The Promise of Integrated Mental Health Services: Katie A.'s Impact on Foster Youth with Special Education Needs

By Fiza Quraishi, Staff Attorney, National Center for Youth Law
and Daniel Senter, Staff Attorney, East Bay Children’s Law Offices

A version of this article originally appeared in the Spring 2013 edition of Northern California Training Academy’s “Reaching Out: Current Issues for Child Welfare Practice in Rural Communities.” A full version of the publication can be found here.

Katie A. v. Bonta, a child welfare and mental health reform class action lawsuit that was settled in December 2011, provides intensive home- and community-based mental health services to children in California who are in foster care or who are at risk of removal from their families. Under the agreement, the State will make “Intensive Home-Based Services” and Intensive Care Coordination available to certain children under Medicaid. It will also determine what parts of “Therapeutic Foster Care” are covered under Medicaid and provide that service to certain children. The settlement requires that state and local agencies coordinate decision-making, develop a team approach to providing services, and instruct providers on delivering these services. The case is currently in the second year of a three-year implementation period and counties are developing plans to begin rolling out services.

Emma is a fourteen year-old child in foster care who just exited a mental health hospital stemming from an involuntary psychiatric hold. She is placed into a group home with no therapeutic services. Her social worker says his hands are tied because Emma does not have an Individualized Education Plan (IEP) that would allow her access to a higher-level group home. Emma is re-enrolled in her middle school, but the school puts her on home hospital instruction until it can complete an IEP assessment, in hopes of finding her eligible for a Non Public School. Her school does provide weekly therapy, but the therapist she had been seeing for over a year stops seeing her because the school says it needs to bill Medi-Cal for its therapy services. Emma makes no connection with the school therapy intern assigned to her; her mental health declines, resulting in suicide attempts and more hospitalizations, as she continues to sit without peers or services for hours each day with little education access.

Unfortunately, when service providers work in silos, youth receive disjointed, incomplete and inadequate assistance. The Katie A. v. Bonta settlement provides an opportunity to prevent situations like Emma’s by requiring intensive individualized, needs-based mental services that draw upon the collaboration of all service providers in a foster youth’s life. Most, if not all, Katie A. class members will be eligible for school-based mental health services through the Individuals with Disabilities Act (IDEA) or Section 504 of the Americans with Disabilities Act.

With this comprehensive approach in place:

• Collaboration can occur through formal Child and Family Teams (CFT) for certain youth who are part of the Katie A. subclass¹, or through more informal teams focused on developing a needs-based plan for services for non-subclass members.
• Services that may be provided in the school, such as In Home Based Mental Health Services (IHBS), can be integrated into the child’s case plan, providing an opportunity to align the educational goals of an IEP (or 504 Plan) with the mental health goals developed through the Katie A. case planning process.
• School personnel who know and work with a particular youth can also contribute to the development of a Katie A. case plan.  Similarly, if a community-based provider has been working with the child, that person can participate in the school-based meetings (IEPs or 504 planning meetings) as someone with special expertise and knowledge of the child’s needs.

In Emma’s case, assuming she meets the criteria for the subclass, she will now be eligible to receive a formal CFT with a trained facilitator. The CFT can be composed of her social worker and original therapist, as well as any other outside supports the family and team identify. This CFT can implement IHBS for an integrated approach to serving her mental needs.  The team can also consider the importance of the pre-existing therapeutic relationship Emma had with her therapist, and determine how that service might be continued even with the possible addition of the school-based IEP therapeutic services. If Emma did not qualify for the subclass, she would not receive a formal CFT, but this type of needs-based collaboration could still occur within teams that already exist, like child welfare team decision meetings.

Had coordinated, individualized services been in place previously, Emma may have avoided home hospital instruction and may have been able to stay in a regular public school. Further, she may have been immediately placed in an appropriate level group home and not been made to wait for an IEP meeting. This could have mitigated her suicidal ideations and anxiety.

Katie A. promises greater availability of intensive, individualized community-based services. Ideally, as local jurisdictions implement the Katie A. settlement, mental health and child welfare agencies will engage school districts and school-based mental health providers to identify barriers to accessing services, like restrictions created by information sharing laws. Through this increased communication and collaboration, foster youth across the state can start accessing the services they need to successfully transition into self-sufficient adults.

Fiza Quraishi is a staff attorney at NCYL, specializing in the intersections between the mental health, child welfare and juvenile justice systems.

Daniel Senter is a Staff Attorney at East Bay Children's Law Offices, where he focuses on the intersection between child welfare and education.

1. “Subclass members are children and youth who are full-scope Medi-Cal eligible, meet medical necessity, have an open child welfare services case, and meet either of the following criteria: A) Child is currently in or being considered for Wraparound, Therapeutic Foster Care or other intensive services, therapeutic behavioral services, specialized care rate due to behavioral health needs; or B) Child is currently in or being considered for a group home (RCL 10 or above), a psychiatric hospital or 24 hour mental health treatment facility, or has experienced his or her 3^rd or more placements within 24 months due to behavioral health needs.” Katie A. v. Bonta Settlement Agreement, p. 6.