Expanding Access to Home-Based Behavioral Health Services for Children in Foster Care

Excerpt

By age five, Rosie D. had suffered traumatizing physical and sexual abuse and lived in at least eight foster care (FC) placements. At six, when most children enter elementary school, Rosie entered a 3-month psychiatric hospitalization followed by back-to-back placements in residential facilities for exhibiting aggressive and self-injurious behaviors. Her foster parents sought intensive, home-based behavioral health services (HBHS) so Rosie could live safely at home, but their efforts to obtain such services failed. Instead, Rosie spent her formative years living in hospitals and institutions. In 2001, Rosie D. became the lead plaintiff in a class-action lawsuit against the state of Massachusetts on behalf of thousands of Medicaid-eligible children with serious emotional disturbance. In 2006, the court ruled Massachusetts in violation of federal Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) provisions, which require that children receive medically necessary behavioral health services, including home- and community-based services. In response to this court decision, Massachusetts implemented a remediation plan increasing access to HBHS, with the hope that children like Rosie get a chance to grow up at home (Ponsor, 2006). …