I’ve been caring for at-risk children for three decades. Children enter foster care having already experienced abuse, neglect and other traumas, such as exposure to domestic violence.
These accumulated traumas can leave them with extensive behavioral and mental health needs. To heal, these children need regular and quality health care services.
But in many places, they do not have that option. When a foster family isn’t available, youth can end up living in residential facilities that house as many as 25 young people. Some of the highest-risk youth I care for are placed in these settings because they don’t have anywhere else to go.
Yet, many of them do not have a single medical or clinical staff person on site. Youth with significant health needs – everything from mental illness to epilepsy – have to wait months just for a full evaluation. Prescription drugs are given out by personnel with no medical training to assess side effects or understand appropriate doses. The lack of medical and clinical staff, especially after hours, frequently leads to the use of high-cost emergency room visits.
Surprisingly, there are no federal quality standards for treatment in residential facilities. Fortunately, there is a bipartisan bill in Congress to address this. The Family First Prevention Services Act of 2016 (H.R. 5456) requires that specially trained clinical and nursing staff be located at these centers during business hours, and available remotely 24-7.
The House passed the bill in June, and it is supported by more than 130 national and state groups, including the American Academy of Pediatrics.
However, some residential facility groups and policymakers in California are urging Congress to weaken these standards and other important provisions in the bill in the name of flexibility and reduced costs.
But lower standards would erode quality and safety and put children and teens at risk. Furthermore, the Congressional Budget Office says the proposed legislation is less costly than a “fix” proposed by the residential facility groups.
Unfortunately, the Senate did not advance the bill before going on recess. I hope that Sens. Dianne Feinstein and Barbara Boxer of California will support the legislation as written so the Senate can approve it without delay.
Children and teens in foster care are the responsibility of all of us, but too often forgotten.
Moira Szilagyi, a pediatrician in Los Angeles, is chairwoman of the American Academy of Pediatrics Council on Foster Care, Adoption and Kinship Care. She can be contacted at firstname.lastname@example.org.