A Letter to the Subcommittee on Human Resources

As a member of Attachment &Trauma Network, Inc. I had an opportunity to write the following letter:

 

August 20, 2013

 

U.S. House of Representatives

Ways and Means Committee Office

Subcommittee on Human Resources

1102 Longworth House Office Building

Washington, D.C. 20515

 

Honorable Members of the Subcommittee on Human Resources: 

I am an adoptive parent from the State of Utah and a member of the Attachment & Trauma Network, a national organization supporting traumatized children and their families, many of whom were adopted through the US foster care system. I’m writing to support the proposed Promoting Adoption and Permanency from Foster Care Act.

As a single foster/adoptive parent, I adopted three siblings (Bubba Doo, YaYa & Bugga Boo) from DCFS, who all had intrauterine drug exposure to heroin and cocaine.  I got my first two children as newborns and my youngest son when he was 3 months old.  I eventually found myself parenting two children who were diagnosed with Reactive Attachment Disorder, ADHD, Bipolar, PTSD, as well as other mental illness.  My family experienced a lack of mental health services, appropriate community based resources and services that were needed to be able to successfully help my children and keep my home safe.  Due to the lack of mental health resources, I was forced to relinquish two of my children back into state custody to get the needed services and this led to ultimately disrupting their adoptions.  My home was the only home my children had ever known until being placed back in foster care.  When I relinquished, YaYa was 12 years old and Bugga Boo was 8 years old.  I placed my children back in foster care not because I didn’t love or want them or because I abused them or neglected them.  I placed my children back in foster care because I was told they could only get the help they needed as wards of the state.  I did not cause YaYa and Bugga Boo’s attachment issues or pre-birth trauma.  I did everything I could to advocate and help my children.  If my children had cancer, I would never have been placed in a position to have to place them in foster care to get appropriate treatment.

I concur with the draft legislation to:

1. Extend the authorization of the program through FY 2016;
2. Add an award for placements with legal guardians;
3. Provide awards based on improvements in the rate of adoption and other permanent placements, even as the number of children in foster care declines; and
4. Require States to report on de-link savings resulting from the Fostering Connections to Success and Increasing Adoptions Act of 2008 (P.L. 110-351), and to use at least 20 percent of such savings for post-adoption services.     

This bill is MUCH needed, but it does not speak strongly enough to the issue of adoption permanency; so, I would like to expand on use of the savings to increase permanency.

As more of the children being adopted since the Adoption and Safe Families Act of 1997 (ASFA) was enacted are reaching adolescence, we are seeing a disturbing trend towards children being forcibly recycled back into foster care to access funds for intensive mental health services.

ASFA provided subsidies for adoptive families, along with Medicaid to provide for medically necessary treatment. This provision was crafted to provide for treatment due to pre-adoptive trauma, including severe abuse, neglect, and the impact of pre-natal substance abuse. The Child Welfare League of America reports that more than 80% of foster children have emotional, developmental, or behavioral difficulties.

However, states are failing to provide for intensive treatment, including residential placements as needed, as required under the Early, Periodic, Screening, Diagnostic, and Treatment (EPSDT) provision of Medicaid, as required by federal law. As a result, in many states, parents are forced to trade custody for treatment, so that states may draw down federal funding in order to recoup costs of expensive treatment. While financially convenient for states, there are devastating consequences for these children and parents.

A 1999 NAMI study called “Families on the Brink: The Impact of Ignoring Children with Serious Mental Illness” showed that about 20% of families surveyed were forced to relinquish custody of their children in exchange for treatment. The NAMI study was confirmed by the GAO report in 2001, “Child Welfare and Juvenile Justice – Federal Agencies Could Play a Stronger Role in Helping States Reduce the Number of Children Placed Solely to Obtain Mental Health Services” which reported that 12,700 families were forced to relinquish custody of their children in exchange for mental health services in 2001. The GAO report did not include all states omitting several states with the large foster care populations. A Freedom of Information Act in Illinois reports a rising trend in the numbers of relinquishments in that state:

2006     77

2007     46

2008     63

2009     72

2010     104  (more than 1 per county / 2 children per week) 

Illinois denies having custody relinquishment statistics for 2011 and 2012.

When children are denied funding for therapeutically recommended treatment, often parents are forced into a “Devil’s Deal”—of choosing between being charged with child endangerment for failing to protect siblings and other children when bringing an unsafe child home, or being charged of neglect for refusing to bring the child home on the grounds they cannot protect the family. States that fail to provide for the adoptive child’s clinical needs often default the child to child welfare and juvenile justice systems which have no proper channels to serve a mentally ill child in a healthy adoptive family. These systems process families using the same laws and protocols that are used for abusive and neglectful parents, instead of providing post-adoption services and mental health care that maintain permanency.

This obviously places extreme mental and emotional duress on adoptive parents and siblings, but there are worse ramifications for the pre-adoptively traumatized child. The process deepens mistrust of adults and results in feelings of guilt that their loving parents are being punished in exchange for their treatment.

This tragedy is preventable. If a state can draw down federal funding for medically necessary services for a foster child, that state should also be able to draw down federal funding for the very same child as an adoptive child. The ability to allow money needed for medically necessary treatment to follow the child will preserve permanency. I recommend that the legal EPSDT wording (§ 1396d(a) “…if a practitioner of the healing arts deems that a treatment is medically necessary to correct or ameliorate a condition, the state must provide it, whether or not it is covered under any other state plan…if they cannot provide it, they must arrange for it…”) be inserted into the Promoting Adoption and Permanency from Foster Care Act, as a directive for a portion of the 20% savings. This allocates state funding towards the express purpose of adoption permanency and the abolishment of involuntary custody relinquishment. In addition, I recommend that this new act include a financial incentive for states that report a zero rate of involuntary custody relinquishment. To provide for accountability, states should be required to track and report he numbers of involuntary relinquishments. In summary, I recommend that the adoption support and preservation services component of this proposed act be expanded to include the following:

1.       Amend Title IV  to allow for funding to follow a former ward into adoption

2.      States direct a portion of the 20% savings of phase out funding towards the purpose of 
abolishing Involuntary custody relinquishment

3.      Mandate that states track and report numbers of involuntary relinquishments

4.      Add a financial incentive for states reporting zero rates of involuntary relinquishments

The Attachment & Trauma Network supports the proposed draft legislation, but would like to see additional items added to strengthen adoption permanency and alleviate involuntary relinquishment for mental healthcare, while requiring accountability for permanency outcomes.

Respectfully submitted,

Amelia Blessings