Mental Health for Out-of-County Youth

| Volunteer Resources | Health & Wellness | Mental Health for Out-of-County Youth
VAR / Advocating for Mental Health Services for Children Placed Out-of-County
One problem that has long plagued child advocates is the how the amount, speed, and quality of specialty mental health services can vary when children are placed out-of-county.

The nearly 15,000 California children who find themselves placed out-of their county of origin often find that mental health services come slowly, if at all. This is a real concern and can pose a serious detriment to the child’s well being.

As a CASA volunteer, you have an enormous opportunity to ensure that mental health services are delivered in the most appropriate way. So what, then, should you know about mental health services for children who are placed out-of-county?

The Problem
This problem is a result of the efforts to find ways to reduce the high costs of mental health services. Medi-Cal mental health services are “carved out” of the normal provision of Medi-Cal health care services and are paid for differently. This means that a child whose foster care case is in Alameda County courts would need to have Alameda County arrange, and pay for, mental health services regardless of where the child lives. This would be the “county of origin.” Conversely, the county where the child is living, or the “host county,” has no responsibility to arrange or provide mental health services for the child.

This required counties to 1) find mental health service providers in a county they might be unfamiliar with, and 2) engage in some contractual negotiations to arrange for payment and provision of services to the child. This, as you might imagine did not always happen as quickly as one might hope. The result could be months, or even years of delays.

New Solutions

  • Determining Who Does What?
    New law went into effect on January 1, 2008 that revolutionized the way counties arrange for specialty mental health services for foster youth who are placed out-of-county. Over the past 19 months the implementation of Senate Bill 785 (2007), has been building steam, and as of July 2009 its effects are being felt. (SB 785 of 2007 is codified in Welf. & Inst. Code section 5777.7.)
  • Standardized Contracts and Forms
    As of July 2009, the Department of Mental Health is now requiring that counties and providers use standardized forms when contracting with each other. This should streamline the process and make it easier and faster to connect an out-of-county provider with the child that needs the services. It should also reduce confusion and facilitate the flow of needed information. Technically though, counties can still hire services however they like, but if they do so by contracting with a provider, then the new standardized forms (and only the new forms) must be used. (Also, note, that old contracts can remain, the standardized forms apply to any new contracts for services.)
  • Strict Timelines
    The other wonderful thing to note is that now there are new timelines for arranging mental health services for children who are placed out-of-county. See 9 CCR § 1830.220(b)(4).

First, it should never take more that 14 days to approve or deny a request for mental health services for the child, and in many cases it should happen faster than that. When services are requested, the county must approve or deny the request within 3 days of receiving any new information, but never more than 14 calendar days from the date of the original request – whichever is sooner.

Second, once the authorization is received, it should never take more than 30 days to set up the method of payment for a service provider.

Therefore, if you have a child who is living in an out-of-county foster home and needs mental health services, the longest it should ever take to arrange for those services – from start to finish – is 42 days. Any longer than this, and you know something is wrong. This is the time to make sure the judge knows that the child needs mental health services, and that some procedural snafu needs attention.

Permanency Planning
If you are advocating for a child and their permanent plans call for adoption or legal guardianship with relatives, then there is more to know. Namely, the law now says that for children whose cases are dismissed to either an adoption with Adoption Assistance Payment (AAP) or relative guardianships under KinGAP, the provision of specialty mental health services are to be arranged by the host county (i.e. where the adoptive parents reside or where the child lives under the KinGAP guardianship). However, the county of origin (where the child’s court case was) is still responsible for authorizing the service and arranging for payment.

This should make it easier for these children to receive mental health services as the standard of care will be what the host county provides – and the county will have to provide mental health services as they would any other child living in the host county.

The bottom line is that the children, and their relatives and adoptive families can be assured that, just because the child is placed out-of-county, any mental health services that might be needed will be arranged for, and provided by, their local agency – not the county that is farther away and perhaps lacks the knowledge, connections, and processes to arrange for nearby mental health services. The host county cannot just send families back to the county of origin when they need services. This is definite reassurance for some families – as well as the CASA – when mental health services are essential for maintaining the placement.

AB 3632
For those of you who are wondering (someone always asks), the new law does not affect the provision of AB 3632 services for children in special education who require mental health services.

Things to Remember
This is not a cure-all. While 1) making clear who arranges and provides mental health services versus who pays, and 2) standardizing the forms, and 3) instituting timelines will help, there will still be children who need your advocacy to access needed services.

For example, this does not remedy the fact that some counties have a severe shortage of appropriate mental health services. Therefore, there may need to be some good old fashioned CASA advocacy to ensure that services are received. The court should always be aware of what the child needs and what barriers exist – it is a CASA’s duty to ensure that the child comes first.

What if a requested mental health service is denied by the county of origin?
This is not necessarily where your advocacy should stop. If the mental health service is needed, look closely at the reason for the denial. County Mental Health Plans are required to authorize out-of-plan services for out-of-county children even if they don’t ordinarily provide that service. See 9 CCR § 1830.220(b)(4). Also, denials are improper when they are done solely on the basis of a higher cost (compared to the county of origin) or pure administrative inconvenience.

Be on the look out for Information
Soon, the California Department of Social Services will be distributing 1) a Caregiver’s Guide, a 2) Wallet Card, and 3) a Social Worker Checklist to help ensure that children who are placed out-of-county receive timely and appropriate mental health services.

Think Outside the Box
If your child is having difficulty getting appropriate mental health services, don’t give up! But also look for other avenues. For example, victims of child abuse (and other crimes) are often eligible for Victims of Crime Compensation (VOC). VOC can increase access to mental health services, and usually has an expanded selection of mental health providers. For more information ask a social worker and/or go to Research the issue and discuss the options with the social worker. He or she can apply for VOC and you might just remove the need for Medi-Cal provided services altogether.

Also, some communities have therapist and other providers who are willing to provide pro bono services – it’s always good to investigate and ask.
Children who are placed out-of-county need even more help and as you know, having a CASA on your side can make all the difference.