Child Welfare Ideas from the Experts, #1: Mental Health Timelines for Youth Entering Foster Care

The Chronicle of Social Change is highlighting each of the policy recommendations made this summer by the participants of the Foster Youth Internship Program (FYI), a group of 12 former foster youths who have completed congressional internships.

The program is overseen each summer by the Congressional Coalition on Adoption Institute, with support from the Sara Start Fund.

Each of the FYI participants crafted a policy recommendation during their time in Washington. Today we highlight the recommendation of Jennessa Ahline, a student at Middle Tennessee State University.

The Proposal

Ahline proposes the federal imposition of hard timelines for mental health services provided to foster youth. These timelines would be set by amending Section 422(b)(15) of the Social Security Act.

That section already requires states to establish a coordinated plan to screen, treat and monitor the mental health needs of foster youth. But it conveys no urgency in getting those things done. Ahline proposes the following three timelines:

  • An initial mental health screening within 30 days of entry to foster care.
  • Initiation of indicated mental health services 30 days after the date of the initial screening.
  • A comprehensive screening to take place within 90 days of entry to foster care, and then at least one more each year that the child remains in the foster care system.

The Argument

The American Academy of Pediatrics recommends that foster youth have a comprehensive mental health evaluation within 30 days of entering care. But about half of the states do not require even an initial screening during that time frame.

In 13 states, Ahline said, “there is no requirement or no time frame for an initial screening.”

In Her Own Words

Jennessa Ahline

“When I was in foster care, I refused mental health services due to fear, stigma and a lack of understanding of how such services could help me. As a result, I experienced depression, anxiety and obsessive-compulsive disorder.”

The Chronicle’s Take

Emily Satifka, an FYI last year, proposed a similar change but suggested putting the requirement in an amendment to the Fostering Connections to Success and Increasing Adoptions Act.

Our sense is that Ahline’s proposal might have more teeth. The section of the Social Security Act to which she refers, pertains to “IV-B,” the Stephanie Tubbs Jones Child Welfare Services Program. It is the primary federal conduit of flexible child welfare dollars to states.

If the feds were serious about withholding some portion of IV-B funds when these timelines were not being met, that might be enough of a catalyst to push states toward sensible timelines. One thing that would need to be ironed out, perhaps, is a caveat about return trips to foster care and whether the screening/treatment/evaluation clock needs to start again each time.

There is also, potentially, an unintended consequence. If kids going into foster care were more likely to get timely mental health intervention, it could unnecessarily provide incentive for taking them from families.

A broader strategy to force timeliness on mental health – one that could assist kids in care or who were not removed – might be to sharpen the requirements of Medicaid’s Early Periodic Screening, Diagnosis, and Treatment (EPSDT). That is a guarantee to any Medicaid-eligible youth, but there is no federal requirement that it include mental health. There is also no codified definition of “early.”

Click here to read Ahline’s entire proposal and those of her fellow FYI participants.

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John Kelly, Editor in Chief, The Chronicle of Social Change
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John Kelly is editor-in-chief of The Chronicle of Social Change. Reach him at