The boy had been screaming for over an hour, and his foster mom was beginning to panic. She didn’t know what had sparked the attack, and already the neighbors were calling to complain about the noise. At this late hour, most foster parents would have no choice but to dial 911 and have the child rushed to a hospital.
Instead, the mother called one of the boy’s new caseworkers, an on-call specialist in emotional disturbances. Soon the worker arrived at her Bronx apartment, helped calm the child and put him to bed. The two women stayed up late discussing ways to help the boy beat his demons, a talk they would continue in their monthly meetings with his caseworker.
Kids who foster families find too tough to handle usually end up in institutional care—at the beginning of last year, nearly a quarter of the 26,199 children in state custody were living in group homes or specialized medical facilities. Despite an increasing emphasis on shifting care to a family setting, achieving permanency is rarely easy. By avoiding a lengthy hospital stay, the boy and his foster mother made an important step towards stability, according to Roslyn Murov, a child psychiatrist and medical director at Abbott House, a social services agency.
Abbott House is one of 10 agencies to participate in the first year of Bridges to Health, a state program that connects children in foster care to a rich array of health services, thereby improving their chance of finding permanent homes. The program targets children with disabilities and emotional trauma, who are at high risk of being institutionalized. “Many of our kids were already in foster homes, but their families were overwhelmed with taking care of them,” Murov said. “B2H has given us new choices for keeping kids in families.”
For the shapers of New York’s foster care system, helping children overcome emotional trauma increasingly means being there for the caretakers, too. Ten years ago, when Mimi Weber joined the policy team of the state Office of Children and Family Services (OCFS), she observed two ways the system was failing families. First, when a foster child was adopted or returned to his birth family he would lose his Medicaid, making it more likely that recurring problems would drive him back into state custody. Second, medical interventions tended to target the child exclusively, without taking into account the needs of adult caregivers.
Weber began consulting with the heads of child welfare agencies, pediatricians and child psychiatrists like Murov. All agreed that traditional Medicaid coverage of doctor visits and medication did not equip parents to deal with their charges’ complex problems. According to the American Academy of Child & Adolescent Psychiatry, some 30 percent of children in foster care have severe emotional, behavioral or developmental problems, often from years of neglect or abuse by their own parents. The consequences of early abuse are so complex that psychiatrists recently coined a new term for it, “developmental trauma.”
Weber describes the condition as a series of neurological gaps and tears, a condition more severe than the disorders frequently ascribed to foster kids: attention deficit, depression, anxiety, post-traumatic stress. “We think medication might be part of filling those gaps, but clearly it can’t be the only treatment,” said Weber. “We tried to think about serving the child and family in a holistic way, so the family understands how to treat the child.”
Launched during the brief Spitzer administration, Bridges to Health takes advantage of a waiver in federal Medicaid law allowing states to create community care for people with disabilities. The program started with 300 children from Rochester, Albany, and New York City, with the goal to reach 3,305 children statewide within three years. While some children have medical conditions like cancer or HIV, and others have permanent developmental disabilities, most fall into the category of severe emotional disturbance. In New York City, 182 of the 220 children currently enrolled in Bridges to Health are there because of emotional problems, says Jodi Saitowitz, who coordinates the program at ACS.
The program revolves around an individualized health plan that caseworkers devise in collaboration with children, their foster parents, and sometimes birth parents. The health plan can include up to 14 components, ranging from socialization training to an in-school advocate. Many offerings, such as 24-hour crisis assistance and planned respite care, help parents care for disabled children over the long haul. Critically, Bridges to Health caseworkers carry a maximum of six cases, far below the average 15 to 20 cases handled by most foster caseworkers. And because the goal is to support permanent family placement, children keep their benefits as long as they need them, up to their 21st birthday.
This mixed service model, combined with intensive home support for parents, is unique in the country. Think tanks are beginning to take notice: Weber and her team were recently invited to apply for an innovations award at Harvard’s Kennedy School of Government. Workers involved also report promising outcomes. Saitowitz recalled the case of one woman who was on the verge of giving up her foster son after his outbursts in school forced her to leave work for days in a row. Bridges to Health arranged for a special needs advocate to model appropriate behavior for the boy in class, and helped his mom and teachers devise a progress plan. The boy was able to stay with his foster family. “This program is about making personal connections in intimate settings, as opposed to handing parents an emergency number that connects them to some random stranger,” said Saitowitz, a former social worker. “We’ve been crying out for something like this for years.”
Such intensive services do not come cheap—Bridges to Health costs about $52,000 per child per year—but they are a bargain compared to the average $185,000 price tag for residential care. In addition, the federal government foots half the bill. Nonetheless, last August, amidst a darkening fiscal climate, the state proposed freezing the funding. “We were in disbelief,” said Weber. “The hardest part was telling families we might not be there tomorrow.”
OCFS protested that hundreds of children in the process of joining the program would have to be cut off. “Foster children are never number one on most funders’ priorities,” said Elizabeth Schnur, senior vice president at the Jewish Child Care Association, which is the largest Bridges to Health provider in New York City. “This is the first program in a long time that came around to make a huge difference in the lives of hundreds of children.”
A lobbying effort ensued, drawing on the support of State Senator Tom Duane and Assembly Member Micah Kellner, both of Manhattan. In December the governor’s budget restored Bridges to Health funding for 610 children, the original enrollment goal for this fiscal year. For the next two fiscal years, the state will spend $61 million on the program; assuming the fiscal situation improves, enrollment will resume sometime in 2011. The goal of reaching 3,305 children is now set for 2013, costing approximately $84 million.
Even if that goal remains steady—and the state’s budget health seems to decline every month—it falls short of the total need. Weber estimates that there are about 9,000 disabled foster children in New York who could qualify for the program. While service providers say they are grateful for the reinstated state support, Kellner and Duane continue to push for broader funding for up to 10,000 slots. “We can’t afford to leave the most at-risk kids out in the cold,” says Kellner. “It’s better to spend the money to help these kids now, as opposed to condemning them to a lifetime of isolation and institutionalization.”