Identity Theft of Foster Children

The nonminor is completing secondary education or a program leading to an equivalent credential.

The nonminor is enrolled in an institution which provides postsecondary or vocational educational education.

The nonminor is participating in a program or activity designed to pro- mote, or remove barriers to employment.

The nonminor is employed for at least 80 hours per month.

The nonminor is incapable of doing any of the activities described in sub- paragraphs (1) to (4), inclusive, due to a medical condition, and that inca- pability is supported by regularly updated information in the case plan of the nonminor. Based on data provided by DCFS, the total population in Los Angeles County eligible for extended foster care services due to AB 12 is estimated to be between 3,800 (16 and 17 year olds as of Nov. 30, 2011) to 5,483 (including those 18 and older as of Nov. 30, 2011). However, this estimate does not include Transition Age and eligible youth that may enter or exit the child welfare system up until 2014, the expected sunset date for AB 12 unless it is extended by the State legislature. Medical and mental health services for youth aged 18 years or older and under the ju- risdiction of DCFS have been limited. However, there are services offered by DMH that youth can continue to receive after they turn 18, independent of their status with DCFS. With the implementation of extended foster care services under AB 12, DCFS, DHS, and DMH should improve or create systems to address the specialized needs of youth aged 18 years or older. Medical Services for 18 Year Olds and Older Prior to the implementation of AB 12, DCFS provided youth aging out of the system with referral information on medical and mental health services and requirements for receiv- ing Medi-Cal under the Former Foster Care Children Program (FFCC) which allowed coverage until the age of 21. However, the former foster care youth would have to re- new their enrollment in Medi-Cal themselves, and DCFS management reported that not all of them were doing so. California Welfare and Institutions Code §11403(a) 18 California Welfare and Institutions Code §11403(b) 294 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH Since most Transition Age Youth are eligible for Medi-Cal coverage, they can obtain medical services from any Medi-Cal provider. There is no mandate or requirement for this population to go to a Hub Clinic. As a result, a majority of the Hub Clinics report serving very few youth aged 18 years or older. Medically Fragile/Vulnerable Youth who are medically fragile/vulnerable are those with special needs due to a mental health diagnosis, developmental delay or a physical or medical condition that requires specific care.19 As of November 30, 2011, there were 2,163 youth under the jurisdiction of DCFS identified as medically fragile/vulnerable, of which 198 were 18 years old or older. Within the medically fragile/vulnerable group, there is a subgroup of youth receiving DCFS services from the Medical Case Management Services (MCMS) Unit. These youth have special health care needs defined as: 1) a condition that can rapidly deterio- rate, resulting in permanent injury or death, or 2) a medical condition that requires spe- cialized in-home health care such as an enteral feeding tube, ventilator, intravenous therapy, or other medical or surgical procedures or special medication regiments.20 Youth under the supervision of the MCMS Unit require the most medical care and atten- tion of all the medically fragile/vulnerable youth under the jurisdiction of DCFS. The MCMS Unit works with families, caretakers, and the youth to ensure that the youth ob- tain the medical services they need. As of February 2012, there was a total of 580 youth under the MCMS Unit, of which 52 are 18 years old or older. The medical services for youth under the supervision of the MCMS Unit are funded through 1) Medi-Cal’s fee-for-service or managed care, depending on their enrollment; 2) California Children’s Services for special equipment such as wheelchairs and beds; and 3) Regional Centers21 for services such as occupational, physical and behavioral therapy. When youth under the supervision of the MCMS Unit turn 18, they may either remain under the supervision of the MCMS Unit because they are still in high school or the Courts have not terminated their DCFS cases due to severe health conditions. Medical- ly fragile/vulnerable youth over the age of 18 who are eligible for long-term Regional Center services are transitioned to service coordination by their local Regional Centers. If a youth does not fall under any of these categories, he/she could be emancipated and transitioned out of DCFS or any other supervision and oversight. DCFS Procedural Guide 0900-522.10 (Specialized Care Increment – D – Rate), DCFS Procedural Guide 0900- 522.11 (Specialized Care Increment – F – Rate). DCFS Procedural Guide 0600-505.10 (Assessments of and Services for Children with Special Health Care Needs) 21 Regional Centers are non-profit agencies under contract with the California Department of Developmental Services that help coordinate services needed because of a developmental disability. Depending on eligibility, most services offered at Regional Centers are free regardless of age or income. 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 295 EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH Medically fragile/vulnerable youth aged 18 and older who do not remain with DCFS or who are not eligible for Regional Center services are at risk of abuse, isolation, home- lessness, neglect, or self-neglect. However, these youth are eligible for referrals to Adult Protective Services (APS) so that they may continue to have contact with social workers and access to needed services. It is unclear if all medically fragile/vulnerable youth ag- ing out of DCFS services are referred and transitioned to APS, when they are not eligi- ble for Regional Center services, but DCFS should strive to make such referrals when- ever possible. According to DCFS management, the medically fragile/vulnerable youth under the su- pervision of the MCMS Unit only access or interact with Hub Clinic staff when they are newly detained and require an Initial Medical Examination. These exams provide the medical history for the newly detained youth. However, continued medical services are obtained at specialized clinics across public and private hospitals throughout the Coun- ty. Although Hub Clinics may not offer the specialized services and clinics needed by the medically fragile/vulnerable youth under the MCMS Unit, the Hub Clinics can still play a role as the medical home for youth with multiple medical providers and specialists within the hospital system affiliated with each Hub Clinic. The Hub Clinics can also serve as the medical coordinators for the medically fragile/vulnerable Transition Age Youth who are 18 and older and have not transitioned to Regional Center services, such as an 18 year old who is diabetic and is in constant need of insulin shots. To serve as the medi- cal home, Hub Clinics would have to obtain and maintain all medical records for the pa- tient from multiple service providers within the hospital system affiliated with each Hub Clinic. Currently, DCFS staff coordinates services across multiple providers in different hospital systems for these youth, and should continue doing so for youth with medical providers across both County and private hospital systems. However, the specialized medical knowledge of Hub Clinic staff could facilitate the transfer of medical information more easily for medically fragile/vulnerable youth with specialists in the same hospital system. Ideally, youth aging out of DCFS would be transitioned to a program where they still have access to social workers and coordinated medical and mental health services ei- ther through a Regional Center, if developmentally disabled, or Adult Protective Ser- vices. For youth transitioned to Adult Protective Services, the Hub Clinics could com- plement the social services provided by coordinating the youth’s medical services. Mental Health Services for TAYs According to data provided by DMH, 3,904 DCFS youths with open DMH cases were aged 16 or older, representing 16.2 percent of the a total of 24,116 DCFS youths with open DMH cases. This also represents 71.2 percent of the 5,483 youth under the juris- diction of DCFS who were 16 years old or older as of November 30, 2011. These youths could have received DMH services through any number of DMH programs pro- 296 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH vided throughout the County including: 1) services provided through the Multidisciplinary Assessment Team (MAT) Assessment Program,22 2) Full Service Partnership Program (FSP),23 3) Assertive Community Treatment (ACT),24 and 4) Specialized Foster Care In- tensive In-Home Mental Health Services (IIHMHS),25 etc. Only two of the seven Hub Clinics, LAC+USC and Children’s Hospital, have contracts with DMH and have multiple mental health service professionals onsite. The East San Gabriel Valley Satellite Hub Clinic has access to mental health service providers through its affiliation with LAC+USC. Children’s Hospital is the only Hub Clinic that has services directed specifically toward Transition Age Youth. These are provided by the Children Hospital’s Division of Ado- lescent Medicine and located in a clinic separate from the CHLA Hub Clinic for younger children. Services for 12 to 21 year olds include specialized services for adolescents dealing with anger management, depression, substance abuse, homelessness, HIV and transgender issues. These services are provided to all adolescents, not just those re- ferred to the Hub Clinic by DCFS. Furthermore, LAC+USC hopes to obtain additional funding and resources to expand its Children’s Medical Village to include service for adults. This would require staffing the Medical Village with providers who are trained in both pediatrics and adult medicine, similar to the staff at the Children’s Hospital Division of Adolescent Medicine. Further, LAC+USC hopes to include Adult Protective Services staff in its proposed expanded Medical Village to provide easy access to social work services while remaining the med- ical home and coordinator of medical and mental health services for medically frag- ile/vulnerable Transition Age Youth aged 18 and older. Targeted Medical and Mental Health Services for Transition Age Youth As discussed in Section 1 of this report, “The Model Medical Hub Clinic”, model Hub Clinics should serve as the medical home and provide onsite mental health services for youth under the jurisdiction of DCFS. With the implementation of AB 12, youth aged 18 years old and older will continue to be eligible for medical and mental health services at Hub Clinics. At this time, Children’s Hospital is the only Hub Clinic that is able to pro- vide both medical and mental health services that are targeted toward the issues and 22 The Multidisciplinary Assessment Team (MAT) Assessment Program provides comprehensive assessments to evaluate a foster youth’s needs and strengths in various areas including medical, dental, developmental, hear- ing/language, education, mental health, vocational, and family/caregiver issues. The Transition Age Youth Full Service Partnership Program offers intensive services with 24/7 staff availability to help 16 to 25 year olds address emotional, housing, physical health, transportation, and other needs to help them function independently in the community. Assertive Community Treatment is a team-based approach to the provision of treatment, rehabilitation, and support services. A variety of services are offered under the Specialized Foster Care Intensive In-Home Mental Health Services (IIHMHS) program, including 24/7 intensive case management, Trauma Focused Cognitive Behavioral Therapy, Functional Family Therapy, as well as programs to assist caregivers with behavioral and emotional problems in young children. 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 297 EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH concerns of youth 18 years old and older. Therefore, DCFS should encourage youth 18 years old and older with complex medical and/or mental health needs to go to the Chil- dren’s Hospital services. According to Children’s Hospital staff, should referrals to the adolescent clinic from DCFS increase, the clinic would then consider applying for Federally Qualified Health Center (FQHC) status, which would allow the clinic to receive greater reimbursement for costs than they currently receive through Medi-Cal. However, until the adolescent clinic officially receives such a status, the clinic will need grant funding to absorb the addition- al referrals. Children’s Hospital is not conveniently located for all Transition Age Youth located throughout the County, particularly for the medically fragile/vulnerable youth aged 18 and older. DCFS, DHS, and DMH should work together to identify funding for additional transportation services to and from CHLA. Currently, Children’s Hospital is able to pro- vide transportation passes to youth participating in its Full Service Partnership Program, funded through a DMH contract. Similar funding should be identified or expanded for the additional DCFS referrals of youth to the Children’s Hospital. For youth who are not lo- cated near public transportation, DCFS, DHS, and DMH should explore funding for van services. This type of service is already provided to youth living in the Lancas- ter/Palmdale area for services at the High Desert Hub Clinic. Children’s Hospital currently has the greatest capacity to serve the special needs of Transition Age Youth aged 18 and older. Additionally, resources could be designated or reassigned to LAC+USC to expand its Children’s Medical Village to include medical services for adults and access to Adult Protective Services social workers to meet the medical and mental health needs of Transition Age Youth aged 18 and older. SUMMARY Prior to January 1, 2012, most youth under the jurisdiction of DCFS were emancipated and their DCFS cases were terminated after they turned 18 years old. Though there were exceptions for some 18 year olds to remain under foster care and receive inten- sive case management services, a majority of the youth 18 years old or older received additional DCFS services on a voluntary basis but did not access medical and mental health services at the Hub Clinics. Though most of these youth were eligible for Medi- Cal after they turned 18, which could reimburse the Hub Clinics if used by the youth, their choice of medical provider was left up to them. None of the County-affiliated Hub Clinics made special efforts to encourage these youth to obtain medical care from them. With the passage of extended foster care services through AB 12, as of January 1, 2012, youth under the jurisdiction of DCFS can remain in the child welfare system until the age of 21, as long as they meet certain criteria. Therefore, Transition Age Youth aged 18 to 21 could continue to use Hub Clinics for medical and mental health needs. Their medical care would continue to be reimbursed under the Medi-Cal fee-for-service arrangement, which provides a better cost recovery for the clinics than Medi-Cal man- aged care rates. 298 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH A majority of the Hub Clinics currently do not provide medical services to youth under the jurisdiction of DCFS that are 18 years old or older. Youth that are medically frag- ile/vulnerable currently receive medical services from specialized medical providers and clinics throughout the County. Further, only two of the Hub Clinics have Department of Mental Health contracts and multiple mental health providers at their Hub Clinics to pro- vide mental health services to DCFS youth. Only Children’s Hospital LA offers an ado- lescent clinic that provides medical and mental health services targeted toward youth aged 12 to 21. However, LAC+USC has plans to expand its Children’s Medical Village with medical services for adults, particularly Transition Age Youth aged 18 and older, including access to Adult Protective Services social workers. The Hub Clinics could serve as medical homes for medically fragile/vulnerable TAYs by coordinating services among the various specialized medical and mental health provid- ers, as long as they are within the same hospital system. Such coordination would re- quire additional training for the medical providers to be aware of the various issues spe- cific to TAYs. Finally, DCFS and DHS could refer other medically fragile/vulnerable TAYs to Children’s Hospital to benefit from their specialized Adolescent Clinic and initi- ate a plan to establish similar specialty clinics for TAYs at some or all of the County Hub Clinics. The Hub Clinic with the greatest capacity for expansion of services for Transi- tion Age Youth is currently LAC+USC because it is building a Children’s Medical Village with an aim to provide access to subspecialty medical services beginning in the summer of 2012. FINDINGS 5.1. According to national statistics, youth transitioning out of foster care are at risk and have higher rates of homelessness, as well as mental health, physical, and devel- opmental problems. For example, 27 percent of the nation’s homeless population have been in foster care, while youth emancipating out of foster care have a one in six chance of being homeless within one year. 5.2. As of November 30, 2011, there were 1,672 youth under the jurisdiction of DCFS that were 18 or older. Prior to January 1, 2012, most of these youth were emanci- pated and their DCFS cases were terminated after they turned 18 years old. Most of these youth were only able to receive additional DCFS services on a voluntary basis and, though not precluded from doing so, most did not access medical and mental health services at the Hub Clinics which are generally geared toward chil- dren, and have not made efforts to encourage Transition Age Youth emancipating from the child welfare system to use their services. 5.3. With the passage of extended foster care services through AB 12, youth under the jurisdiction of DCFS may now remain in the child welfare system until the age of 21, as long as they meet certain criteria. Based on DCFS data on youth 16 years old and older and under DCFS jurisdiction as of November, 30, 2011, the estimat- ed total number of Transition Age Youth that could remain in DCFS through 2014 ranges from 3,800 to 5,483 youth. 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 299 EXPANDING HUB CLINICS – 5. TRANSITION AGE YOUTH 5.4. The number of medically fragile/vulnerable youth with special needs due to a men- tal health diagnosis, developmental delay or a physical or medical condition that requires specific care under the jurisdiction of DCFS was 2,163 as of November 30, 2011, of which 198 were 18 years old or older. Though Hub Clinics may not of- fer the specialized services and clinics needed by the medically fragile/vulnerable youth, the Hub Clinics can still play a role as the medical homes for youth who need to see multiple medical providers and specialists within the hospital system affiliated with each Hub Clinic. 5.5. The majority of the Hub Clinics currently do not provide medical services to youth aged 18 years old or older. Further, only two of the Hub Clinics have Department of Health contracts and multiple mental health providers onsite at their Hub Clinics to provide mental health services to DCFS youth. Only Children’s Hospital LA current- ly offers an adolescent clinic that provides medical and mental health services tar- geted toward youth age 12 to 21 years old. However, LAC+USC has plans to ex- pand its Children’s Medical Village, which will provide access to several medical subspecialty services, to include adult medical services for Transition Age Youth aged 18 or older.