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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Vermont first state to propose bill to screen for ACEs in health care

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Dr. George Till, Vermont state legislator and physician

When Vermont State Legislator and physician Dr. George Till heard Dr. Vincent Felitti present the findings of the CDC’s Adverse Childhood Experiences Study at a conference in Vermont last October, he had an epiphany that resulted in a seismic shift in how he saw the world. The result: H. 762, The Adverse Childhood Experience Questionnaire, the first bill in any state in the nation that calls for integrating screening for adverse childhood experiences in health services, and for integrating the science of adverse childhood experiences into medical and health school curricula and continuing education.

That Vermont would be the first in the nation to address adverse childhood experiences so specifically in health care at a legislative level isn’t unusual. More than most states, Vermont is a “laboratory of change” for health care. It has embraced universal health care coverage for all Vermonters, and it passed the nation’s first comprehensive mental health and substance abuse parity law. (Washington State passed a law in 2011 to identify and promote innovate strategies, and develop a public-private partnership to support effective strategies, but it was not funded as anticipated. The Washington State ACEs Public-Private Initiative is currently evaluating five communities’ ACE activities.)

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Arresting our way out of drug crisis is yesterday’s theory, says VT Gov. Shumlin; urges public health approach

AshumlinState of the state addresses—like the State of the Union—tend to cover a wide range of topics from the economy to health care to education.  Vermont Governor Peter Shumlin broke the mold when he devoted his entire 2014 State of the State address to the state’s drug addiction crisis.  The rising tide of drug addiction and drug-related crime spreading across Vermont is “more complicated, controversial, and difficult to talk about” than any other crisis the state confronts, he said.

“We have lost the war on drugs,” he said. ” The notion that we can arrest our way out of this problem is yesterday’s theory.”  Even though Vermont is the second smallest state in the union (pop. 626,600), more than $2 million of heroin and other opiates are being trafficked into the state every week. Shumlin expressed alarm over the increase in the deaths from heroin overdose that doubled in 2013 from the year before and the 770 percent increase in treatment for opiates.

Shumlin told emotional stories of young Vermonters becoming addicted to prescription opiates and heroin — one recovered, one died from an overdose. While stories of young and promising individuals dying from heroin overdoses may grab headlines, data from the Centers for Disease Control and Prevention (CDC) show that deaths from prescription opioid pain relievers — such as codeine, methadone, and oxycodone — between 1999-2008 now exceed deaths involving heroin and cocaine combined.

CDC reports that in 2008, 36,450 deaths were attributed to drug overdoses in the U.S.  Opioid pain relievers were involved in 14,800 deaths (73.8%) of the 20,044 prescription overdose deaths.  The drug overdose death rate of 11.9 per 100,000 (Vermont’s rate was 10.9 per 100,000) was roughly three times the rate in 1991. Prescription drugs accounted for most the increase.  An April 12, 2012 statement from the Office of National Drug Control Policy reported that death from unintentional drug overdoses is greater than car accidents, the leading cause of injury in the U.S.

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Survey shows 1 in 5 Iowans have 3 or more adverse childhood experiences

iowaacesIowa’s 2012 ACE survey found that 55 percent of Iowans have at least one adverse childhood experience, while one in five of the state’s residents have an ACE score of 3 or higher.

In the Iowa study, there was more emotional abuse than physical and sexual abuse, while adult substance abuse was higher than other household dysfunctions.iowaprevalence

This survey echoed the original CDC ACE Study in that as the number of types of adverse childhood experiences increase, the risk of chronic health problems — such as diabetes, depression, heart disease and cancer — increases. So does violence, becoming a victim of violence, and missing work days.

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Foster human flourishing, and improved economic production will follow

lifelinesIn a recent New York Times opinion piece, “Lifelines for Poor Children“, James J. Heckman, Nobel Laureate and professor of economics at the University of Chicago, makes a compelling case for quality early childhood programs for disadvantaged children that “more than pay for themselves in better education, health and economic outcomes.” But making these high-yield investments in children from birth to age five will require us, according to Heckman, “to rethink long-held notions of how we develop productive people and promote shared prosperity.”

Heckman points to two long-term research studies that have demonstrated high rates of return on investment: the Ypsilanti, Michigan Perry Preschool project and the Carolina Abecedarian Project, aka “ABC.” Both programs included cognitive stimulation as well as non-cognitive skill development such as training in self-control and social skills, and parenting practices. The Perry Preschool project showed that while the experience did not make lasting changes in children’s IQs as was expected, it did improve their overall, lifetime success in education, earnings and stability overall. The “ABC” project did show lasting effects on IQ as well as on parenting practices and

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Terrifying children into a life of asthma

Credit: Cellular Image/Flickr

Credit: Cellular Image/Flickr

Sometimes the clearest indicator of a family’s dysfunction is, unfortunately, illness in its children. Like the proverbial canaries in the coal mine, it’s the children who are most susceptible to the toxicity of family addiction and dysfunction. Hurt people hurt people, and literally scare the life out of little kids.

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