Children & Youth Experiencing Foster Care

If you are a child or adolescent in foster care, you have a right to be part of the team working on your health and mental health. Your ideas about what is going well, how you are feeling and where you need help are an important part of figuring out what kinds of support you need. Sometimes you may not think you need supports or agree with your treatment plan. If so, it’s fine to ask your treatment team questions so you can understand your plan and discuss possible changes to it.

If you are having thoughts and feelings that make you scared you might do something to hurt yourself or anyone else, tell an adult right away. If they don’t get you help right away, call 911 for help.

Most of the time, the adults in your life (parents, foster parents, relatives, case worker, teachers, counselors, doctors) will want to hear about your feelings, thoughts and ideas about your care. If you are younger than 14 and don’t feel the adults around you are listening to your concerns, try talking with some other adult who is on your team. If you are 14 or older, you can call your local Community Mental Health center to get help. A minor 14 and older can get an emergency appointment, an appointment for screening to see if they can get services through Community Mental Health, an assessment and up to 12 outpatient appointments without a parent’s consent. For other services a parent or guardian has to be involved. A link to find the center in your area is below.

• Alphabetical list of local Community Mental Health Centers in Michigan
• Map by county of Community Mental Health Centers in Michigan

When you meet with the doctor or with a counselor, most often you will have an opportunity to meet with him or her by yourself. If you do not get invited to talk to the doctor or counselor alone, it is OK to ask for time alone if there is something you need to talk about and don’t want to do it in front of the adults who come with you to an appointment.  Most of the time, anything you say during that time will stay between you and the doctor or counselor. If the doctor or counselor is worried that you won’t be safe, the two of you will need to figure out how to get the right adult involved to ensure you get the help you need. Also, doctors and counselors will need to call protective services if they are worried that someone is hurting you. These rules are in place to make sure that you are safe.

If you are getting near to 18 years old, it is important to figure out if your health and mental health services will need to change after your birthday and how to help this go smoothly. It will also be important to make sure you have information about your health and mental health history because you will probably have to switch to new providers and having this information will help them do the best job working with you.

• Foster Youth in Transition
• Finding Support: Teens and Young Adults
• Association for Children’s Mental Health

You also have the right to know about medications a doctor may want you to take. The first place to go to get questions answered is the doctor. If you want to look things up on your own, it is important to remember that not all information on the internet is correct. Here are good sources for reliable health information:

• Making Healthy Choices: A Guide on Psychotropic Medications for Youth in Foster Care
• Mental Health Medications: National Institute of Mental Health
• Fostering Success Michigan: Resources and inspiration for youth
• WebMD

For more information about your rights as a child in foster care, see the following:

• A Handbook for Youth in Foster Care
• Rights of Children in Foster Care

Assessments are the first step to determining whether you need help, and if so what kind. The main purpose of an assessment is to get a clear picture of the needs that a you and your family have, the reasons for these needs, the strengths of the child and family and engaging family-driven, youth-guided process to develop an individualized services plan. There are many kinds of assessments and sometimes a child might need several in order to figure out the best way to help. During the assessment process, you and parents and caregivers can ask about any specialized assessments that might be needed to understand your and your family’s situation and needs.

Assessments are the most useful when the person doing it has all the information available including health history, past treatment, family history, and current and past living arrangements. The knowledge and ideas you bring about you and your family is key to ensuring that the provider understands you and your family. Sometimes you (and your parents and caregivers) might worry about being judged or that they are doing things wrong, but you and your family are the experts about your situation. Before an assessment, the office where it is scheduled should be able to tell you and your family how long the appointment will last, what information to bring and may ask your parents’ or caregivers’ permission to get records from other places. This will help you and your family know what to expect and plan your time.

The Michigan Department of Human Services works with providers in the community to make sure that children involved in child welfare services (that is, child protective services, foster care) can get the kinds of assessments they need. The first access point for an emotional or behavioral assessment is the child’s insurance (private or Medicaid). If an assessment is needed that can’t be paid for through insurance, the Michigan Department of Health and Human Serives will work with the child’s Children’s Protective Services or foster care worker to schedule and pay for the assessment.  Assessment is not a one-time activity. When children enter foster care there is usually an effort to make sure that assessments are done right away because these will be important to putting together an initial service plan. However, as your needs change over time, it is important to review how things are going and decide whether new assessments are needed.

The services listed below are provided by Community Mental Health to children and youth with mental illness, serious emotional disturbance or developmental disabilities. The services provided to you and your family are determined by an initial intake assessment, development of an individualized plan of service and what is decided to be “medically necessary." The descriptions below will give you an idea of the services that may be helpful to you and your family. Although there is a large array of services, the particular services provided to you and your family will be discussed during the development of your family-centered, youth-guided individualized plan.

For more information on mental health services please see the sections on Mental Health Services for Children and Intellectual and Developmental Disability Services in the Michigan Medicaid Provider Manual.

Outpatient Child Therapy

Sometimes when children and adolescents have emotional or behavioral problems, meeting with a counselor to learn new skills to understand and deal with thoughts and feelings can help them do better at home and in the community. Based on the assessment and discussion with the child and family, things like goals, treatment approaches and how often to meet are decided.

Outpatient Family Therapy

Outpatient family therapy is another option that counselors may use when it’s important for the family to work together on a child’s behavior. In this way, the whole family can work together on treatment goals.

Home-Based Services

Home-Based services are more flexible because the services occur in the home and community and can be scheduled more often than is usually true of outpatient counseling. Sometimes Home-Based services are recommended when a child and family have more intensive needs and services are focused on both the child and the family. The goals for Home-Based services, how often sessions are scheduled and what approaches will be used are decided together by the child, family and Home-Based worker. Home-Based services are designed to support the child to remain in their family home. Home-Based services also may be used when children and families who have been separated are working on being reunified.  

Medication Review

When children are taking psychotropic medications as part of their treatment plan, they will meet regularly with a medical provider to discuss whether the medications are helping enough and what problems, if any, the medications might be causing. These medication reviews are scheduled every few weeks or months depending on the child’s current situation. Because child and family input is important and children aren’t allowed by law to consent to medications, parents or guardians need to attend these appointments with children.

Respite

Respite services provide relief from the daily stress and care demands of a child with behavioral challenges. Respite care for a child can be provided in the home or in another setting to support a parent who needs relief. Respite services can be scheduled on an hourly basis, or overnight, and can be added to a child’s comprehensive treatment plan.

Community Living Support (CLS)

CLS services are used to help a child or youth build his or her skills to be more successful in the community. CLS services are provided by aides who can help teach skills of activities of daily living (for example personal hygiene), social skills or other things that are part of the child’s care plan. CLS is also used with older children or adolescents to build skills so that they can become more independent.

Wraparound

What is Wraparound?

Wraparound is an EPSDT (Early and Periodic Screening, Diagnostic and Treatment) service when delivered to youth under 21 years of age. Wraparound was developed in the 1980’s and adopted by Michigan in the 1990’s. Wraparound became a Michigan State Plan Service in 2013. Wraparound is made available to Medicaid-eligible youth and families in all Michigan counties. It is made accessible through a network of CMHSPs (Community Mental Health Service Programs) and their contracted providers. Wraparound supervisors and facilitators receive extensive initial and ongoing training to become certified to deliver the planning process to youth and families.

Wraparound in Michigan is guided by 13 values: Child Well Being, Family Focused, Safety, Individualized, Cultural Competence, Direct Practice and System Persistence, Community Based, Strength Based, Parent Professional Partnership, Collaboration, Social Network/Informal Supports, Outcome Based, Cost Effective & Responsible.

How does Wraparound work?

Wraparound is an individualized, holistic, comprehensive, youth-guided, and family-driven planning process. This voluntary process utilizes a collaborative team approach including youth and their family and their choice of professional and natural supports. The planning process follows four stages: Hello-Engagement and team preparation, Help-Initial plan development, Heal-Implementation, and Hope-Transition. 

The Child and Family Team Plan is built on strengths and driven by underlying needs. The plan provides realistic strategies to meet measurable and attainable outcomes that the Child and Family Team develop. Ongoing evaluation of the Child and Family Team Plan occurs during each Child and Family Team meeting and adjustments are made as needed.

Who is Wraparound For?

All Medicaid-eligible youth that meet two or more of the following criteria are eligible for Wraparound: Children/youth who are involved in multiple child/youth serving systems; Children/youth who are at risk of out-of-home placements or are currently in out-of-home placement; Children/youth who have received other mental health services with minimal improvement in functioning; The risk factors exceed capacity for traditional community-based options; Numerous providers are working with multiple children/youth in a family and the identified outcomes are not being met.

All youth served under the Children’s Serious Emotional Disturbance Home and Community-Based Services Waiver (SEDW).

All youth in placement at CCIs (Child Caring Institutions) or Hawthorn Center (up to 180 days while in placement).

Why Wraparound?

The Title IV-E Prevention Services Clearinghouse conducted a systematic review and rated Wraparound as “promising”. Wraparound has shown an overall increase in functioning and self-sufficiency. The planning process promotes youth and family voice and choice. Data has shown Wraparound is an effective process in reducing out-of-home placement, promoting community inclusion and partnership, increasing youth and family confidence and resiliency, and improving mental health and interpersonal functioning.

Where is Wraparound?

Wraparound is available in all Michigan counties, made accessible through a network of CMHSPs and their contracted providers. Referrals may be made by anyone (child-serving agencies, professional providers, community partners, educators, parents/caregivers, families, friends, etc.) on behalf of the child/youth. A referral to Wrapround can be made by contacting the CMHSP in the county in which the child/youth resides. For a CMHSP directory, please see below.   

CMHSP Directory • CMHAM - Community Mental Health Association of Michigan

Reference Section 3.29 MedicaidProviderManual.pdf (state.mi.us)

Case Management

Case management services are provided when a child has emotional and behavioral needs and his or her family could use help connecting to supports and programs, like medical services, school supports or financial assistance. A case manager works with a family to figure out what supports are most needed and helps them connect to those services. They also help the family learn how to advocate for themselves.

Parent Support Partner (PSP)

Parent Support Partners have personal experience parenting a child with emotional or behavioral needs and are experts at helping families to be empowered during the treatment process and to build confidence and skills to assist their child to improve. Parent Support Partners work with families as identified in their child’s family-centered, youth-guided, individualized treatment plan.

Applied Behavior Analysis

Applied Behavior Analysis is used in young children with autism to develop positive social skills and in older children with autism to help deal with challenging behaviors. Applied Behavior Analysis (ABA) has been studied and used for many years for children with autism. ABA is a way of figuring out the factors that affect a child’s behavior so that a plan to change behavior can be successful. It includes looking at situations a child may be experiencing before he or she does something, like hitting or running away. It also includes looking at how responses by adults after a behavior can make that behavior more or less likely in the future. ABA can be used at home, in school and during treatment sessions. It is important for all the individuals working with the child to be following a consistent plan. ABA providers have gone through specialized training in ABA and in helping teams to work together. 

Inpatient Psychiatric Hospitalization

Inpatient psychiatric care is used when a child or adolescent with mental illness or serious emotional disturbance needs 24/7 care because they are at a high risk of harming his/herself or someone else. Treatment usually includes individual therapy, group therapy, and medication treatment. Families are involved in treatment. Sometimes school services are available on site. For children who have Medicaid insurance, the decision about whether inpatient treatment is medically necessary is usually made by Emergency Services at the local Community Mental Health for the child’s legal county of residence. If a child is placed out of home in a different county, the county of legal residence will have to work out the best way to assess the need for inpatient care.

Occupational Therapy / Sensory Integration Therapy

These therapies help children build strength and coordination for day to day tasks and can help when a child has problems with how their senses react to the world around them, for example when children are extra sensitive to touch or noise. The goal of occupational therapy is to help children function better over the long term. Occupational therapy is provided by trained professionals for a specific period of time. A doctor’s referral is needed for occupational therapy assessment and treatment.

Speech, Hearing, and Language

Children who are struggling with making letter and word sounds, understanding language, or expressing themselves might get speech, hearing and language services for a specific period of time. A doctor must refer for assessment and treatment, and the services must be determined to be needed for the child to function (medical necessity). Services might be provided to the child alone or in a group, depending on the child’s needs.

Evidence Based Practice (EBP)

Evidence Based Practice is a general term used for treatment that has either been proven effective by research studies, or seems very likely to be useful based on the best opinion of experts in the field. Across Michigan, treatment providers are expected to use Evidence Based Practice.

Substance Use Disorder (SUD) Services

Substance Use Disorder Services help people struggling with alcohol or drug addiction. It may include a number of interventions that are decided according to the individual’s need. When someone also has a mental health disorder it is addressed when developing the treatment plan.

Youth Peer Support (YPS)

YPS is designed to support youth with a serious emotional disturbance through shared activities with the Youth Peer Support Specialist. The goals of YPS include empowering youth, developing skills to improve overall functioning and quality of life and working collaboratively with others involved in delivering the youth’s care. YPS services is are provided by a trained youth peer support specialist, one-on-one or in a group, for youth who are resolving conflicts, enhancing skills to improve their overall functioning, integrating with community, school and family and/or transitioning into adulthood.

Child and Adolescent Psychiatrists – Medical doctors (MD or DO) who have training and experience focused on assessing and treating children and adolescents with mental health problems.

General Psychiatrists – Medical doctors (MD or DO) who have training and experience focused on assessing and treating adults with mental health problems. Sometimes general psychiatrists also work with children and adolescents.

Primary Care Physicians – Medical doctors (MD or DO) who have training and experience in general medicine; for example, family doctors and pediatricians. Primary care physicians also sometimes assess and treat adults and children with mental health problems. A primary care physician might also want to refer a patient to a psychiatrist.

Nurse Practitioners/Advanced Practice Nurses – Individuals with a nursing degree and have gone through additional training to provide some types of medical care. In Michigan, nurse practitioners provide care, treatment and education about health and mental health problems by working with a supervising physician. Nurse practitioners may provide services in primary care or in some mental health care settings.

Physician Assistants – Individuals who have gone through specific training in medical care. In Michigan, physician assistants provide treatment of health and mental health problems by working with a supervising physician. Physician’s assistants work in both primary care and mental health settings.

Psychologists – Psychologists can have a master’s degree (limited licensed psychologist - LLP) or doctoral degree (licensed psychologist - LP) and provide assessment, diagnosis and treatment. Their primary focus is mental health and/or learning problems.  In Michigan, psychologists may not prescribe psychotropic medication. Psychologists sometimes provide specialized assessments (see psychological and neuropsychological assessments).

Case Managers – Case managers have (at least) a bachelor’s degree and training/experience in mental health systems and child/family engagement

Outpatient Therapists – Outpatient therapists have at least a master’s degree (for example a Masters of Social Work, or MSW) and training/experience in mental health assessment, diagnosis and treatment. They may have training and/or certification in specific types of therapy, for example Trauma Focused Cognitive Behavior Therapy or Structural Family Therapy. Experience and certification is one way to decide whether a specific therapist will be good fit for the child and family.

Home-Based Workers – Home-Based workers can have a bachelor’s degree or a master’s degree depending on what kind of work they will be doing with the child and family. They can have training and/or certification in specific types of therapy.

Wraparound Facilitators – Wraparound facilitators may have a bachelor’s degree, master’s degree or no advance degree if they have enough experience. They must have approved training in the Wraparound model.

Parent Support Partners – No degree is required to become a parent support partner, but they must have lived experience as a parent of a child involved in the mental health care system and hired by the Community Mental Health system or by a contract provider. Parent support partners must complete approved training.

Youth Peer Support – No degree is required to be a youth peer support, but a youth peer support must have lived experience of receiving mental health services as a youth and must complete approved training.  

Board Certified Behavior Analysts (BCBA) – Board certified behavior analysts have at least a master’s degree and have completed a specific set of courses and exams as set by the Behavior Analyst Certification Board. BCBAs provide comprehensive behavioral assessments using Applied Behavior Analysis and put together a plan of care for children or adolescents with autism spectrum disorders. They supervise the work of Registered Behavior Technicians (RBT), and Board Certified Assistant Behavior Analysts (BCaBA) who work directly with the child and family on the treatment goals.

Occupational Therapists (OT) – Occupational therapists have gone through an accredited OT program and have a master’s degree. They are required to pass a state licensure examination.