May 30, 2013
Planning For a Healthy Transition
Photo via westpark on Flickr
Note: This post is part of a series of posts recognizing National Foster Care Month.
At least one third of youth in foster care have disabilities—ranging from minor developmental delays to chronic and severe health and behavioral health impairments—that will require treatment and care after they age out of the child welfare system. These youth are entitled to the same independent living, permanency, and transition planning services as all foster youth in the system. They also are entitled to all the protections of federal and state law that prohibit discrimination based on disability and require that reasonable accommodations be made in the provision of benefits and services.
The fact that foster youth with disabilities have these legal rights to treatment and services is not enough. More thought and planning must be given to ensure that these services are delivered in a way that meets the needs of these youth. They must be able to achieve their potential and their goals for the future. This is especially true for youth whose transition to adulthood requires coordination among multiple systems.
Despite the large number of youth with disabilities in the child welfare system, there has been little emphasis on tracking these youth and making sure their needs are met. Sadly, the little research that has been done tends to show that these youth are faring poorly in comparison to youth in care who are not disabled: they are more likely to be mistreated, placed on psychotropic medications, be institutionalized, experience placement instability, and have poor educational outcomes.
Youth with disabilities can and deserve to thrive in the community with full access to educational, employment, and career readiness services. Sometimes this means being creative and mixing services, such as child welfare services and those from the mental health or developmental disabilities systems. It might mean fighting for accommodations and access to basic services, such as extracurricular activities and mentoring programs.
To ensure that youth with disabilities successfully transition to adulthood, the child welfare system must do a better job of identifying them. The system must enhance its monitoring of their treatment and care to ensure that their health needs are met and that they thrive.
There are steps the child welfare system can take. They include beginning planning earlier. They include establishing protocols for accessing benefits and services with adult-serving systems for those youth who need supports as adults. The good news is that two federal laws—the Fostering Connections to Success and Increasing Adoptions Act and the Affordable Care Act—provide states with more tools to make these reforms achievable in accountable ways.
What You Can Do To Help
Learn more about the prevalence of disabilities for youth in foster care. View these publications and websites:
Take action to reform the system. Find out how your state is complying with the Fostering Connections to Success and Increasing Adoptions Act of 2008, which requires that there be a state plan for the oversight and coordination of health care for children in foster care. The state plan must include a strategy for identifying and responding to children's health care needs, including their mental and dental health. This plan must also include how transition needs to the adult health care system will be handled. Every state must have a plan in place, but state plans vary in their level of quality, and there is much room for improvement and advocacy.
If you're a lawyer or an advocate for foster youth, consider taking these actions:
1. Make sure that the youth is in the least restrictive community- and family-based setting possible. This is required by federal child welfare law, and by federal and state laws prohibiting disability discrimination. All efforts should be made to work toward permanency for youth, including adoption. Special needs adoption subsidies are available and include Medicaid coverage. Even if permanency is not achieved, youth should not grow up in institutions. If you think a youth is not being provided with the services he or she is due as a result of having a disability, contact your state Protection and Advocacy (P&A) Office. Every state has a P&A Office. They are charged under federal law with ensuring that people with disabilities are treated fairly. They enforce disability laws. They can provide individual advocacy and legal representation. They are also empowered to investigate conditions and treatment in facilities. Find the P&A Office in your state.
2. Make sure youth who receive special education services and have Individualized Education Plans (IEPs) have an educational decision maker and a quality IEP, including a transition plan that includes goals in education/training, employment, and independent living. Only about 9% of youth with disabilities in foster care attend college. This rate is even lower than that of their peers in foster care. To find out more about identifying an educational decision maker for a foster youth or determining when there is a need for a surrogate parent, see this Foster Care and Education issue brief.
3. Make sure transition planning begins early for youth who will need supports and services past their time in the child welfare system. Many have compared the transition from child-serving to adult-serving systems to falling off a cliff. If you are working with a youth with disabilities, you need to know the difference between the health and service delivery systems for children and adults. Many supports for adults with disabilities are just services. Planning for a living arrangement and a funding source for that arrangement must be made. To navigate these systems, you must begin early to ensure that the eligibility for services and supports can be established. It is likely that you will have to build in time for waiting lists that are growing in most states.
4. Make sure all youth who were in foster care at age 18 know that they are eligible for Medicaid until age 26, effective January 1, 2014. The Affordable Care Act makes youth who were in foster care at age 18 and enrolled in Medicaid categorically eligible for Medicaid until age 26, regardless of income. While final regulations have not been issued, it is clear that this provision will be retroactive. It will thus apply to a large number of former foster youth who may not know of their eligibility.
To learn more about the provisions that apply to current and former foster youth: