Wednesday, December 28, 2011

A Medical Guide for Youth in Foster Care

A Medical Guide for Youth in Foster Care
New York State’s Office of Children and Family Services has released a 28-page booklet to guide youth in care through the health care system. The booklet covers informed consent, rights to privacy and to refuse medication, and information about how to get and pay for medical care. (2011)

Tuesday, November 29, 2011

Overmedication of Foster Youth - and Yes, the Drug Companies Are Making Money

Drugs Used for Psychotics Go to Youths in Foster Care
Carey, Benedict. New York Times, Nov. 20, 2011

Foster children are being prescribed cocktails of powerful antipsychosis drugs just as frequently as some of the most mentally disabled youngsters on Medicaid, a new study suggests.

The report, published Monday in the journal Pediatrics, is the first to investigate how often youngsters in foster care are given two antipsychotic drugs at once, the authors said. The drugs include Risperdal, Seroquel and Zyprexa — among other so-called major tranquilizers — which were developed for schizophrenia but are now used as all-purpose drugs for almost any psychiatric symptoms.
“The kids in foster care may come from bad homes, but they do not have the sort of complex medical issues that those in the disabled population do,” said Susan dosReis, an associate professor in the University of Maryland School of Pharmacy and the lead author.

The implication, Dr. dosReis and other experts said: Doctors are treating foster children’s behavioral problems with the same powerful drugs given to people with schizophrenia and severe bipolar disorder. “We simply don’t have evidence to support this kind of use, especially in young children,” Dr. dosReis said.

In recent years, doctors and policy makers have grown concerned about high rates of overall psychiatric drug use in the foster care system, the government-financed program that provides temporary living arrangements for 400,000 to 500,000 children and adolescents. Previous studies have found that children in foster care receive psychiatric medications at about twice the rate among children outside the system.

The new study focused on one of the most powerful classes of drugs, antipsychotics. It found that about 2 percent of foster children took at least one such drug, even though schizophrenia and bipolar disorder, for which the drugs are approved, are extremely rare in young children.

“It’s a significant and important finding, and it should prompt states to improve the quality of care in this area,” said Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University who did not contribute to the research.

In the study, mental health researchers analyzed 2003 Medicaid records of 637,924 minors from an unidentified mid-Atlantic state who were either in foster care, getting disability benefits for a diagnosis like severe autism or bipolar disorder, or in a program called Temporary Assistance for Needy Families. All of these programs draw on Medicaid financing. The investigators found that 16,969, or about 3 percent of the total, had received at least one prescription for an antipsychotic drug.

Yet among these, it was the foster children who most often got more than one such prescription at the same time: 9.2 percent, versus 6.8 percent among the children on disability, and just 2.5 percent of those in the needy families program.

Antipsychotic drugs, the authors said, also cause rapid weight gain and increase the risk for metabolic problems in many people, an effect that may be amplified by the use of two at once.

Doctors who treat such children are aware of the trade-offs and often prescribe lower doses of the medications as a result. And when they add a second such drug, it is often to counteract side effects of the first medication.

Still, the relatively high rates of these drug combinations in such a young and vulnerable group have prompted policy makers across the country to take notice. A consortium of 16 states, in collaboration with Rutgers University, has drawn up guidelines to improve care for foster children and others dependent on state aid.

“The psychiatrists who are treating these kids on the front lines are not doing it for money; there are very low reimbursement rates from Medicaid,” said Dr. Ramesh Raghavan, a mental health services researcher at Washington University in St. Louis. “There’s enormous anguish because everyone knows that this is not what we should be doing for these kids. We as a society simply haven’t made the investment in psychosocial treatments, and so we are forced to rely on psychotropic drugs to carry the burden.”

Tuesday, October 25, 2011

One-fourth of New York City foster youth age out immediately into homelessness

A Deal to Help Foster Youths Find Housing
Secret, Mosi. New York Times, October 20, 2011

New York City has reached an agreement on a proposed settlement of a lawsuit that claims the city allows older children to leave foster care only to become immediately homeless.

Each year, roughly 800 to 1,100 people age 18 to 21 are discharged from foster care to fend for themselves, the plaintiffs complained in the class-action suit.

There is no current data on the youths’ housing after foster care, but previously the city’s Department of Homeless Services and the City Council estimated that more than a quarter of youths discharged from foster care because of their age end up homeless almost immediately, according to the complaint, which accuses the city of shirking its responsibilities to those youths.

The city is required by state law to supervise and assist in providing housing for people who have left foster care until they reach age 21.

The accord calls for the city to maintain a unit in the Administration for Children’s Services for those people, initiate training for foster care agencies, revamp its procedures for helping youths find stable housing and improve their access to services.

The agreement is the product of two years of negotiations among the Administration for Children’s Services, the Legal Aid Society and the advocacy group Lawyers for Children. The parties said they had agreed to settle to avoid protracted litigation, and they actually reached the agreement before the lawsuit was filed in Manhattan Supreme Court on Monday.

The plaintiffs’ lawyers filed the suit to provide for court enforcement if problems develop down the road, said Pat Bath, the spokeswoman for Legal Aid. A judge has to approve the settlement before it goes into effect.

The four lead plaintiffs remain anonymous. Three are 21 years old and at risk of being homeless at discharge because they do not have stable housing lined up, according to the complaint. One is 20, has already been discharged and is at risk of becoming homeless, the complaint says.

“An alarming number of young people are being discharged from foster care into homelessness,” Tamara Steckler, the lawyer in charge of the juvenile rights practice at the Legal Aid Society, said in a written statement.

Ronald E. Richter, the commissioner of the Administration for Children’s Services, said in a written statement, “We are committed to helping young people leaving foster care achieve successful adulthood, which includes appropriate stable housing.”

Under the accord, the children’s services agency will develop permanent housing plans for youths living in foster care. It will work with foster care agencies to create the plans in time to find adequate housing. The city and the agencies will monitor the young adults discharged under the plans until they turn 21.

Children’s Services will also track and monitor data on their housing until they turn 21.

Also, a new unit in Children’s Services will oversee the foster care agencies’ adherence to the new requirements.

New York foster youth "aging out" into homelessness

Deal reached to help older foster care children
Associated Press, October 21, 2011

NEW YORKNew York City has reached an agreement on a proposed settlement of a lawsuit that claimed it allowed foster care children to fall into homelessness after leaving the system at age 18.

The lawsuit said the Administration for Children's Services failed to abide by state laws that mandate children be prepared for independent living when they leave foster care.

The agreement calls on the ACS to maintain a special unit for children who turn 18. It also calls on the ACS to initiate training for foster care agencies, update its procedures for helping youths find stable housing and improve their access to services.

The agreement was reached after two years of negotiations among the ACS, the Legal Aid Society and the advocacy group Lawyers for Children.

Sunday, October 2, 2011

"Aging Out" of foster care - and into a harsh, new world

The "Aging Out" Dilemma Plaguing the Foster Care System
Baccaglini, Bill. Executive Director of the New York Foundling.
Huffington Post, September 25, 2011.

Imagine that because you've been abused or neglected as a child, you've spent the first 21 years of your life separated from your biological family, bouncing from one foster home to another and changing schools every few years. At 21-years-old, you have never paid rent, bought your own groceries or managed your own expenses.

With an education that's spotty at best, and no family or other support systems in place, you're told that you're now an adult and responsible for functioning in the world on your own. Would you be able to do it?

That is precisely the situation facing many young adults who age out of our child welfare system. And while outgoing ACS Commissioner Mattingly did a tremendous job on many fronts, he would probably agree that the "aging out" population is one that still requires urgent attention. As new Commissioner Richter takes over the agency, this would be an excellent time to take a fresh look at how we serve - or fail - these young people.

While local statistics are hard to come by for a population no longer under the city's care, nationally, one in four of the 20,000 foster care youth who age out of the child welfare system each year are incarcerated within two years; one in five become homeless, only half graduate from high school. With more than 900 young people aging out in New York each year, these numbers reflect a real problem.

Under the current system, when young people in foster care turn 21, they have the rug pulled out from under them.

They must sink or swim. But if they sink, we all pay a price. Unable to manage on their own, with none of the support systems in place that we all take for granted, all too often, they end up homeless, or turn to drugs and crime - all of which take a toll on government budgets and the quality of life in our communities.

Because of their life experiences some kids need more support than others - and they may need it for longer. A 21-year-old who has lived most of his life in either the child welfare system or a dysfunctional family setting is not at the same level emotionally or cognitively as other 21-year-olds. And as every parent knows, you can't set an arbitrary schedule for maturity.

As nervous as we may be to send our own children away to college, for example, we recognize that we could not have gotten them more ready simply by training them better or earlier. Most of the kids we're talking about are not going away to college; they may not have graduated high school. There are no teachers or mentors or parents they can call when run out of money or get into trouble. They're on their own and, for many of them, 21 is simply not old enough. And no amount of training or better programming by the child welfare system could have hastened their readiness. Because of their many pressing needs and challenges, they have not been the beneficiaries of structured or guided exposure to life experiences that naturally facilitates the maturation process.

What's the solution? First, we need more and better programs to prepare these kids for life on their own. Once they are on their own, they are likely to still need help with housing, jobs and enrolling in some form of academic or vocational higher education. They may also need social work or mental health assistance to deal with issues like parents coming out of prison or siblings with drug problems. For those kids, providing this kind of support until age 23 could mean the difference between a productive life and a life in the corrections system or a homeless shelter. These age appropriate programs that work beyond the system are a very good investment indeed.

At the same time, we need to make it clear that this support for young adults is temporary, and that the recipient must ultimately bear responsibility for his or her own success. These young people must stay enrolled in school and hold a job, even if part time. There must be high expectations, no free rides, and a path toward independence in a relatively short term.

For Hispanic youngsters today, we're seeing particular challenges, at least partly due to changing immigration trends. Many young immigrants, coming here from a variety of countries, do not have the generational, family and community support that has existed for previous immigrant groups. Whatever extended family they may have to fall back on may already be stretched thin. Combine lack of family with language barrier and overall cultural differences, and that child is at even greater risk.

Critics may argue that at some point we need to stop supporting these kids and cut them loose, and that 21 seems like a logical age. After all, we spend hundreds of thousands of dollars on each of these kids up until that point - When is enough enough? If release from the child welfare system is no more than a path toward a homeless shelter or a jail cell, what have we accomplished? If by creating short term programs to teach the necessary skills prior to turning 21 and by providing some additional support for a limited period of time afterwards, we can put that young adult on the path to a successful productive life. Isn't that worth it?

Thursday, September 15, 2011

Aging out of NY foster care system into homelessness

Many Foster Children End Up Homeless: Report
Flanagan, Jenna. WNCY, September 8, 2011.

New York is not doing a good job preparing its foster children for the workforce, charges a new report.

The report from the Center for an Urban Future found that one in 10 youths in New York City who left foster care in the mid-2000s entered a homeless shelter within a year. Within three years, that number doubled to one in five.

"These young people go from being official wards of the state as part of the foster care system to adult wards of the state," said Jonathan Bowles, executive director of the center.

The report showed that as many as half of the roughly 1,000 young people who aged out of the city’s foster care system failed to obtain and hold onto jobs.

Bowles said many foster care agencies are failing foster kids due to their scant connections with employers.

"We're at a time now when skills and higher education are becoming more important than ever and so many of these young people are being further and further behind," Bowles said.

Bowles has called on incoming commissioner Ronald Richter to focus on strengthening workforce readiness for young adults leaving foster care in the city.

Tuesday, September 6, 2011

Overcoming Hurdles to Employment for NY Foster Youth

Job Hurdle After Foster Care.
De Avila, Joseph. Wall Street Journal, Sept. 6, 2011.

Even as the unemployment rate for New York City teens remains stubbornly high, a new report finds one group of young people faces especially tough odds: the city's foster children.

Only about half the young adults who leave the city's foster system are able to find work, estimates the report that examines joblessness among current and former foster children. Young people still in the system also struggle more than their peers to find jobs, the report by the Center for an Urban Future found.

"There is a lack of both a preparatory system that simulates and substitutes for what kids get from their parents and a lack of a safety net for young adults going out in the work force," said Tom Hilliard, the report's author.

Cordale Manning, 19, spoke to a manager at Champs Sports in Times Square who told him to submit an online application. Mr. Manning was 12 when he and his older brother were placed into foster care. Since then, he has lived in five different homes.

Prior to the recession, the unemployment rate for all teens in New York City between the ages of 16 and 19 was just under 20%, according to the report by the Manhattan-based think tank. By the end of 2010, that rate shot up to 40%.

Neither the city nor foster-care agencies track how many teens and young adults in the system find employment, Mr. Hilliard said. But his research among foster-care professionals in New York appears to show that about half the 1,000 young people who age out of the system every year, typically at age 21, find jobs.

As of 2010, there were about 16,000 children in the city's foster system, and about 2,000 of them were older than 18, according to the report.

The report comes amid a $127 million initiative launched by Mayor Michael Bloomberg to aid Latino and black men between the ages of 16 and 24. The three-year program will include mentoring and literacy services and efforts to boost employment.

Cordale Manning, 19 years old, said he thought having a stable foster home in the South Bronx instead of bouncing from home to home would help him hold onto a job. Instead, he was laid off earlier this year after two months stocking groceries at a Manhattan store.

Mr. Manning was 12 when he and his older brother were placed into foster care. Since then, he has lived in five different homes.

After losing his job, he's applied to about 10 retail positions and hasn't been called for any interviews.

"When I turn 21, I'm worried about if I'm going to be able to hold my own," Mr. Manning said. He's enrolled in vocational school learning how to repair computers. "I'm really kind of anxious about it because I don't know what's going to happen."

Mr. Hilliard said even children with stable foster homes often have missed out on the years of financial, educational and familial support that readies a young person for a working life and can shore them up during their first unsteady attempts.

He said the city Administration for Children's Services, which manages most aspects of the child welfare system in New York City, has spent much of its efforts in recent years on family reunification and preventive services, he said.

Mr. Hilliard called that mission vital but said older foster children are no longer a top priority of the agency. He pointed to the agency's elimination of the Office of Youth Development in 2008, which worked mainly with older foster children to help them ease into independent life.

"ACS will continue to collaborate with the public and private sectors to make stable employment a reality for our young people," said an ACS spokeswoman in a written statement. "Through the Mayor's Young Men's Initiative, for example, the city is expanding evidence-based employment programs...These programs have been successful in helping young people, particularly those with limited or no work experience, connect to work and increase their earnings."

The economic downturn has made employment in New York increasingly competitive for young people who rely on retail and food service jobs, said Courtney Hawkins of F.E.G.S. Health and Human Services Systems, which runs a program that prepares foster youths for the work force. Many of those jobs now require high-school diplomas or GEDs, while many of the working-age youths whom her group assists have fifth-grade reading levels, she said.

"You end up seeing 20- and 21-year-olds who have never had a job before," Ms. Hawkins said.

Emotional problems and anger issues that affect some foster children mean they end up getting fired once they do become employed, said Jane Golden of the Children's Aid Society, which provides foster care and other services.

"There is no quick fix for fractured relationship-building skills," Ms. Golden said. "It's a long haul."

Marcia Wilson, 21, recently aged out of the foster care system and credits her good attitude for the success she's had.

"Every teen that I've known, they had jobs," Ms. Wilson said. "It's a matter of keeping the jobs before you age out of care."

Ms. Wilson says she has had influential social workers who have helped her along the way. She also wants to be a good role model for her younger brothers who are 19 and 18. Neither have jobs, but both are still in high school, she said.

Later this month, Ms. Wilson will start a six-month fellowship working at an investment bank. She also recently got her own apartment in Harlem and is enrolled in community college and wants to get a degree in political science.

Kevin Peterson, 20, of Staten Island, is preparing to move out on his own in January, when he turns 21. He has an apartment lined up through the New York City Housing Authority but worries about finding a job. Earlier this year, he was fired from a pet store where he worked for three months after he says he mistakenly stocked a product that had expired.

"I always had a dream of having a job that I can stick with," said Mr. Peterson, who has been in foster care since he was 11. "I'm just having trouble right now."

Mr. Peterson eventually wants to become a firefighter. But now he's been applying to retail jobs to have steady income by the time he moves out of his foster parents' home.

"I'm going to need a job," Mr. Peterson said. "I don't want to have to live off public assistance."

Out of Foster Care -- and Into What??

Out of Foster Care -- and Into What?
Miller, Marissa. Gotham Gazette, Aug. 2011.

Anthony Boyd, 22, Armstrong Pelzer, 26, and Joseph Branca, 22, all attend college, have part-time jobs and live at Schafer Hall, a supportive housing facility for former foster children in East Harlem.
When Chimore Mack Glover recently turned 21, she aged out of the New York City foster child program and so needed a place to live.

"I usually plan things ahead of time, and my first step was to get a job and find a place to live," she recalled recently. She tried to stay with family members, but one turned her down, Her grandmother was sick and so could not help. "It was also very scary because I didn't know if my foster care agency was going to help me or not," said Glover.

Despite all that, Glover now says she is doing well -- living on her own and working part time. She dreams of being a journalist some day, saying, "My grandmother always told me to chase my dreams. I love to write. It’s an outlet. If I am going through something, I will just write it down. Then I’m relieved and I’m not stressed. "

While things may have worked out well for Glover, every year hundreds of young adults must adapt to life after foster care-- and a number do not succeed. For many the transition presents a huge challenge, and though programs exist to help, they cannot aid all the young people who need it.

On Their Own
There are currently 16,000 children in the foster care system throughout New York City. Of them, about 1,100 leave the system each year, according to In Transition: A Better Future for Youth Leaving Foster Care, a report published in the New School’s Child Welfare Watch.

The majority attempt the transition to independent living on their own. Most lack any type of a strong support network. Not surprisingly, for these young adults, the transition to the "real world" abounds with financial, physical and emotional hardship.

Child Welfare Watch and an internal city review have found that about 15 percent of young adults who age out of foster care end up in the homeless shelter system within two years of their initial discharge.

"In extraordinary numbers, children who age out of the foster care system end up homeless, incarcerated or both in a brief time period," said Topher Nichols, the communications manager at Children’s Village, a New York-based organization devoted to professional and educational development for troubled youth. "When we really look hard at our own experiences as young adults, how many times we called home because we were a little short on rent or because we made a silly mistake and needed support, we have to recognize that most of us don't become successful on our own. We have a network of people who support us and take care of us. This is a critical piece missing from the lives of most youth aging out of the city."

The one-time foster children also do not have the same opportunities as many young adults, especially when it comes to education, employment and housing, which are all connected, said Kim VanBurch, coordinator of youth development at the Vincent J. Fontana Center for Child Protection. "If they don't have an education, then they can't find employment, and if they can't find employment then they won't be able to secure housing," VanBurch said.

Preparing for the Big Change
The foster care agencies -- private organizations under contract with the city to place children in appropriate homes and monitor their care -- are supposed to prepare the children under their auspices for life after foster care, said Elysia Murphy, the deputy communications director at the city's Administration for Children's Services.

"Prior to leaving care, foster care caseworkers work with adolescents to develop plans in preparation for their discharge from foster care. Agencies are expected to set developmentally appropriate expectations that encourage youth to achieve their highest potential in their careers, educational and personal lives and to enable youth to plan responsibly for their own needs," Murphy said.

Advocates, though, say many agencies don't start this preparation until a few months before the youth is slated to leave the foster care program. This leave the young adults, some of whom suffer from mental illness and emotional instability, with few resources to turn to when trying to find a place to live and a source of income.

"In the vast majority of cases meaningful transition planning by the agencies responsible for a young person in foster care ... occurs, if at all, in a last minute scramble in the months before the adolescent is to leave foster care," said Glenn Metsch-Ampel, the deputy-executive director of Lawyers for Children. "More often than not, without the intervention of their advocates and the court, these young people are faced with the prospect of leaving foster care without truly stable housing, employment or a connection to a caring adult in their community."

To add to the difficulty, the Administration for Children's Services has suffered budget cuts over the past few years that affect its ability to handle issues confronting the city's low-income youth.

"ACS has just had budget cut after budget cut, and its internal operation services have really fallen apart. Without there being strong support inside the agency, it just means those services become vulnerable and haphazard. That means that foster care agencies do not deliver services with the same consistency," said Abigail Kramer, the associate editor of Child Welfare Watch. According to research published in Child Welfare Watch, the number of families participating in preventive service programs, which help children in foster care and neglectful or abusive homes, has dropped by 30 percent decline since 2009.

Murphy, though, denied budget cuts have had an effect on transition programs. "Despite the difficult decisions made in the past two years to reduce agency spending in response to the financial climate, the agency has been able to sustain funding to support services for youth in foster care as they make the transition into adulthood," Murphy said.

Bridging the Gap
Both New York City social workers and government officials have recognized that many young adults aging out of foster care are not adequately prepared to enter into independent living without any familial or professional support network.

In 2005, the city and the state created the New York/New York III program. According to Child Welfare Watch, it provides funding for about 400 young adults who have aged out of foster care. Many of the supportive housing programs receive New York/New York III funding and thus, are able to support their residents. However, there is still a huge population of young adults leaving foster care who are left with very few options.

In the past decade, government officials, philanthropists and non-profits have created transitional housing programs. These support programs not only house young adults who have aged out of the system (at 21 in New York though they can leave at 18), but also provide them with the life skills training, academic and professional advice, and counseling to help them achieve stability in their own lives.

In the past 10 years, eight non-profits have cooperated with city agencies to establish various supportive housing programs scattered throughout the five boroughs. Most of them receive funding from a combination of private donations, and city and state programs, such as the New York State Supportive Housing Program and the New York City Department of Health and Mental Hygiene.

Sharp cutbacks to Section 8 housing vouchers and the elimination of the Advantage program, which provided rent subsides for homeless families, has severely limited the housing options for these young adults and homeless people alike. These cuts make transitional housing programs an even more important safety net for young adults coming out of foster care.

Inside Supportive Housing
In 2001, Schafer Hall became one of the first supportive housing programs established in New York City. Located in East Harlem, Schafer Hall is one of the many housing developments run by the Lantern Group, a non-profit committed to the construction and development of permanent, special needs housing.

Schafer Hall was created to help young adults acquire the independent living skills necessary to achieve a stable lifestyle. Each resident lives in one of 25 studio apartments where he or she learns how to prepare meals, maintain a clean living space, do laundry and budget their money along with other basic skills. The residents also meet regularly with on-site caseworkers and tutors who help them make decisions about their education -- obtaining a GED or working toward an associate's and bachelor's degree -- and employment.

"Our young adults are incredible bright, strong, and resilient individuals," said Jessica Katz, the executive director of the Lantern Group. "They just need to learn the necessary life skills."

The young adults living at Schafer Hall must have some source of income and use 30 percent of it to pay their monthly rent. This teaches them how to balance a budget and set aside a portion of their monthly income for their housing needs.

Many of the other supportive housing programs in the city-such as Chelsea Foyer and the Lee also charge their clients rent and encourage the residents to seek stable employment, as opposed to welfare, as their primary source of income.

The young people, many whom leave foster care without a college degree or even a high school diploma, have limited job prospects, particularly in this economy. Despite that, Schafer Hall currently has an 85 percent employment rate amongst its residents.

For many individuals living there, Schafer Hall offers an escape from the tumult of their foster homes. "I enjoy my home being a stress-free environment now. I'm not really territorial, but I know in my head that this is my house and no one is stressing me out. I don't have to worry about that living here, and that is good enough for me," said Anthony Boyd, a 22-year-old resident, who attends Queensboro Community College and works at a human services organization.

Joseph Branca, also 22, has been in foster care for 13 years. He now lives at Schafer Hall, works as a shift manager at Duane Reade and attends Medgar Evans College in Brooklyn. "I want to give back to the community," he said. "Since I grew up in foster care, I feel like I can."