Tuesday, January 30, 2007

Levels of Care: An Unsolvable Conundrum?

In nearly every state, foster care payments are determined by how difficult the child is to parent. Incident Reports are filed and there are reviews periodically to make sure that the behaviors still exist that were initially reported. Keeping a child at a "therapuetic level" is a good thing for the foster parents (they make more money) and the therapuetic agencies (if the child is no longer therapuetic, their services are unnecessary).

Even the most integritous of indviduals is going to have a hard time proving that the child is improving to the point that they need to be paid less money. And then there is the other extreme. I placed a 17 year old who told me that his foster parents sat down every night and filled out incident reports about him and the other foster children in their home. "They had me at a Level Four for a while and there's no way I was ever more than a Level Two," he reported.

I suppose that the other extreme could also occur, though I would guess that it happens less often. If a basic care foster parent falls in love with a child and does not want that child moved into another home (to receive therapuetic foster care services) couldn't that foster parent downplay the child's issues and paint an inaccurate picture?

The conundrum comes into play when the child is legally free for adoption and the foster parents, for whatever reason, cannot adopt the child. At this point it is time for the social worker to recruit a family for a child. The level of care is one of the first things that the parents hear about the child and eventually the prospective adoptive parents in many states will be reading through the many incident reports. Can prospective parents be convinced to adopt a child who has over 1,000 pages of incident reports in their file and a therapuetic level of care?

I post this because this is one of the issues around which my brain cannot wrap. I don't think we can honestly say that all foster parents and therapuetic agencies are going to accurately report improvements that will reduce their salary. I am sure that there are many out there who do, but unfortunately, they may be the exception rather than the rule.

Am I missing something obvious here? Is there a solution that I'm simply not seeing?

Please comment either here or at the Adoption Think Tank site.


Linda said...

I can only speak for our family's experience: The child reported to have the lowest level of care (out of sib group of 4) has aboslutely the biggest issues and needs the highest level of care. Otherwise I would have suspected the same as you are suggesting: improvements would not be reported to keep the money coming.

PKP said...

The other complication is that levels of care are subjective. There are not set criteria to determine levels. I'd love to see our state employ a medical professional and a behavior specialist to review and help set levels of care. For example, a child who requires occasional or even daily nebulizer medications shouldn't qualify for the highest level of care, but a child who has life-threatening asthma should. Our state uses a check list but its not very comprehensive.

It would be even more helpful if there was some consistency from state to state. One state sets a maximum rate regardless of level of care---unless the child is HIV positive. Not a very useful level of care determination.

I'd love to see some concrete suggestions on enhancing the level of care system to truly reflect a child's care needs. I think it would help families and workers determine best placement options.

AND why shouldn't kids who are SSI Disability eligible be able to stay in the SSI-D program regardless of parents income/resources? I think it would help bio and adoptive families to better provide for care needs and obtain services.....