• Katie A. foster care case, part 3: Los Angeles — making progress, but much work left in mental health services

    Dr. Astrid Heger, executive director of VIP Community Mental Health Center.

    Dr. Astrid Heger, executive director of VIP Community Mental Health Center.

    By Jeremy Loudenback

    The Katie A. v. Bonta lawsuits leveled California and Los Angeles County with the charge that every county in the state provide adequate mental health services for some of its most vulnerable children.

    The state settled the case in 2011. Los Angeles County settled a separate lawsuit in 2003, suggesting that it would be ahead of the state’s 57 other counties in providing better mental health services for what is known as the Katie A. Subclass (read part one for a breakdown of which children are eligible to be counted in the subclass).

    In Los Angeles, the largest single child welfare system in the country, Katie A. observers note significant overall advancements, particularly in screening, with a lot of work left to do regarding treatment. 

    Thanks to a new focus on supporting mental health services at medical centers across the county, Los Angeles is poised to continue its progress on coordinating these services for children in its massive child-welfare system. But lingering questions remain about its ability to consistently provide services to children who require specialized mental health services.

    The number of Los Angeles foster youth receiving mental health treatment has greatly increased under the settlement. About three percent of youth

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  • Katie A. foster care case, part 2: Sun sets, perhaps prematurely, on CA settlement

    National Center for Youth Law Executive Director John O’Toole.

    National Center for Youth Law Executive Director John O’Toole.

    By John Kelly

    In Katie A. v Bonta, a class-action lawsuit over mental health services for children involved in California’s child welfare system, Los Angeles County settled with plaintiffs in 2003; the state settled on behalf of the other 57 counties in 2011.

    Like most lawsuits and the settlements that stem from them, Katie A. involves lots of technical requirements. Counties must demonstrate that they assess and treat mental health using a core practice model that involves specified coordination and service delivery strategies.

    But what it comes down to is this: Prior to the settlements, child welfare agencies in California were failing on both ends of the mental health spectrum. Most children and youth in – or at risk of entering – foster care were not assessed for problems; the ones who were treated often found themselves locked in psychiatric facilities.

    Part one of our series explains the genesis of the lawsuit, and analyzes the raw numbers reported by counties to the court. Those numbers suggest clear increases in mental health assessments and mental health services delivered to children’s homes, but leave lingering questions about the consistency of reform.

    In this article, we turn to the state’s settlement and what the future holds. What do leaders close to the settlement have to say about what progress has been made, and what remains undone, as the case nears a potential end date of December 1? 

    The State Exit Date
    In 1993, the California-based National Center for Youth Law (NCYL) settled a class-action lawsuit with the state of Utah over broad shortcomings in its child welfare system. The parties agreed on a four-year time frame for needed reforms.

    The state then played a game of wait-out-the-clock for four years, said NCYL Executive Director John O’Toole.

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  • Katie A. foster care case, part 1: Present and future of CA’s mental health mandate

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    By John Kelly

    In 2002, lawyers representing foster youth in Los Angeles sued the county and California over its failure to service the mental health needs of children in or at risk of entering foster care. For years the mental health issues that these vulnerable children face were often ignored. The children who did receive treatment were frequently hospitalized when outpatient services would have sufficed.

    Twelve years later, the clock has nearly run out on the settlements that stemmed from Katie A. v Bonta. On December 1, 2014, separate court settlements with the state and Los Angeles County could end.

    Following is our analysis of what has happened since the settlement and where the state and Los Angeles could go next with regard to providing quality mental health services to children in need.

    How We Got Here
    In 2002, Los Angeles County and the state of California became ensnared in a federal lawsuit. Lawyers represented a handful of children and youth, alleging massive gaps in mental health care services available to children in the child welfare system.

    These children were either in foster care or at risk of placement into foster care due to a maltreatment report. Katie A., the lead plaintiff, had never received therapeutic treatment in her home. By age 14, she had experienced 37 separate placements in Los Angeles County’s foster care system, including 19 trips to psychiatric facilities.

    Evidence strongly suggests that children in foster care deal with significant mental health issues at a much higher rate than the community at large. One study showed that foster youth in California experienced mental health issues at a rate two-and-a-half times that of the general population.

    Los Angeles County settled with the plaintiffs in 2003 and accepted the oversight of an advisory panel. After years of litigation and negotiation, the state came to terms only in 2011. A “special master” was appointed to oversee compliance efforts.

    The requirements are the same for both Los Angeles and the state, and they apply to certain children and youth who are in or at risk of entering foster care. These children are identified as the “Katie A. subclass.”

    Eligibility for the subclass is tricky to explain. First, a youth absolutely has to be fully Medicaid-eligible, and meet the criteria for specialized mental health services set by the state. He or she would also need to be in foster care, or be at risk of entering foster care, because of a maltreatment investigation.

    There is another hurdle. A youth can only be considered part of the subclass if one of the following two things is true:

    • A system is considering wraparound or specialized services for the child;
    • A child is currently hospitalized for a behavioral condition, or has been hospitalized three times in the past 24 months for behavioral issues.

    If a youth meets those criteria, the settlement mandates that counties adhere to a “core practice model” for screening and treating foster youths. This

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  • California’s first ACEs summit: Children Can Thrive

    Parker Blackman. [Photo by Jason Steinberg/Steinberg Imagery]

    Parker Blackman. [Photo by Jason Steinberg/Steinberg Imagery]

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    A three-day summit on Adverse Childhood Experiences, or ACEs, strengthens California’s efforts to orient policy and practice around preventing and responding to child trauma.

    By Parker Blackman

    “We know that it makes sense to keep kids in school for $9,000 a year versus individuals in prison for $62,000 a year.”

    This statement is the kind of thing you’d expect to hear from a leader in education or child welfare, right? What if I told you instead that the person who said this is a leader in the criminal justice system? In fact, no less than the Chief Justice for the California State Supreme Court Tani Cantil-Sakauye made this statement as part of a panel at a three-day summit held this month called: “Children Can Thrive: California’s Response to Adverse Childhood Experiences.”

    From November 5 – 7 in San Francisco, more than 200 leaders from across the state and from various sectors – including health, medicine, education, child welfare and criminal justice – gathered for the first-ever state summit on the impacts of early childhood trauma.

    Organized by The Center for Youth Wellness, the goal of the summit was to engage key stakeholders to learn more about the impacts of adverse childhood experiences and begin to think about how to build a comprehensive, integrated system for identifying, screening and treating adverse childhood experiences. While that’s a daunting task, the summit was a smashing success. It brought together leaders across sectors to learn from each other and begin to ask important questions about how we identify and respond to ACEs.

    Here are just a few of the key issues that folks grappled with over the course of the summit:

    • How do we get the various systems talking to one another? For example, if a child is acting out in pre-school, how can teachers be trained to not only identify symptoms of adverse childhood experiences, but who can they then connect with in order to get the child the help he/she needs and deserves?
    • How do we talk about this issue in a way that will resonate with a broader audience? Adverse childhood experiences, or even toxic stress, are insider terms that have little to no resonance with the average Californian. And this issue is relevant to a wider audience as we found out at the conference. The Center for Youth Wellness released its groundbreaking report,  “Hidden Crisis: Findings on Adverse Childhood Experiences in California” (HiddenCrisis_Report_1014), which found that nearly 62 percent of all Californians have experienced at least one adverse childhood experience such as abuse, neglect or ongoing household dysfunction. So we need to develop
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  • The town of The Dalles, OR, remakes itself as a trauma-sensitive sanctuary

    Adalles7

    Tucked into a curve of the Columbia River, which marks the watery border between Washington and Oregon, lies the small town of The Dalles. Its claims to fame include being a major Indian trading site for 10,000 years, a camping spot for Lewis and Clark in 1805, and the terminus of the Oregon Trail.

    Now The Dalles is seeking a different kind of notoriety. This city of 13,000 is the first in the nation to seek certification from the Sanctuary Institute—a model of organizational change that challenges every part of the community to examine and remake itself through a trauma-informed lens.

    Dalles (pronounced “dahl,” with a silent “s”) is a French word for “slabs” of rock around and over which the Columbia once roared.  The population of this rural community, 70 miles east of Portland, is mostly white, 30% Hispanic, and less than 10% other ethnicities. “It’s small enough that I’m able to call the chief of police and go out for coffee,” says Trudy Townsend, assistant to the superintendent of the North Wasco County School District 21.

    The community is no different from others its size: If people don’t know you, they know someone who knows you. That intimacy provides a sense of belonging and connection that is hard to find in larger cities. But if you had told any leader—or citizen—in The Dalles in 2008 that deepening those connections and becoming a trauma-informed community was on the horizon, they would not have believed it.

    That was the year when the U.S. Substance Abuse Mental Health Services Administration (SAMHSA) awarded the community a five-year, $2.7 million Safe Schools/Healthy Students grant. It specified that law enforcement, mental health, juvenile justice and education agencies work together to make schools safer and students healthier. “We added the Department of Human Services,” says Townsend, who was hired as project director. “One of SAMHSA’s hopes for an outcome was that communities would build better relationships and systems.”

    Many communities that received the grants hired school resource officers. The Dalles did something different. With the exception of the school district, which was the grantee, the partners on the core team did not receive any direct funding. They wanted to focus on sustainable change, so they combed the agencies’ data for specific problems and asked how each partner could help resolve them. For example, when data showed significant behavioral issues at the middle school among a group of students, the director of  juvenile justice volunteered to greet those students at school every morning, and a targeted intervention for boys was put into place.

    The core team opted to put resources into after-school programs, mental health and crisis intervention for students in the Adallescommunity’s three

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  • Most Californians have experienced childhood trauma; early adversity a direct link to adult onset of chronic disease, depression, violence

    ACAreport

    Nearly two-thirds of California adults have experienced at least one type of major childhood trauma, such as physical, verbal or sexual abuse, or living with a family member who abuses alcohol or is depressed, according to a report released today.

    The report – “Hidden Crisis: Findings on Adverse Childhood Experiences in California” (HiddenCrisis_Report_1014) – also reveals the effects of those early adversities: a startling and large increased risk of the adult onset of chronic disease, such as heart disease and cancer, mental illness and violence or being a victim of violence.

    Ten types of childhood trauma were measured. They include physical, sexual and verbal abuse, and physical and emotional neglect. Five family dysfunctions were also measured: a family member diagnosed with mental illness, addicted to alcohol or other drug, or who has been incarcerated; witnessing a mother being abused, an losing a parent to separation, divorce or other reason.

    Each type of trauma counts as an ACE (adverse childhood experience) score of one. The more ACEs a person has, the higher the risk of facing physical, mental and social problems.

    ACAfindings

    For example, Californians who have an ACE score of 4 or more are nearly twice as likely to have asthma, 2.4 times as likely to have chronic obstructive pulmonary disease, 1.7 times as likely to have kidney disease, and 1.5 times as likely to have a stroke. They’re five times more likely to be depressed and four times more likely to develop dementia or Alzheimer’s. Those with an ACE score of 4 or more are approximately three times more likely to smoke, binge drink and engage in risky sexual behavior. They’re nearly 12 times more likely to be the victim of sexual violence after they’re 18 years old.

    One in six Californians – 16.7% — has an ACE score of 4 or higher. (Got Your ACE Score?)

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  • Alberta Family Wellness Initiative changes minds by informing Canadians about effects of toxic stress on kids’ brains

    Screen Shot 2014-11-02 at 7.05.27 PM

    A cartoon outline of a child – in a video – stands alone near a cracked sidewalk heaped with obstacles: giant red bricks labeled “neglect,” “abuse” and “parental addiction.” The voice-over says: “It’s possible to fix some of the damage of toxic stress later on, but it’s easier, more effective and less expensive to build solid brain architecture in the first place.”

    The four-minute animation—which covers toxic stress, caregiver-child interaction and the role of communities in building healthy brains—has reached many people since its release in October 2013. But the video is just one snippet of the Alberta Family Wellness Initiative (AFWI), a project aimed to better the lives of children and families in one of Canada’s westernmost provinces.

    Dr. Michelle Gagnon, vice president, Norlien Foundation

    Dr. Michelle Gagnon, vice president, Norlien Foundation

    The AFWI, launched in 2007 by the private Norlien Foundation, has an ambitious agenda: to promote the use of scientific knowledge about early brain and biological development in order to change beliefs, policies and practices related to children, families and communities—in short, to “bridge the gap between what we know and what we do,” according to a 2013 AFWI report.

    The AFWI began its work by capturing the attention and engagement of high-level “change-makers”—government officials, community leaders, policy experts, academics and administrators who could learn the newest science, discuss it in depth, then take that story home to influence research, policy and practice.

    “In the early days, the focus of our effort was on policy-makers and professionals rather than the public. You need to start changing the thinking of those in the system who are making decisions before you start focusing on a public audience,” said Dr. Michelle Gagnon, vice president of Norlien.

    AFWI focuses on the “core story of brain development,” a series of metaphors grounded in emerging biomedical science and developed with the help of the FrameWorks Institute  and the Center for the Developing Child at Harvard University.

    • Brains are not just born; they are built through a child’s experiences and interaction.

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