Children who have experienced child welfare involvement are among Arizona’s most vulnerable populations with many having experienced significant trauma from neglect, domestic violence, physical and/or sexual abuse.
The very act of being removed and placed in foster care is traumatic, because it means the loss of their birth family, their friends, their home and everything that is familiar to them. We know from experience that children placed in foster care as well as their families need access to urgent and timely routine behavioral health services.
Through our foster care journey these past 11 years, my husband and I have witnessed behaviors developed out of the need for survival, which in the past helped protect these children from the neglect or abuse that they were experiencing. Presenting challenging behaviors can include distrust, increased aggression, acting out, depression, nightmares and night terrors, as well as regressive behaviors. We know that healing can come with time and patience; however, finding the expertise and help from trained professionals should be the first call that we make after placement or as needed post-adoption. These professionals can provide the children in our care the tools, coping skills, support, nurturing and guidance that they need. As caregivers, it is crucial that we receive the therapeutic interventions and in-the-moment skills needed to help us develop and enhance our parenting skills. Every child is different and they will each require individualized service plans for their particular needs.
We’ve all heard that knowledge is power; as one of the moms that helped author Jacob’s Law, and as the former Foster Care Community Liaison for AHCCCS, I hope to provide you with the necessary knowledge to assist you in addressing the needs of your children. There are laws, resources and supports that were implemented to assist the thousands of families who willingly open their hearts and homes to children who may be suffering from mental health issues. You have a critical role to play in their life. Not only are you responsible for their day-to-day care but you must also be their voice. Because they entered foster care, because they became wards of the state, they are now entitled and eligible to receive a variety of supports and speedy access to behavioral health services. It is not only our job to be their voice, but also our duty to become strong advocates on their behalf.
Medicaid-insured children:
Foster children are eligible for medical and dental care, inpatient and/or outpatient behavioral health, and other services. Medical services are provided through the Comprehensive Medical and Dental Program (CMDP), Behavioral Health services are provided by the Regional Behavioral Health Authorities (RBHAs) and some children with complex health care needs receive integrated medical and behavioral health services through Children’s Rehabilitative Services (CRS). Adoptive children are typically AHCCCS eligible and enroll in a health plan to receive medical services, they are enrolled through the RBHA to receive behavioral health services and some children with complex health care needs are enrolled through CRS. In just a few months, our Medicaid system will be changing to integrated care. Starting October 1, 2018 all adoptive children will be enrolled with one health plan that will provide both medical and behavioral health services. The following expectations are for all foster and adoptive children (referred to on Jacob’s Law as Title 19 eligible children) as well as all children who are currently enrolled in Kids Care (referred to as Title 21).
Requesting and receiving Behavioral Health (BH) Services in a timely manner:
When a foster child enters care, there should be an evaluation done by Rapid Response within 72 hours. If you feel that there is an urgent need or if 72 hours have expired, caregivers now have the ability to call the Dedicated Foster Care Hotline to request the evaluation. The law states that the clinicians need to be in your home within 2 hours from the time of your request. Rapid Response clinicians will triage any crisis or trauma-related issues. The evaluation will include screening for developmental delays, support to the child as well as the foster family and they will make an immediate referral to a behavioral home agency (health home) by connecting the family to receive an assessment for ongoing services. By law, the child will need to be seen within 7 calendar days. It is at this appointment that the assessment will be made, and a referral will go out for behavioral health services. It is expected that for the first six months of CMDP enrollment, a child has a minimum of one BH service per month. The service should ideally include provider oversight, needs assessment, and tracking for developmental or behavioral health changes. This monthly service will allow the team to provide appropriate and quality health care services for children in foster care should the need arise.
If your child has been in foster care and does not currently receive early intervention and/or BH services, the caregiver can call any AHCCCS covered behavioral health agency to initiate services. If you have an adopted child and you would like to initiate BH services you can call a behavioral health agency to initiate services.
Whether it’s a brand new foster child, a current foster child or an adopted child, when requesting an assessment for services, the appointment must be provided within 7 calendar days from the time of your request. If you experience difficulties, please call your assigned RBHA or AHCCCS for assistance in obtaining a timely appointment.
It is during this assessment that the team will determine what services are appropriate and necessary to meet the need of the child. Referrals will be sent out after you leave their office and it is the case manager’s responsibility to ensure that the services that have been identified in the service plan are initiated within 21 calendar days. If providers are at capacity and they are unable to find a clinician to provide the recommended service prior to the 21 calendar days expiring, it is the case manager’s responsibility to call the RBHA Children’s Liaison to ask for their assistance in finding a provider. AHCCCS policy states that wait lists are prohibited. The RBHA has the ability to look at their entire network to find a provider who can meet your child’s needs. If the 21 calendar days have expired the caregiver now has the ability to go out of network and use their own provider. The provider will be reimbursed at 130 percent of the AHCCCS Fee for Service Rate or the provider standard service rate, whichever is less. AHCCCS is the largest insurer in our State with over 1.64 million members and they have over 60,000 registered providers. To initiate and secure services with an identified provider, the caregiver will need to notify both AHCCCS and the assigned RBHA.
Timelines and contacts have been listed on the table found here. Should you need additional help in Navigating the BH system, to read Jacob’s Law in its entirety, to take a Jacob’s Law Training or to learn more about our soon to open Community Center in Mesa, please visit us at www.ASANow.org.
Please take a few minutes to read through the following flyers which I assisted in creating. The second link will provide you with your assigned RBHA’s contact information.
https://azahcccs.gov/Members/Downloads/Resources/BHSChildreninFosterCarebilingual10-2017.pdf
https://www.azahcccs.gov/AHCCCS/Downloads/NoWaitList_06182018_English.pdf
https://www.azahcccs.gov/AHCCCS/Downloads/ChoiceInHCdecisionsFlyer.pdf
https://www.azahcccs.gov/AHCCCS/Downloads/Grievances_in_the_Childrens_System_Dec2017.pdf
https://www.azahcccs.gov/Members/Downloads/Resources/FosterCaregiverFAQs-FINAL10-04-2017-ENGLISH.pdf
With much love and appreciation for all that you do,
Anika Robinson
ASA Now President
