The Front Lines of Children’s Mental Health: Coordinated Care

This is part one of a two-part look at mental health services mandated by the settlement of Katie A. v Bonta, a class-action lawsuit brought against the State of California over its lack of community-based mental health services for youths.

Michael’s biological parents were working hard to get him back, but they needed more time. Meanwhile, his foster parents were ready to call his social worker and ask that the department place him somewhere else.

Six months after entering foster care, the eight-year-old was referred to Fred Finch Youth Center for services, including a psychiatric evaluation.

Headquartered in Oakland since opening its doors as an orphanage in 1891, Fred Finch provides mental health and social services to children, youth, and their families in four California counties: Alameda, San Mateo, Contra Costa, and San Diego.

It was in San Diego where Michael was referred to the agency’s Comprehensive Assessment and Stabilization Services (CASS) program.

Having experienced significant trauma in his young life, Michael was prone to outbursts and bouts of physical aggression toward his siblings and classmates. He often tore up his room or lashed out at others when he got frustrated, which happened frequently.

Although they had over ten years’ experience providing foster care to numerous other children, Michael’s foster parents felt they could not manage his behavior and let his child welfare worker know.

“As their placements fail, the outcomes for children and youth plummet,” said Charlotte Moore, Senior Director of Programs at Fred Finch. “Every time a placement fails because it doesn’t meet the child’s needs, that child falls further and further behind.”

This is where Intensive Care Coordination (ICC), one of the mandated services that resulted from the Katie A. vs. Bonta class action lawsuit, comes in. As described in our recent series, Katie A. sought to close the gaps in mental health services for children involved in California’s child welfare system.

The lawsuit produced two settlements, one with Los Angeles County in 2003 and another with the state in 2011. They required the provision of coordinated, home and community-based mental health services for children like Michael under a Core Practice Model established through the settlement process. (Court oversight of the state settlement ends this month.)

Fred Finch began providing ICC services to Michael and his foster parents immediately after his referral to CASS.

Rogelia Becerra, a Fred Finch clinician, coordinated services for Michael. A key part of her job was bringing together Michael’s “Child and Family Team,” one of the elements in the Core Practice Model.

“Part of the reason this team approach is so valuable is because, fundamentally, it takes a family to raise a child, and that family can be both informal and formal connections,” said Patrick Gardner, a lead attorney in the Katie A. lawsuit, and founder and president of Young Minds Advocacy, which is monitoring implementation. “So if you don’t have a strong care coordinator, it just doesn’t work.”

In Michael’s case, the team included his sister, biological parents, foster parents, the county child welfare caseworker, and a teacher. From the Fred Finch staff, the team included Becerra, who also provided family therapy, a behavior specialist, and a family partner (a paraprofessional with experience as a foster parent.)

Becerra brought the team together to assess the needs as well as strengths of the child and his family, including natural supports that could remain in place after the services had concluded. Having created a treatment plan out of the consensus of the team she had assembled, Becerra now had to ensure that Michael got the services he needed.

As a result of the assessment phase of ICC, Michael and his foster family were referred for Intensive Home-Based Services (IHBS,) another Katie A. mandated service. IHBS must be provided when it is determined that intensive support will help the child build the skills necessary to function successfully in his home and community, and likewise, to help the child’s “team” support his ability to do so.

In our next story, we will see if IHBS was enough to help Michael remain with his foster family until his biological parents were ready to bring him home.

Melinda Clemmons is a reporter and marketing manager for The Chronicle of Social Change

Note: The true name of the subject in this story has been changed to protect the child’s identity.

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Melinda Clemmons
About Melinda Clemmons 26 Articles
Melinda Clemmons is a freelance writer and editor based in Oakland, California.

2 Comments

  1. This sounds like a very good idea for a program!!! Have other parts of the country considered picking it up? I would think though that this may be a tough program in rural areas or very high use areas with lots of poverty because you would have to have well trained mental health home workers. I went to a home visit for an at risk young family yesterday with a worker for a local program for mothers with young children. I think the program is good but the workers don’t have to have any special training and this mother and her boyfriend were very much affected by their childhood hx of abuse (that’s why I went along – see if I could offer suggestions). The father had a horrific childhood with multiple foster care placements and had been in the psychiatric ward many times for weeks at a time when a child, he finally really was given up on and placed in a group home after suffering persistent horrific abuse–mom had a similar history–so it was very obvious to me that both parents could really use help for their trauma before they would be able to parent more effectively, but not just any help would do. The workers in the home were becoming frustrated as the parents kept coming up with reasons why they were having difficulty following recommendations for these optional programs but the reasons the parents gave for blocks in their action to me as I listened were obvious and predictable blocks considering the horrific child maltreatment they had both suffered. One of the home workers out of frustration called CPS and I don’t think this is right because if she understood the effects of abuse and could be patient and guide these parents through there obstacles there could be a much better outcome. Instead a family had CPS called on them bringing in a system that had already traumatized them. I can see how easy it can be for people who don’t understand to re-traumatized already traumatized people. While at the same time, the resources of CPS which are already very limited in my state were directed away likely in the form of a screened out call from a child who may indeed be in a huge amount of danger but because the family is not enrolled in any of these programs all the abuse goes under the radar and that hidden abuse can be massive… Thanks

    • Thank you for your comments. You make a very good case for the importance of trauma-informed care. We would love for you to consider writing a guest piece for The Chronicle about your experiences.

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