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