Child Welfare Professionals

The main resource for health and mental health services for any child served by the child welfare system is the child’s Medicaid health plan (MHP). This is why it is critical for children to get enrolled in Medicaid and assigned to an MHP as soon as possible after entry into foster care.  The health plan covers the initial comprehensive medical examination and ongoing periodic medical examinations, dental care and mental health care for children with mild-moderate mental health needs. When children have Serious Emotional Disturbance, they are served through the Community Mental Health Service Provider (CMHSP). Children might start services in an MHP but if their mental health needs increase to a Serious Emotional Disturbance, they would shift to the CMHSP for treatment. Similarly, children receiving services through CMHSP might shift to a Medicaid health plan if they no longer meet criteria as Serious Emotional Disturbance. Care coordination during these transitions is critical.

The programs and/or services listed below are also available to children served by child welfare.

Children with Special Health Care Needs – Children's Special Health Care Services is a Michigan program within the Michigan Department of Health and Human Services that provides certain approved medical service coverage to some children and adults with special health care needs. Children must have a qualifying medical condition and be under 21 years of age. Persons 21 and older with cystic fibrosis or certain blood coagulating disorders may also qualify for services. For more information, click here.

Michigan Department of Health and Human Services (MDHHS) Incentive Payment – When community mental health providers provide Wraparound or Home-Based services to children in foster care or CPS Category 1 or 2, MDHHS provides an incentive payment to the Pre-Paid Inpatient Health Plan (PIHP), the administrative structure for the Community Mental Health service providers (CMHSP), in addition to the Medicaid capitation payment for the services provided. The incentive payment supports the CMHSP in building capacity for Wraparound or Home-Based services. Incentive payments are also provided to a CMHSP when a child in this population receives Wraparound or home-based services AND is new to the CMHSP or has not received services from the CMHSP for the last six months. This payment process is available to all the PIHPs/CMHSPs across the state.

Serious Emotional Disturbance (SED) Waiver – Children with a very high level of need (likely to be hospitalized without intensive community supports) may be eligible for the SED Waiver. Even children with private insurance can be made Medicaid eligible as a family of one if they meet the criteria for SED Waiver services. The SED Waiver providers services that are enhancements or additions to Medicaid State Plan coverage for children through age 20 with SED.  Wraparound is a required service for children in the SED Waiver. The SED Waiver is not yet available in all counties. Click here for a map of the counties that participate in the SED Waiver.

Adoption Medical Subsidy – This is a program that can reimburse adoptive parents for costs to treat medical or emotional problems. The problems must have been there before the adoption. Parents must apply for this subsidy before the child’s 18^th birthday. The subsidy is used only when all other medical coverage has been used fully. For more on adoption subsidy, see the Michigan Department of Health and Human Services (MDHHS) Adoption Assistance Manual (AAM 400).

In the uncommon event that a child needs assessment or treatment that is not able to be covered by Medicaid, MDHHS contracts with providers who perform these services. These services need to be approved by the MDHHS Adoption Assistance caseworker.

Health Liaison Officers - The Health Liaison Officers are based in Michigan Department of Health and Human Services offices. Their chief task is to provide support to protective services and foster care workers so that children’s health and mental health needs are met. This includes assisting with enrollment in Medicaid and scheduling comprehensive health examinations and building relationships between the foster care and health systems.  If you do not know the Health Liaison Officer in your area, click here for a current listing.

Family Support Subsidy Program - Families may be eligible for this program if they have a child under age 18 who has been identified by Michigan’s public school system as having a special education eligibility category of:

• Cognitive impairment
• Severe multiple impairment
• Autism spectrum disorder

The local Community Metnal Health determines eligibility for this program. Families are paid a little over $200 per month. The family’s taxable income may not exceed $60,000. Families can be headed by birth parents, adoptive parents, or legal guardians. Foster parents are not eligible. In addition, the family cannot receive reimbursement from the medical Subsidy Program for Adoptive Children.

Mental Health Services for Children in Residential Settings – Mental health care including therapy and psychotropic medication treatment is arranged by a residential treatment provider. Community Mental Health service providers (CMHSP) cannot provide services to a child in a residential setting. However, 60 days prior to planned discharge, CMHSP can provide case management or Wraparound services to facilitate discharge and transition planning. Contact the Permanency Resource Manager in your area for assistance with transition planning from residential services to the CMHSP.

Health Liaison Officers (HLO) provide guidance to child welfare staff to meet the health needs of children in foster care.  They troubleshoot Medicaid coverage issues, health plan coverage and issues with access to community health providers.  They track compliance with timeliness of medical and dental exams.  HLOs are a good resource for any health-related questions.

HLO’s are assigned to a county, or number of counties depending on the local/regional population of children in foster care. The Health Liaison Officer working with your county may have their base in a county nearby.

To locate your local HLO click here: https://www.michigan.gov/documents/mdhhs/DHHS_HLO_List_528954_7.pdf

Children who come into protective services and foster care are at a higher risk for both health and mental health problems than are children in the community. There are several reasons for this including exposure to trauma, lack of access to health and mental health services when problems were mild, possibility of exposures to drugs and alcohol or maternal stress prior to birth, or family history of mental health problems. Recognizing and addressing mental health problems that a child has is important to the child’s well-being, safety and permanency.

Child welfare and Medicaid policy mandates that children get a comprehensive medical examination within 30 days of entry into foster care so that health and mental health problems can get recognized and addressed as soon as possible.

When children first come into care it is important to find out if they have ongoing health and mental health problems and to make sure that new medical providers get information about past services from previous providers. At the time of foster care placement, legal parents are required by law to provide the names and contact information for all the health and mental health providers who have been working with their child. The best way to get accurate health and mental health information for the child is to request records from prior providers. For this, parents should be encouraged to sign a completed DHS-1555 Authorization to Release Confidential Information form for each provider. These forms can be sent to the providers so that they will be able to release medical and mental health records to providers who are new to the child and family.

There are many resources to learn more about these mental health needs. See links to some useful sites below.

• Supporting Youth in Foster Care in Making Healthy Choices: A Guide for Caregivers and Caseworkers on Trauma, Treatment, and Psychotropic Medications
• Child Welfare Information Gateway
• National Child Traumatic Stress Network
• Healthy Foster Care America: American Academy of Pediatrics
• Child Abuse Resource Center – American Academy of Child & Adolescent Psychiatry

Children in foster care tend to be on medications more often and on more medications than children in the general community. There are probably a number of reasons for this. For the children who have very complex mental health problems, being on a set of medications may be necessary. However, it is important for the treatment approach to be based on a comprehensive examination including information from the child’s history, attention to the impact of trauma, treatment that includes talking/behavior therapy and careful reassessment of treatment needs over time. Foster care workers are usually in the best position to help bring important information about the child and family to the mental health providers, to help the child and family communicate effectively with these providers and to advocate for effective care.

The policy on psychotropic medication (FOM 802-1) requires the foster care worker to talk with the child and caregivers about how they are doing emotionally and how things are going with their medications at each visit. This information can be passed along to the medical team, but the foster care worker can also use MiTEAM skills to coach the child and caregivers to communicate with providers directly.

There are a number of ways to get more information about psychotropic medications. In each county Michigan Department of Health and Human Services and Private Agency Foster Care office has a copy of the book/CD ROM – “Helping Parents Youth and Teachers Understand Medications for Emotional and Behavioral Problems.” This book is from 2007 so some of the newer medications aren’t included, but many medications are there. Check out our Helping Parents & Youth Understand Medications video that describes this resource and how it can be used to help with this aspect of casework.

Additional Resources:

• Supporting Youth in Foster Care in Making Healthy Choices: A Guide for Caregivers and Caseworkers on Trauma, Treatment, and Psychotropic Medications
• Making Healthy Choices: A Guide on Psychotropic Medications for Youth in Foster Care
• Child Welfare Information Gateway  
• WebMD
• State of Michigan: Psychotropic Medication in Foster Care
• Mental Health Medications: National Institute of Mental Health