In July of last year, I had the opportunity to present at the Human Services Finance Officers (HSFo) Annual Conference in Louisville Kentucky about trends in Child Welfare. Preparing for this panel discussion got me thinking about all of the things we experience every day in the behavioral health world and its intersection with the foster care system.
We frequently hear information about psychotropic medications and studies comparing children in foster care with children in the general Medicaid population. We hear conversations about evidence based practices, and the trauma that these children have experienced, and in my opinion, continue to experience by the simple nature of being in a temporary system.
We hear about challenges with placements, shortages of foster homes, the move away from congregate care, and the move towards normalcy, among many other topics.
As I prepare for these talks, I cannot fully separate my prior experience in the foster care world, or my experience as a foster and adoptive parent, with my experience in the behavioral health world. I have come to realize that is actually better. Nothing is one dimensional, and thus, our understanding, perspective and approach should always be multi-dimensional.
Why is it so important to write about foster care and its linkage with behavioral health? It is important because when you are a child, and wounded, there are so many things that go on inside you. You feel of little value, you think things happen because you aren't good enough, you aren't sure who to trust or how, you learn from what you see, and the world doesn't understand why you act the way you do. You have pent up anger or are scared to open up and it creates this path that just grows over time. Your self-esteem is low, you look for some sign from others that you are worthy, you are afraid of rejection; you build up walls around you. Basically, you learn to survive and protect yourself, and that comes across in many forms.
Flip to the other side of the system, the foster care system, where adults want to help, try to help, but sometimes no matter what they do or try, it doesn’t work. It may not be the people, or the approach, it may just be the timing. It may be many things. Our job in the foster care world is to create an environment where children can grow and learn in a healthy environment, while helping children to understand the whys and wherefores of their past, or biological family, or their siblings, etc.
Understanding and empathizing is the key. Knowledge is how this is achieved.
Children in foster care go from therapist to therapist as a result of placement changes. Quite often I hear that if only their trauma was dealt with, they could heal. On the behavioral health side of the world, I believe that the right approach is necessary, but, there are so many small and large wounds, that one thing, one approach, doesn’t heal all. What helps is stability and commitment. Understanding trauma, and the uncertainty of living in a temporary world, is a critical part of this equation.
In the behavioral health world, we strive to bring expertise about human emotions, child abuse, neglect, and trauma to the front lines of the child welfare system. It is complex and complicated, but so are all of us, not just the children. They say it takes a village to raise a child, and that is under the best circumstances. And it certainly does within the foster care system, and it is imperative all of the villagers are in the same village.
Because behavioral health services, in the form of mental health and substance use services are funded through Medicaid, there is an excellent opportunity to improve the system of care for kids in the foster care system.
Children in foster care are not like children in the typical Medicaid population. Children in foster care often have a state government as a parent, are living with strangers, and learning new daily life activities, going to new schools, trying to feel comfortable, as comfortable as they can without letting too much of their guard down. This would be scary for any of us, not to mention children, and particularly, children in the foster care system.
What we can do in the behavioral health world, however, is help to inform and educate all of those that touch the lives of these children with what trauma is, how attachment works, or doesn’t work, and why these children aren’t simply grateful every day to be in a safe, loving home.
These children are pulled in many directions internally, on a daily basis. Just because an environment changes, doesn’t mean the imprint of the former environment goes away. It just co-mingles with the new environment, the new people, and the new lives.
Because Medicaid pays for behavioral health services for children in the foster care system, it is imperative the behavioral health world adapt to this unique population, not vice versa.
We need clinicians and para-professionals that understand the complexities of being in foster care.
We need clinicians who can build rapport with children, who understand the child is present because they have to be, not because they want to be. These children have shared various parts of their story with so many, often within the first 30 days of being removed, and they are scared. There are loyalties tested, there is grief that is felt. There is uncertainty daily. There is also often a lack of understanding of why they are being punished, being removed from their home.
Children don’t understand there isn’t a home to take all five siblings at once, for example, or why some of the siblings get to stay with a relative, while they do not. Additionally, many children learned before coming into care not to trust law enforcement, or case workers.
So where do we start?
We start with the right understanding, the right clinicians, and the right resources to continually, daily, keep advocating for these children. We share information from national experts, and organizations such as the National Child Traumatic Stress Network (NCTSN), and we build the right system.
Having come from the foster care world to the behavioral health managed care world, I can see clearly how systems can be shaped to better serve children. It takes a village, and in this case, an understanding, willing and committed behavioral health managed care organization with the tools to not only focus on the child, but to focus on the caregiver, clinicians, doctors, case workers, child placing agencies, and residential facilities that all serve the child. The continuum needs to be aligned, and flexible, all with the goal of helping the child, and the child’s environment, whatever that environment might be today.
Continuing learning is essential. My company, Cenpatico, a subsidiary of Centene Corporation, decided two years ago to implement a national community service called Foster Care EDU. This is a ‘conference to you’ approach to learning. I realized that while I had the opportunities to attend conferences, learn from experts and meet with state representatives, the information was lost on me if it could not be shared with those closest to the child – the caregiver. Thus, we have developed a national platform through Cenpatico University that brings in national experts, and offers educational, facilitated, live trainings during evening hours for caregivers.
To learn more, go to www.cenpaticou.com and click on Foster Care EDU. This is free to anyone who wants to participate.
Owner/Editor - Chris Chmielewski