, Arkansas News Bureau, March 13, 2007.

Colorado law lets foster children see siblings
"Colorado's foster children can now see their siblings if they have been separated but want to stay connected.

"Gov. Bill Ritter (D-Colorado) signed the measure into law on Thursday.

"It requires counties to arrange the visits.

"Former foster children like Tony Corley helped lobby at the Capitol in favor of the measure, which was passed unanimously by state lawmakers.

"I was in foster care and unable to see my siblings. Being in foster care can be challenging. Now, with this new law, the connection between siblings will be easier for others in the system of care," said Corley.

"When a foster child makes a simple request to see their brother and sister, we should all listen. We should put that request at the top of their list and our list. It might seem like a little thing, but for a child in foster care, it's not," said Ritter.

"Ritter says, on any given day, there are 8,800 Colorado children in foster care. "


Wednesday, February 13, 2008

Who has the authority to define "permanency?"

How the System Defines Permanency
A recent round table of experts, convened by Casey Family Services and the Annie E. Casey Foundation, defined permanency as:

Having an enduring family relationship that:
- is safe and meant to last a lifetime
- offers the legal rights and social status of full family membership
- provides for all levels of a young person’s development
- assures lifelong connections to extended family, siblings, other significant adults, family history and traditions, race and ethnicity, culture, religion and language.”

These are lofty goals. It’s almost as if a group of people who emerged from a “normal” family looked at everything that they personally had, and said, “Yes, we want foster care youth to have that.” So, they set that as the standard, after taking upon themselves the responsibility to define what that standard is…

Is it realistic? Is it attainable? I don’t know. As a former foster care youth, I found my first “family” in my peers while living in a college dorm. But I did not have the legal rights of full family membership until I was married in 2001.

How Youth Define Permanency
It's important to note that young people in foster care define permanency very differently. When the Urban Institute and the California Youth Connection facilitated focus groups of foster youth to ask them about this issue:

- Some youth referred to permanency as a physical or concrete entity. They said things like: “Staying in one place” and “Not having to move” and “A place to stay until you age out.”

- Other young people said, “No, it’s more than a place to live. It’s a feeling of connection.” They defined permanency as an emotional commitment from other people.

One young man described the concept of permanency as being like a permanent marker; he said, “If you draw on the paper, that mark ain’t going nowhere. The paper may go somewhere or it could be picked up, but the mark ain’t going nowhere.”

That is a great visual. Think about the people who have made an indelible mark upon your life. Not all of them were connected to you by blood, birth or legal contract.

Whose Permanency Is It, Anyway?
Now, I am going to suggest something radical here… I believe that the “experts” and the “professionals” should allow the input of foster care youth and alumni to influence how they measure success in the area of permanency.

What do youth say about adoption, guardianship, reunification with their biological family, independent living programs and aging out of foster care?

During a youth panel at the 2006 Casey It's My Life conference:

1.) Young people differentiated between biological or legal family and chosen family

2.) Youth said that they needed an entire network of connections, and not just one person

3.) Young people didn't want to be viewed as a "failure" if they aged out of the system without being adopted

4.) Teenagers in foster care expressed their need for independence and independent living skills

There Is No “One-Size-Fits-All” Approach To Foster Care
The experiences of young people differ according to the situation. Some find happiness through reuniting with their biological families. Others report being taken advantage of by ‘predatory parents.’

Here are some legitimate fears that young people in foster care express:

1. “Do you just want to close my case, or am I really safe now?” Many young people fear becoming a ‘closed case.’ The rate of re-entry into the foster care system after an initial attempt at reunification is high.

2. “Aren’t I too old for adoption?” Teenagers in United States foster care report that they have learned from past experience that most foster parents are not eager to take teenagers into their homes. They also report their fears that, by being adopted, they might lose access to independent living classes, college tuition assistance and medical insurance.

3. “Why should I take the risk of adoption by a stranger?” One of the horrors of foster care is its unpredictability. Teenagers who have grown up in the system often know what to expect from independent living programs. They anticipate having some power and control over their personal living situation.

Young people interviewed by the Urban Institute said that when they were placed in a group home or foster home, they had opportunities to leave if they did not like it – but “once you are adopted, you are stuck.”

Broadening Our Definition of Permanency
We live in a pluralistic society, where the word ‘family’ can be defined in many ways. Perhaps the definition of permanency from that roundtable was more than just lofty… maybe it was limiting, too.

I would ask the experts: "Is it a nuclear family that we are trying to accomplish, and is anything less a failure? Are we engaging in partisan politics? Or are we trying to lay a foundation that will lead to lifelong emotional resiliency?"

Foster care alumni often report finding their first experience of “permanency” through friendships and mentoring relationships. A FosterClub intern from Michigan reported finding permanency through her involvement with the Jim Casey Youth Opportunities Initiative, which she described as being an ‘emotional parent’ in her life.

The way I see it, the choice is simple: We can keep defining what permanency should look like for a young person and forcing it upon them. Or we can listen to the young people themselves.

Because for a researcher, this is an outcome. For a staff person, this might be a job performance issue. But for a young person in foster care, this is their life.

Chambers, K., et al. Foster Youth’s Views of Adoption and Permanency. Urban Institute, Child Welfare Research Program, January 2008.
Research Roundtable: Convening on Youth Permanence, Sept. 12-13, 2006.
Sanchez, Reina M. Youth Perspectives on Permanency, California Youth Connection, California Permanency for Youth, 2004.

Sunday, February 03, 2008

Youth Transitions Finance Project

The Youth Transitions Resource Center provides resources on how to develop and sustain supports and services for youth transitioning out of foster care.

Friday, February 01, 2008

Previous articles, current news and proposed legislation

1. Sibling visitation:
I have written about foster care and the pain of sibling separation and Hawaii's Project Visitation. Foster care youth in Iowa have lobbied state legislators to mandate sibling visitation, because this issue is so vitally important.

Recently, the Indiana Senate unanimously passed a bill to support sibling visitation. The battle is not won, however... the bill now moves to the Indiana House of Representatives for consideration.

2. Psychotropic medication:
A new proposal by the Oregon Department of Human Services could affect over 2000 Oregon children who receive psychiatric medications are taking multiple prescriptions with little or no state scrutiny.

It has been alleged that the high rate of prescriptions for psychotropic drugs for children in the foster care system is motivated by financial gains by the pharmaceutical industry.

It is unconscionable that the use of these drugs is not monitored and, in fact, group homes have financial incentive to drug the children in their care.