Mental Care of Children Faulted

Two years after Los Angeles County pledged to dramatically improve mental health treatment in its child-welfare system, a panel of independent experts has concluded that thousands of mentally ill and troubled children are still not receiving the intensive care they need.

The court-appointed panel, which monitors a 2-year-old legal settlement, said the county was failing to provide mental health services to children while they were at home with their families or foster parents, a lapse that it said means many eventually wind up in group homes and psychiatric hospitals.

In the report filed Tuesday in federal court, the panel said the county Department of Children and Family Services “has still not demonstrated a commitment to achieving the objectives of the settlement” and has failed to develop a comprehensive plan to deliver home-care services.

The panel said it had “little confidence” that county officials were committed to the promised reforms and accused them of making their obligations under the settlement a “low priority.”

“After two years, we would have hoped for greater progress than we have seen,” said Paul Vincent, the panel’s chairman and director of the Alabama-based Child Welfare Policy and Practice Group.

Vincent said the panel estimated that at least 10,000 children under the department’s jurisdiction needed intensive home-based mental health services. The county does not track those numbers.

County officials acknowledged that they continue to rely on institutional care for many mentally ill children, but said they had made far more progress than the report suggested.

Since the settlement, the county has shut down MacLaren Children’s Center, its maligned shelter in El Monte for troubled foster children. The county says it now treats hundreds more children in their homes and has reduced the number in foster care from 28,000 in 2002 to 23,500.

“Those are dramatic improvements, and they were not captured in the report,” said David Sanders, director of the children’s department.

The settlement stems from a class-action lawsuit that lists as plaintiffs five children who claim they received substandard care.

Advocates for two of those children said their fates illustrated the difficulty children in the county’s child-welfare system have in getting mental health treatment.

One teenage boy, known as Gary E., received the mental health care he needed only after he was incarcerated in another state, said Michael Ludin, his court-appointed representative.

Another Ludin client, Katie A., bounced among dozens of group homes, foster families and psychiatric facilities for much of her youth while the county failed to provide adequate care, he said. Ludin said she was released from the system when she turned 18 and now lives on the streets.

“Their needs are failed to be met time and time again,” he said. “A kid’s parent dies, there’s no grief counseling. They don’t get to visit the cemetery. A group home or foster home says that they don’t want a kid anymore, and the kid acts up; they wonder why.”

Under the settlement, the county promised to offer intensive mental health care to children with psychiatric, emotional and behavioral problems. It also promised to tailor care to each child, ideally while he or she remained at home.

The emphasis on treating children at home follows studies showing that children do better academically and are more successful later in life if they grow up in a permanent family rather than bounce from group home to group home.

The report is the fifth from the panel of six children’s welfare consultants, who are evenly split between members chosen by the county and those selected by the plaintiffs’ lawyers.

The panel reports to U.S. District Judge A. Howard Matz on the county’s efforts to reform its mental health system for children in foster care and those at home who are monitored by county social workers -- about 38,000 children.

Only one of the five children in the lawsuit remains in the child-welfare system. That boy, who was not identified in the report, was reunited with his mother after the settlement and treated at home. But social workers later removed him after allegations that his mother abused him, the report said.

The report, which said Katie A.’s case was closed after she ran away from foster care, described her as “profoundly damaged both by early maltreatment and failure to provide trauma treatment and a permanent family home earlier in her life.”

Ludin, the court-appointed representative, said the county did not offer the traumatic psychiatric care that Katie A. needed even after the settlement.

He said he urged the county to find her a secure home with professionals that could meet her severe needs. But the county resisted, he said, even after she pleaded guilty to misdemeanor child endangerment for allegedly kidnapping a baby.

“If the county investigated itself as if it were the parent, for many reasons they would have removed Katie from their care and custody,” Ludin said.

He added that Gary E. received no mental therapy in Los Angeles County either before or after the settlement.

Gary, who grew up in an abusive home, was expelled from school and had a history of violence, Ludin said.

After the settlement, the county contracted with a private mental health agency to treat Gary. His case manager, complaining of an allergy to cats, would not enter the home, Ludin said, while Gary often refused to leave his sofa. So Ludin said the case manager would stand on the porch and try to talk to Gary through the doorway.

It took an arrest during an out-of-state visit to his father for Gary to get the services he needed, Ludin said. Gary’s attorney obtained a court order that required Los Angeles County to pay for the therapy the boy receives while living with his father.

“He is, in fact, getting more services out of state being paid for by Los Angeles than when he was in Los Angeles,” Ludin said.

The panel did say the county had made some progress: Social workers do a much better job assessing the mental health needs of children when they come into the system. And the children’s department has expanded programs to provide individualized care.

But those expanded programs “are either quite small in scope or at the early planning stages,” the panel wrote, so they have had little practical effect for many children.

Vincent, the panel’s chairman, said other areas of the United States had managed to make dramatic improvements in mental health services while keeping children at home. He noted that he served as director of Alabama’s child welfare agency when a similar class-action lawsuit forced it to alter how it provided psychiatric care.

Kimberly Lewis, an attorney at the Western Center on Law and Poverty who worked on the lawsuit, agreed that the county’s reforms were not enough.

“It’s a drop in the bucket considering the need,” she said.

Marvin Southard, county director of mental health, said some mental health agencies that contract with the county had been slow to offer services for children living at home. But he said that was changing.

His department, he said, already treats about 11,780 children and is planning to increase that by at least 950 in the coming year, though the county does not track how many of those need intensive services.

In the next six months, the county will receive an extra $90 million from Proposition 63, the voter-approved tax on millionaires that will fund mental health services statewide. About two-thirds of that will be spent on children in Los Angeles County, the bulk of them in foster care, he said.

“Our intention is to provide foster kids with whatever they need to thrive,” Southard said. “We believe we are well on the road to providing those services.”