Out-of-County Foster Youth Lack Access to Mental Health Care

/, Foster Youth, Out-Of-County, Policy Action/Out-of-County Foster Youth Lack Access to Mental Health Care

Out-of-County Foster Youth Lack Access to Mental Health Care

A CLOSER LOOK: The case of Andrew J.

Hear Me Out recently posted about the challenges faced by “out-of-county” foster youth in accessing adequate mental health care. The post was accompanied by a report we released, in collaboration with the National Center for Youth Law, entitled “Access to Mental Health Services for Foster Children Placed Out of County”. The report highlights mental health care access problems for foster children transferred between counties who “may wait months, or even years, for appropriate mental health treatment or be denied treatment altogether.” To make matters worse, data show that foster youth who are sent out-of-county often have greater need for mental health care than foster youth that are not.

Although there have been steps taken in the past to minimize this longstanding problem, the challenge persists with devastating impacts on foster youths with unmet mental health needs.  Today’s blog presents the story of Andrew J., a foster youth whose ongoing case in California’s Fifth Appellate District

[i] sadly demonstrates the harms caused by administrative inaction. [Read full Opinion]

Brief Background of Andrew J.

When Andrew was nine years old, a sheriff’s deputy found him and his sister “dirty and disheveled locked out of their house in San Bernardino County. No adults were home and the house lacked water service and heat.”[ii] After an investigation, San Bernardino County Children and Family Services found that Andrew’s mother was incarcerated for heroin possession and his father, “who had schizophrenia, was in prison serving a term of 15 years to life.”[iii] Andrew was placed with Mr. and Mrs. D., who were relatives of Andrew’s former stepfather. Two years later, in 2007, San Bernardino County Juvenile Court terminated Andrew’s parents’ parental rights.

As with many foster youth that have experienced severe childhood trauma, Andrew began exhibiting behavioral problems. Friction between Andrew and his foster parents increased, and in December 2006, they requested his removal from their home.  Andrew was placed in a group home where he “confronted issues of depression, separation, and loss. He was sometimes teased and made fun of, and on those occasions he mutilated himself with an object. He was failing all his subjects in school . . . and said he was afraid to ask for help.”[iv] In 2008, Andrew was “diagnosed with depression and disruptive behavior disorder . . . an evaluation by a school psychologist found [he] was qualified for an Individualized Education Plan.”[v]

In 2010, when Andrew was almost fifteen, Mr. and Mrs. D. again agreed to allow him to live with them in their home in Kern County, California. The relationship between Andrew and his foster parents was again strained as Andrew continued to have behavioral and emotional problems.  To make matters worse, “[f]rom Mr. And Mrs. D.’s home in Kern County, Andrew encountered severe difficulties in obtaining services through the San Bernardino agency to help him cope with his problems. … Andrew’s psychotherapy services were terminated because it was no longer possible for Mr. and Mrs. D. to drive him two hours to the therapist’s office.”[vi] As of January 2012, Andrew’s social worker in San Bernardino County was unable to get in-home psychotherapy through Kern County Mental Health. Attempts by Andrew’s Court Appointed Special Advocate (CASA) to obtain wraparound were also thwarted, “because Andrew lives in a different county than the one his case originated in . . .”[vii]

The Lawsuit

In January 2012, the San Bernardino social services agency recommended that Andrew’s case be transferred to Kern County, so that he could receive wraparound services. San Bernardino County Juvenile Court agreed and ordered the transfer on January 13, 2012, “finding that Andrew’s legal residence was the home of Mr. and Mrs. D. in Kern County and that the transfer was in his best interest. The court’s order specifically called for wraparound services in Kern County.”[viii]

However, during the transfer-in hearing on February 2, 2012, the Kern County Department of Human Services requested that Andrew’s case be transferred back to San Bernardino County. Kern County argued that San Bernardino was Andrew’s county of origin and thus San Bernardino County should be responsible for providing his mental health care services. According to the Court of Appeal, “The Kern agency’s paramount concern . . . appeared to be avoiding financial responsibility for Andrew.”[ix]  The Kern County Court granted the request.

Seeing no other option, San Bernardino Juvenile Court accepted the transfer back from Kern County at a hearing on February 22, 2012. During the hearing the Judge stated:

The problem is clear that the minor has nobody, except these people in Kern County.  He lives in Kern County.  So [they’re] refusing to accept the case, the consequences are the minor will get no services.  And, certainly, looking at his history, the recent history, the minor needs services.  And that it’s going to be denied.  It makes no sense to me.[x]

In March 2012, Andrew and the San Bernardino social services agency jointly appealed the decision by the Kern County Juvenile Court to transfer Andrew’s case back to San Bernardino County.

The Court of Appeal’s Opinion

In response to San Bernardino’s appeal of Kern County’s transfer back, the lawyers filed a flurry of motions and arguments. Meanwhile, “[w]hether the Kern agency intended it or not, its actions resulted in Andrew receiving no services from anyone for one year even as he now approaches majority and becomes no longer eligible for services, which he clearly needs.”[xi]

On February 6, 2013, the Court of Appeal reversed the Kern County Juvenile Court’s transfer-out order, holding that, “Andrew’s case is now the responsibility of Kern County.”[xii]  The Court observed that a transfer order can be issued only if “the transfer would be in the child’s best interest.”[xiii]  Furthermore, the Court ruled that the evidence presented to the courts below did not support such a finding because “Andrew’s access to services would be facilitated by the transfer to Kern County, where he lives.”[xiv]

While the case below seemed to be driven by haggling over financial responsibility, the Court sought to redirect the agencies to consider Andrew’s interests:

The question of which county ultimately will foot the bill for the services this child needs has nothing to do with his best interest. The issue is instead whether it will be better for Andrew to have his case managed locally or from a distance. The Kern County Juvenile Court ruled, in effect, that it will be better for him to have his case managed from a distance. The evidence does not support this position. Other things being equal, it will generally be the case that a ward’s best interest will be served if he is a ward of the county in which he lives, not some other county.[xv]

It’s Time to Fix This Problem

Just as the Court of Appeals concluded that managing a child’s case locally is better than managing it from a distance, the California Child Welfare Council in December 2010 unanimously agreed that a foster child’s mental health care would be better managed by their county of residence.  A policy of routinely or presumptively transferring responsibility for foster youths’ care from the county in which they entered care to the county where they reside would largely eliminate the challenge of gaining equal access to care for thousands of foster youth [See Recommendations in Report]. A policy of presumptive transfer would have allowed Andrew to receive wraparound services years ago.  Changing existing policies that encourage counties to fight over who provides services and who pays would prevent children like Andrew being denied the services they demonstrably need and are entitled to by law.

How much longer do children like Andrew need to wait for the state and counties to take action?

______________________________

[i] San Bernardino Cnty. Children & Family Servs. v. Andrew J. (In re Andrew J.), (Cal. App., 2013).
[ii] Op. at 3.
[iii] Id.
[iv] Op. at 4.
[v]Id.
[vi] Op. at 5.

[vii] Op. at 5-6
[viii] Op. at 6.
[ix] Op. at 22.
[x] Op. at 9.
[xi] Op. at 20.
[xii]Op. at 24.
[xiii] Op. at 20.

[xiv]Id.
[xv] Op. at 22, emphasis added.

About the Author:

Young Minds Advocacy
Posted by the Editors of Hear Me Out.