Diana D., a teenager with severe mental health disorders, entered the New Mexico foster care system when she was 14 and over the next 12 months was prescribed nine psychiatric medications. But she was only intermittently monitored, and after two years in state custody became “mostly uncommunicative.”
And Justin B., who witnessed the death of his sister in a house fire and watched his parents use crystal meth, was deprived of adequate mental and behavioral health care to address his grief and neglect, according to a lawsuit that accused New Mexico of failing to protect those in foster care.
Calling the state’s child welfare organization a “broken system,” advocates for Kevin, Diana, Justin and 11 other foster children sued the state in 2018, claiming it was ill-equipped, understaffed and had a pattern of traumatizing already deeply troubled children by failing to provide vital mental health care and stable, safe foster homes.
But in a legal settlement set to be announced Thursday, New Mexico agreed to revamp its foster care system and essentially start over with one that is better prepared to manage its most vulnerable charges.
Under the terms of the agreement, the state committed to several changes aimed at improving childhood well-being, such as early screenings to diagnose and treat trauma. Other reforms include easy access to behavioral health services; long-term placements with families and culturally appropriate communities that nurture relationships; and training for foster parents, caseworkers and mental health professionals on the neurological effects of trauma.
The settlement resolves the lawsuit that was filed in September 2018 and was seen as a major victory to child advocacy groups that say the agreement could serve as a national model for foster care reform.
Across the country, foster care systems have been sued over the years for having too few caseworkers and for cycling children through unsafe housing. But rarely have states agreed to such broad reforms, said Kathryn Eidmann, a lawyer with Public Counsel, a nonprofit group that filed the suit along with several law firms and advocacy organizations.
“New Mexico is the first state to build a comprehensive system of child welfare organized around the principle of understanding and addressing the impact of trauma on foster youth,” she said. “The new approach will be transformative for the children of New Mexico, but it also paves the way for broader change across the country.”
New Mexico’s efforts reflect a growing awareness nationwide about the need to address the harmful effects of childhood traumas such as poverty, abuse and parental addiction. Research has shown that such traumas can disrupt healthy brain development and can lead to substance abuse, incarceration and health problems later in life. In response, legislators and schools have devoted increasing amounts of funding and resources to “social and emotional” learning that can help children cope with trauma and develop healthy response habits before they reach adulthood.
The need is particularly dire in New Mexico, a largely rural state with a majority-minority population, including 23 tribal nations. The state has the nation’s second-highest rate of childhood poverty and is ranked last for overall child well-being, according to the Annie E. Casey Foundation, a nonprofit organization in Baltimore. According to the lawsuit, New Mexico also has the highest rate of childhood trauma exposure in the country, with 18% of children having experienced three or more significant traumatic events.
Across the country, children entering foster care are likely to have experienced multiple forms of trauma, including physical and sexual abuse, but state foster care systems have often lacked the resources to provide even basic needs.
More than 2,500 children are in foster care in New Mexico, but they have long encountered a “gutted system,” said Ezra Spitzer, executive director of NMCAN, a nonprofit group in Albuquerque that helps foster youth.
Child advocates said many of the problems stem from policies made years ago, when cooperation efforts with Native American and Pueblo communities largely ceased and Medicaid funding was cut off to 15 behavioral health providers.
“In some places, there was one child psychiatrist or one provider who did everything,” Spitzer said. “It wasn’t ideal, but then they shut everything down, and nothing has filled that void. All of that trickles onto these kids who can’t get appointments or services.”
Two advocacy groups, Disability Rights New Mexico and the Native American Disability Law Center, filed the federal lawsuit against the state’s Children, Youth and Families Department, which operates foster care, and the Human Services Department, which oversees Medicaid services for children in state custody.
The suit accused the agencies of failing to provide adequate mental and physical health services to foster children, and of cycling them through a series of unsafe, unstable home environments where many were abused, drugged and physically restrained. Some children were sent to live with insufficiently trained families or housed in state agency offices, emergency shelters or residential treatment facilities, in many cases outside the state.
“New Mexico’s child welfare practices systematically re-traumatize vulnerable children,” said the complaint, policies that have led to “tragic and enduring consequences.”
The state disputed the allegations, but under Gov. Michelle Lujan Grisham, a Democrat who took office last year, her administration’s goals largely have aligned with the plaintiffs’ demands, the Children, Youth and Families Department said, and it has moved to address many of the issues at the heart of the lawsuit while collaborating on the settlement agreement.
Over the past year, the Children, Youth and Families Department has more than doubled the state’s number of child welfare caseworkers, increased adoptions, and has begun to rebuild relationships with Native American communities, said Brian Blalock, the department’s secretary.
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While fully revamping the foster care system will take time, Blalock said the settlement created a framework for ensuring that children in state custody, many of whom have suffered extreme adversity, receive the care they need to heal from traumatic experiences and grow into happy, healthy adults.
“We’re creating a system that makes sure everyone who interacts with kids understands if a child has been highly traumatized,” he said. “It gives kids the tools to navigate trauma and build resiliency.”
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The settlement agreement stipulates a series of concrete child welfare changes that must be completed by 2023, a timeline that allows the state to fund the reforms.
Among the terms, New Mexico will no longer send foster children to hotels or to out-of-state residential or treatment centers. It also will prioritize the least-restrictive long-term placements with relatives or family friends. It will ensure access to mental, behavioral and physical health services and adopt regulations to limit the use of psychotropic medications.
As part of the settlement, New Mexico will also expand protections for Native American children so they remain connected to their families, communities and cultural traditions.
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The new system aims to address the impacts of trauma, with one of the most important changes taking place at the very beginning, advocates said.
Under the terms of the agreement, New Mexico will now require that children be screened, and their trauma assessed and treated, as soon as they enter state custody, “which often happens in the middle of the night with their belongings in a plastic trash bag,” said Nancy Koenigsberg, a lawyer with Disability Rights New Mexico.
The screenings will play a significant role in shaping where foster children are placed and how they are treated, a radical shift from traditional child welfare practices, Koenigsberg said.
“Kids told us over and over that ‘things got done to me, and nobody asked me what I needed,’ ” she said. “The new system will ensure that all kids are heard, as opposed to having things done to them.”
This article originally appeared in The New York Times .