BILL ANALYSIS �
AB 1790
Page 1
Date of Hearing: April 22, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 1790 (Dickinson) - As Amended: April 9, 2014
SUBJECT : Foster children: mental health services.
SUMMARY : Requires county mental health plans to take steps to
increase the pool of specialty mental health providers to meet
the needs of children formerly in foster care who have been
adopted or placed with a guardian. Specifically, this bill :
1)Requires the Department of Social Services (DSS), county
adoption agencies, and licensed adoption agencies, prior to
the finalization of an adoption, to inform the adoptive
parents of the importance of working with mental health
providers who have specialized adoption training and
experience, should they require those services in the future.
2)Requires the entities described in 1) above, when filing a
homestudy report with the juvenile court prior to releasing a
child for adoption, to describe in the report whether the
prospective adoptive parents have been provided with
information regarding the importance of working with mental
health providers who have specialized adoption training and
experience, should they require those services in the future.
3)Requires the courts to determine whether or not prospective
adoptive parents or guardians have been informed of the
importance of working with mental health providers who have
specialized training and experience, should they require those
services in the future.
4)Requires the county mental health plan where an adopted child
who is eligible for specialty mental health services resides,
to take steps to increase the pool of specialty mental health
providers who meet all of the following criteria:
a) Completed requisite education and obtained all necessary
licenses required by law; and,
b) Completed, and can provide documentation of, a minimum
of 48 hours of training from an evidence-informed
post-graduate adoption or permanency training program,
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continuing education courses or individual workshops that
cover the issues most frequently encountered in adoption,
such as separation and loss, and knowledge of specialized
techniques for addressing common problems.
5)Requires DSS to convene a stakeholder group comprised of
adoptive parents, representatives from the mental health and
child welfare fields, and others, as appropriate, to
facilitate the development of a process to approve curricula
and determine criteria for trainers, and to facilitate the
establishment of a process by which mental health
practitioners document adoption and permanency training and
experience that satisfies the criteria set forth in 4) above.
6)Makes various findings and declarations and states the intent
of the Legislature to increase stability of adoptive and
guardianship families by increasing the pool of adoption and
permanency competent mental health professionals.
EXISTING LAW :
1)Establishes DSS to serve, aid, and protect needy and
vulnerable children and adults in ways that strengthen and
preserve families, encourage personal responsibility, and
foster independence.
2)Provides that a foster child whose adoption is final,
receiving or is eligible for Adoption Assistance Program
assistance, including Medi-Cal, and whose foster care court
supervision has been terminated, will be provided medically
necessary specialty mental health services by the local mental
health plan in the county of residence of his or her adoptive
parents.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, most children
enter foster care with traumatic histories caused by abuse and
neglect and most suffer multiple losses within foster care -
separation from siblings, friends, and neighbors. Despite the
increase in the numbers of children achieving permanence
through adoption and guardianship, placement of a child into a
stable and motivated family is not considered sufficient to
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compensate for psychosocial problems related to prior trauma
and chronic maltreatment. The author states as the number of
adopted children with significant developmental and emotional
issues surrounding their adoption experience has grown, the
need has increased for child welfare professionals and
clinicians with an in-depth understanding of adoption and
permanency issues and the skills to work effectively with
adoptive persons and their families.
2)BACKGROUND . In May of 2011 a coalition of leading child
welfare organizations, including the Child Welfare League of
America, the North American Council on Adoptable Children, the
Dave Thomas Foundation for Adoption, Voice for Adoption, and
many others, participated in a Congressional hearing on the
need for post-adoption services and recommended policy
reforms. One of the recommendations to come out of that
hearing was to ensure that services offered to adoptive
families embrace best practice and are provided by
adoption-competent professionals.
According to the federal Department of Health & Human Services
(HHS) Children's Bureau, quality mental health services are
difficult to find for the general population, as demonstrated
by the efforts of a number of national groups that have sought
to improve access, quality, and availability of child and
family mental health services for decades. Qualified
adoption-sensitive mental health professionals are even more
difficult to find, and families typically visit many providers
before finding one that can truly understand and meet the
needs related to adoption, i.e., separation and loss. HHS
notes that these families often find themselves in the
position of having to teach therapists about the basic issues
of adoption such as trust, loss, rejection, and divided
loyalties.
In order to address these issues, HHS recently put out a funding
opportunity announcement to establish a National Adoption
Competency Mental Health Training Initiative (Initiative) that
will build the capacity of child welfare professionals and
mental health practitioners that serve youth moving toward
permanency through adoption or guardianship, as well as youth
already moved to permanency in adoptive or guardianship homes.
The Initiative is intended to improve the outcomes for the
children moving to adoption/guardianship as well as providing
support and the appropriate therapeutic interventions to
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assure stable and secure post permanency experiences for these
youth.
The Initiative will build on previous adoption competency models
and complement existing initiatives aimed at strengthening the
capacity of child welfare staff and mental health
practitioners serving the population of the children/youth
with goals of adoption /guardianship, as well as those already
in adoptive/guardianship homes. This funding opportunity
provides for a five year cooperative agreement that will
include the following activities:
a) Assess existing Adoption Competency Mental Health
Training Curricula and identify gaps in critical
competencies;
b) Select, adapt, and deliver state of the art curricula in
a Web-based format for both child welfare staff and
curricula for mental health practitioners;
c) Deliver technical assistance on the Web-based training
models to all states;
d) Evaluate delivery, utilization, and effectiveness of the
two Web-based models of training; and,
e) Develop a national adoption competency mental health
certification process.
Applications for this grant are due by June 9, 2014.
3)SUPPORT . Mission Focused Solutions (MFS), the sponsor of this
bill, writes that while the child welfare field's awareness of
the need for adoption competent clinicians is heavily
supported by respected research, graduate education in
relevant fields does not usually include adoption issues. MFS
argues that this bill addresses an underlying and critical
need by empowering prospective adoptive and guardianship
families with knowledge about the importance of working with
adoption/permanency competent mental health professions when
they seek help for their families and creating a
well-researched criteria for adoption/permanency clinical
competence. The California Association of Adoption Agencies
writes that as their member agencies, who struggle to refer
clients to adoption-competent mental health providers they
strongly support this bill.
4)OPPOSITION . The California Association of Marriage and Family
Therapists (CAMFT) has an oppose unless amended position on
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this bill stating they understand the sponsor's interest in
assuring proper training for mental health professionals
working with adoptive/foster families, the practical impact of
this legislation would likely harm currently employed marriage
and family therapists (MFTs), as well as those seeking
employment. CAMFT states they are aware of numerous MFTs
working in this field within various non-profit agencies and
organizations licensed and contracted by the state, as well as
MFTs working for the state and these MFTs were hired because
they met the qualifications of the job, and did not
necessarily have the exact training spelled out in this
legislation. CAMFT asks that language in the Legislative
Findings be removed as it implies that MFTs are not qualified
to work with this population, which is inaccurate.
5)POLICY COMMENTS . This bill requires county mental health
plans to take steps to increase the pool of mental health
providers who meet specified training and experience. As this
bill moves forward, the author may want to specify what those
steps should be.
Given the federal proposal to develop a national adoption
competency mental health certification process that will
provide technical assistance on Web-based training models to
all states, the author may wish to consider how state efforts
can take advantage of similar efforts at the federal level, as
well as consider adding language to the bill that will
instruct the task force to insure that proposed state and
federal requirements do not conflict.
6)SUGGESTED AMENDMENTS .
a) As currently drafted this bill does not necessarily
acknowledge that many mental health providers may have
experience and competency in treating adoptive/guardianship
families. The Committee may wish to amend this bill to
reference the specified training "or" experience, rather
than "and" experience, and to delete the language in the
findings and declarations as requested by CAMFT.
b) Given that the author and sponsors assert there are
currently not enough mental health professionals with
adoption competency, it seems premature to require county
mental health plans and adoption agencies to direct parents
to services they may not be able to access. The Committee
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may wish to amend this bill to delete the requirements that
the reports and assessments contain, and prospective
adoptive parents and guardians be notified of the
importance of working with mental health providers who have
specialized adoption training and experience.
c) This bill could result in changes to Medi-Cal benefits
provided by the county mental health plans and should be
amended to require consultation with the Department of
Health Care Services to ensure that state or federal
requirements governing the Medi-Cal program is complied
with.
REGISTERED SUPPORT / OPPOSITION :
Support
Mission Focused Solutions (sponsor)
Adopt a Special Kid
Aspiranet
Better Life Children Services
California Alliance of Child and Family Services
California Association of Adoption Agencies
Capital Adoptive Families Alliance
Community Champions Network, Sacramento Chapter
David & Margaret Youth and Family Services
Several individuals
Opposition
California Association of Marriage and Family Therapists (unless
amended)
Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097