The Imprint is highlighting each of the policy recommendations made this summer by the participants of the Foster Youth Internship Program (FYI), a group of 11 former foster youths who 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 carefully researched policy recommendation during their time in Washington. Today, we highlight the recommendation of Emily Satifka, 23, a junior at Temple University who entered the Pennsylvania foster care system at age 10.
Amend the Fostering Connections to Success and Increasing Adoptions Act to establish two timelines for the health care plans of foster youth:
- Screenings for physical, mental and oral health must occur within 30 days of entry into the foster care system
- “Comprehensive assessments” for physical, mental and oral health must occur within 60 days of entry into the foster care system
The Fostering Connections Act of 2008 requires that states coordinate a health care plan – screening, treatment and monitoring – for all youths in the foster care system. But there is no set timeline for when those things happen.
The wide array of state policies suggest that timelines are necessary, especially in regard to mental health assessments. A few examples cited by Satifka:
- Illinois requires a behavioral health screening within one day of entry into foster care
- Oklahoma required a behavioral health screening within 90 days
- Pennsylvania did not require a formal behavioral health screening
In Her Own Words
“Though in reality I felt overwhelmingly confused, depressed and disgusting, my caseworker assumed that because I was a cheerleader and had high grades, I did not need to see a therapist. I do not recall receiving a formal mental health screening or assessment from a health care professional, and although I did not ask to see a therapist, I wish an adult had helped me access professional support so I could heal from the trauma I had experienced.”
The Imprint’s Take
Most of the health services provided to foster youths is done so through Medicaid, which has its own guarantee of timely services for minors: Early Periodic Screening, Diagnosis, and Treatment (EPSDT).
To Satifka’s point, there is no hard definition of the “early” in that program. EPSDT screenings and services often arrive after a long stay on the waiting list, and the intensity and quality of the services rendered through EPSDT has been questioned by policy experts.
This is most true in the arena of mental health. Satifka cited the timelines imposed in a few states, but the truth is that almost half the states (23) don’t require a behavioral health screening at all for youths taken into foster care. The same is true with ESPDT; not all states perform mental health screens as part of the package.
Satifka’s proposal tacitly entails requiring states to place foster children on a fast-track for health services as compared to low-income children. There are likely advocates who would agree with that proposition, based on the premise that many of the children in foster care come from low-income families and now have a known, extra layer of risk.
Another way to look at it is: why not just amend and clarify the “early” in EPSDT? If the timelines Satifka proposed were imposed on EPSDT, it would improve things for foster youths and also every other low-income child.
It is also worth considering that a mandate placed on a state or county child welfare agency is not a mandate necessarily placed on that area’s Medicaid system. Consider the requirement in Fostering Connections that child welfare agencies keep foster youths in their school of origin if that’s preferred. This provision has not yielded the impact that was hoped for because local school districts, which control the transportation, are not compelled by Fostering Connections to move foster youths long distances to keep them in school.
So just because a state child welfare system would be obligated to meet screening and assessment timelines, it would not mean the state Medicaid program felt the need to meet them. This might leave the child welfare agency in the position of paying another way for screening and assessment, likely a significant cost.
Click here to read Satifka’s entire proposal and those of her fellow FYI participants.