A child who needs routine medical treatment goes to their primary care doctor. But what happens to children who need routine mental health treatment? Kids in the care of the Department of Children and Family Services, who are more likely to need preventative mental health care than other children, do not have access to this support.
Youth in DCFS care undergo an initial mental health screening but do not receive routine mental health care. State Rep. Stephanie Kifowit, D-Aurora, says the state provides care only in crisis, and that needs to change.
Kifowit introduced HB 4306 this year to address the mental health crisis and put more prevention efforts in place for 23,000 foster kids in Illinois. Her proposal would ensure that a mental health care provider is assigned to every child in the foster care system, in addition to the primary care doctors they see for checkups.
“If we're proactive, we develop a relationship with that child that they trust. Then, if something down the line happens where there's a trigger or they are in crisis, we already have an established relationship,” said Kifowit.
Opponents of the bill say that not all kids in foster care need mental health treatment. While it’s true that not all youth in care have a mental illness, Cook County Public Guardian Charles Golbert said just being in out-of-home care results in childhood trauma.
“You had to have been taken away from her parents due to abuse, neglect, or abandonment or sex abuse. So by definition, if you're in DCFS care, you've come through a very substantial trauma,” Golbert said.
Removal from the family home is among the many traumatic events classified as an Adverse Childhood Experience, or ACEs. ACEs can affect brain development if not addressed early on, and experts say the more ACEs a child experiences, the more likely they are to develop mental health issues.
Medicated in foster care
Golbert believes children in the foster care system are overmedicated to keep them calm, though data on this claim was not provided. Golbert says prescription drugs are cheaper for DCFS than providing behavioral psychotherapy.
According to the 2017 Illinois Child Well-Being Study, conducted by the Children and Family Research Center at the University of Illinois, psychotherapy drug use among foster kids in Illinois fell below both the national average and the rates reported in Illinois in past years.
The medication usage in foster care is self-reported by caregivers rather than prescribers.
The U of I study showed 20.7% of children in Illinois’ foster care system were prescribed one or more psychiatric medications. The likelihood of being prescribed medication increased as a child got older. But it also increased with the number of other children they live with in a congregate setting.
Kyle Hillman, president of Illinois’ chapter of the National Association of Social Workers, does not believe that overmedication would be an issue if neurodiversity in children is identified early.
“One of the best ways that we can prevent some of that from happening is just to address it early. If we can deal with depression before it manifests into something that materializes into attempted suicides or cutting or some of the more violent elements of it, we can avoid some of those outcomes … I don't want to see suicide rates go up. I don't want to see kids cutting themselves go up,” said Hillman.
The General Assembly has mandated a new report on medication usage in foster children, which is set to come out later this year.
However, many children who need to be in mental health facilities cannot get access to the critical services, according to former DCFS chief of operations Deb McCarrel.
Here’s the problem, according to McCarrel: Without mental health treatment for kids in foster homes, children who need treatment are more likely to be escalated to group homes or residential treatment. Likewise, without room in foster homes for children who need regular mental health treatment, advocates say neurodiverse youth in care occupy residential or hospital beds without a plan for stepping down.
McCarrel explained the process of “stepping down,” when a child is in DCFS care. Children with the highest need are in a psych hospital, and they step down to residential care when they are able. After residential treatment is finished, the child would ideally step down to be in a foster home placement. But, McCarrel said, this system is easily clogged.
“If I’m a 16-year-old girl who nobody wants in a home, I’m just sitting in residential care. That means that the kid in the psych hospital has nowhere to step down to. So you’ve got this cascading problem,” McCarrel said.
This lack of everyday mental health care also affects kids who are not in the system.
Michelle Trager is a mom from Montgomery, a Chicago suburb. Trager has an adoptive son who struggles with mental illness. Trager's son was only able to get into residential treatment after being charged by the Illinois Department of Juvenile Justice, which found him a danger to himself and others.
Trager says her son is neurodiverse, not a criminal. But residential care can only be accessed through certain channels like DCFS or IDJJ.
The facility Trager looked at reserves 95% of beds for DCFS youth, leaving the other 5% for justice system referrals and kids with private insurance.
“The facility said, No, we have too many kids on the DCFS waiting list, and the waitlist can be six to 12 months. So this is a really important fact is that there's a very limited number of residential treatment facilities in this state,” said Trager.
Other legislation
If Kifowit's bill were to pass as initially filed, it aimed to ease the DCFS blockage and make room in care for neurodiverse kids across the state. However, it failed to win enough support in the House Mental Health committee.
Kifowit has since filed an amendment, which replaces the bill with language to create the Holistic Mental Health Care for Youth in Care Task Force.
This bill isn't the only one focused on the mental health of Illinois children. State Sen. Meg Loughran Cappel is sponsoring SB 3889, which would establish the Children Mental Health Council to create safety plans for children who need residential care.
The bill would create blueprints for crisis care before a child is in crisis. Loughran Cappel has worked with Trager, the state’s board of education, DCFS, and others to potentially create this council to evaluate residential care and treatment pipelines.
Loughran Cappel's bill has passed the Senate. Kifowit's bill is waiting to be read on the House floor, as amended.
Despite differing ideas of how to approach mental wellness, everyone seems to agree on one thing. As Kifowit said:
“If you have a trusted physician that sees your children once a year for physical, to make sure their weight and their you know, their eyes and the reflexes and everything is fine, why don't we do that for mental health to just have a quick, you know, physical checkup that says, How are you doing? How are things going?”
DCFS has been contacted six times over the past three weeks for comment on these bills and has not responded.
