Opponents of Psychotropic Foster Care Reform Bills Rally Forces as Bills Await Governor’s Approval


California — The battle lines have now clearly being drawn between those who genuinely advocate for the benefit of youths in state care, and those who make handsome livings exploiting them. Legislators have unanimously approved three of four bills that would impose some meaningful oversight over the administration of psychotropic drugs to children in care – particularly those under age 5. Opponents of these reforms have lobbied extensively to block their passage, derailing one bill completely. Three are on Governor Brown’s desk awaiting his approval. Your support may help.


Background

A comprehensive Bay Area News Group investigation, “Drugging Our Kids,” revisited the longstanding issue of youth in California’s foster care system being prescribed psychotropic medications at alarming rates. This provided the impetus for legislative hearings.

Psychotropic Hearing Background Paper

In a background paper provided for a legislative Hearing held on February 24 of this year, Chairman Mike McGuire explained, “Over the last 15 years, prescribing rates of psychotropic medications for California’s foster youth have steadily increased, from less than 1 percent of foster youth receiving such medications in 2000, to nearly 15 percent of all foster youth today. When adjusted to account only for adolescent foster youth, prescribing rates rise to nearly 1 in 4 youth, and 56 percent of all youth residing in group homes were prescribed at least one psychotropic medication.”

Legislators took action, drafting four bills to address this longstanding problem. By some miracle, three of them are on Governor Brown’s desk awaiting his possible approval. These three bills include:

SB 484, introduced by Senator Beall, would require the department of social services, if it determines that a facility is administering psychotropic medications to children at a rate exceeding the average authorization for all group homes, to inspect the facility at least once a year to examine the contributing factors.

SB 238, introduced by Senators Mitchell and Beall, would require updates to ensure that the child and his or her caregiver have an opportunity to provide input on the medications being prescribed. It would require the updates to include a process for periodic oversight by a court.

SB 319, introduced by Senator Beall and coauthored by Senator Monning, would require a county to provide the services of a foster care public health nurse to children in foster care. That nurse would oversee the prescriptions of psychotropics to foster children.

Opponents mounted a vigorous and expensive lobbying campaign, managing to derail one of the original four bills. SB 253, introduced by Senator Monning, with principal coauthor Assembly Member Chiu, would have required that whenever a court authorizes the administration of a psychotropic medication, it would ensure that the administration of the medication is only one part of a comprehensive treatment plan for the child, and specify the psychosocial services the child would receive in addition to any authorized medication.

As of September 2, 2015, the last action on SB 253 reads: “Ordered to inactive file on request of Assembly Member Holden.”

The Opposition

Bay Area News Group journalist Karen de Sá has certainly done her homework. As she reported on September 6:

Monning’s bill is supported by the state’s Judicial Council, but opposition has been building: On Wednesday, the California Medical Association, the California Psychiatric Association, the California Academy of Child and Adolescent Psychiatry and the California Alliance of Child and Family Services, representing residential group homes, released a surprising last-minute “Assembly floor alert” calling for a no vote.

The groups charge the bill would hamstring doctors by requiring proof to the juvenile court that they had reviewed foster children’s medical records, obtained lab results, and confirmed there were no “less invasive” treatments available. The physicians also balk at being subject to second medical opinions, which under Monning’s bill would be triggered by requests for multiple medications or prescriptions for kids ages 5 and younger.

According to filings with the California Secretary of State, the groups opposing the bill have spent more than $1.4 million between Jan. 1 and June 30 lobbying the Legislature, an amount equal to more than $11,000 per business day. The alliance representing residential facilities alone spent more than $325,000.

“SB 253 is really key,” said Bill Grimm, senior attorney with the National Center for Youth Law. According to Grimm, SB 253 is the “the linchpin of this whole package because the courts are the gatekeepers, and if the gatekeepers are not doing their job, everything else is not going to come together to solve the problem.

“The opposition that’s been mounted by the medical community is unconscionable,” said Grimm.

A Closer Look

The interconnectedness of it all is astounding, both in scope and scale. This point was not lost on the Mendocino County Grand Jury, which noted in its 2010 report that:

The GJ was surprised to learn of the connections between County and private agencies serving youth. The web of services, utilized by multiple agencies makes it difficult to determine the lead agency and who is accountable for problems that may arise. The GJ also noted duplication of services and potential inflated costs by the non-profit agencies.

Just how closely-knit the universe of physicians, psychiatrists, group home providers, and other industry stakeholders is suggested by the membership roster of the County Behavioral Health Directors Association of California. The Association bills itself as “a non profit advocacy association representing the behavioral health directors from each of California’s 58 counties, as well as two cities.”1

This Assembly “floor alert” was distributed to legislators in a last minute effort to defeat SB-253

While not mentioned in the article by Karen de Sá, the County Behavioral Health Directors Association of California’s logo appears prominently on the letterhead of the floor alert. Among those who recieved a copy: all of the Honorable Members of the California State Assembly; The Honorable Bill Monning, 17th Sen. Dist.; The Honorable David Chiu, 17th Assembly Dist.; Agnes Lee, Office of Speaker Toni Atkins; William Grimm, National Center on Youth Law; Frank Mecca, County Welfare Directors Association; Patricia Huston, Department of Social Services; Jennifer Kent, Director, Department of Health Care Services; Farrah McDaid-Ting, California State Association of Counties; and – to be sure – Donna Campbell, Office of Governor Jerry Brown.

Bearing in mind the intertwined relationship between the County Behavioral Health Directors Association of California and the the California Academy of Child and Adolescent Psychiatry, consider that the County Behavioral Health Directors Association maintains an agenda item, namely the CBHDA 2015-16 Legislative Bill Matrix, a document that details the group’s stand on all of the bills that they are monitoring. Comparing that document to the Academy of Child and Adolescent Psychiatry’s Form 635 filing, which by law discloses all legislative or state agency administrative actions actively lobbied on – whether for or against – reveals stark similarities. Consider that the California Academy of Child and Adolescent Psychiatry spent $12000.00 on lobbying over the three-month period spanning April 1 through May 30 of this year. An unspecified amount of that money went to lobbying against these four specific reform bills.2

California Alliance of Child and Family Services

Another organization fighting tooth and nail to block the proposed legislation is the California Alliance of Child and Family Services. What must be understood is that once the sugar-coated rhetoric about serving vulnerable children and families is stripped away, what remains is the unvarnished fact that the California Alliance of Child and Family Services is a business association, whose primary task is to promote the financial interests of the industry that it represents.

In 2006, the Alliance of Child and Family Services sued the State of California claiming that rates paid to group homes and other related facilities had been flat for five years, and that the facilities were therefore being “underfinanced” by the State. As the Alliance describes itself in its own lawsuit:

The Alliance’s membership includes approximately 150 private, non-profit agencies that provide adoption, foster care, group home, mental health treatment, family preservation and support, wrap-around, educational, and other services. Approximately 130 of these agencies operate one or more group home programs, with a total licensed capacity for 5,700 children and youth.

The Alliance of Child and Family Services filed a suit claiming group homes were underpaid

The lawsuit continued on to explains that, “the Alliance seeks to protect the interests that are germane to its purpose and affiliation with member group homes. Each group home that is a member of the Alliance has independent standing to bring an action. Nevertheless, the Alliance asserts the claims alleged in this complaint without the participation of any individual member of the Alliance. Should it be deemed necessary for a group home to participate in this action, the Alliance will seek leave to amend this Complaint to name specific group homes as parties-in-interest.”

Perverse incentives

Reports concerning perverse financial incentives abounded, and even well prior to the filing of the Alliance’s suit, it had become public knowledge that some group home owners were profiteering, even as they provided precious few services to the youth assigned to their care. The Madera County 2005-06 Grand Jury reported agency rates for placement of a child ranged from $2,966 to $6,371.00 per month, putting “a burden on taxpayers.” The amount spent in that County alone had risen 58% from 1998 to 2004, an amount totaling $1,446,017.00.

During the mid-1990s, reports came out of wealthy owners keeping their group homes on meager budgets, and failing to provide children with adequate food, books, school supplies, or supplies for daily hygiene. Among the many problems identified by investigators in San Diego were instances of children being mistreated, or left unsupervised. At one group home, a female staff member had sex with a young boy numerous times; a suicidal girl was given bottles of pills by a staff member and subsequently attempted suicide; a girl had been molested at a bus stop after a staff member failed to pick her up as scheduled.

Inspectors from the San Diego community care licensing office routinely found health and safety violations at the group homes, including rodent droppings in the kitchens, bugs in a cereal bags, and meals that failed to meet nutritional standards. But the operating licenses were never suspended or revoked.

A longtime foster care licensing official, speaking to reporters on condition of anonymity, said that the group home system was tainted by providers who enrich themselves, and by regulators incapable of stopping
them.

“It’s a barrel with a lot of rotten apples. The level of greed hasn’t changed.”

He said operators employed a variety of cash-skimming methods, from costly lease-backs, to exaggerating or falsifying the credentials of staff members so as to obtain a higher rate of funding.3

The Los Angeles Auditor-Controller released an audit in December 10, 2003, finding that Teen’s Happy Home, Inc., – a business that provided services for 41 children in 31 certified homes and one certified group home with a capacity of six children – was being paid anywhere from $1,589 to $3,458 per child, making for “a total of $1,087,104 in foster care funds from DCFS.”

Another audit released in late 2002 explained, “New Concept is one of two group homes licensed to operate under the corporate name of Humanistic Foundation, Incorporated. The other group home, Stockdale Boys Center, is located in Kern County. New Concept has a resident capacity of eight children and, during our review period, received $335,084 from Los Angeles County.” In this one facility alone, the Auditor-Controller’s office “identified $56,381 in excess salary compensation, $30,732 in expenditures that are not supported or inadequately supported by original receipts and $10,340 in expenditures that are unallowable because they are not program related.”

Many other group homes were paid equally exorbitant rates. The Auditor-Controller’s Office released an audit on November 3, 2011, explaining, “DCFS paid Project 6 $5,8891 per child per month, based on a rate determined by the California Department of Social Services, for a total of $1,208,908 during Fiscal Year (FY) 2008-09.” Another audit revealed that Little People’s World – which ran four group homes each with a capacity of only six children – took in $5,891 per child, for a total of $1,112,598 during 2009. The audit also identified well over $182,000 in unallowable expenditures. $172,311 of those expenditure “consisted of non-salary payments to the Agency’s Executive Director.”

Another audit revealed that the Mozell Pennington Boys Center, Inc., – which ran one foster care group home with a capacity of only eight children – was paid $3,862 per month per child, for a grand total of $285,337 in 2009. Over $12,000 in questioned expenditures were identified, according to the Auditor-Controller’s office.

The amounts paid out to various group homes continued to escalate. In its audit of Luvlee’s Residential Care, Inc. – which had a resident capacity of two homes holding only six children each – the Auditor-Controller found that, “DCFS paid LRC $4,941 per child per month, based on a rate determined by the California Department of Social Services. The rate increased to $5,490 per child per month, effective December I, 2009, and increased again to $7,274 per child per month, effective December 14, 2009. During calendar year 2009, DCFS paid the Agency a total of $737,063 in GH foster care funds.” In May 2010, the United District Court, Northern District of California, acting under a ruling from the Court of Appeals, ruled in favor of the Alliance, ordering the rates paid out to group homes in the State of California must be increased.

The Rate Structure

California has a 14 tier Rate Classification Level, with the allegedly more difficult to manage youth being assigned higher rates for placement under the presumption that they will be provided with increased services. It is the group homes and other specialized care facilities that get the higher tiers of reimbursement, as they are assigned those children who allegedly have the most complex needs.

The crème de la crème are the tier 14 youth, who, as of September 1, 2015, generated $10,130 per month per child for their treatment and care, according to the 172-page Foster Care Rates Group Home Facility Listing available from Governor Brown’s office.

With regard to the Rate Classification Level as it applies specifically to California’s group homes, the 9th Circuit Court of appeal explains:

California uses the Rate Classification Level system (RCL) to determine the amount of the foster care maintenance payments it makes. The RCL uses a point system that classifies group homes in fourteen categories. The funding they receive depends on the category. A group home’s RCL is based on “the level of care and services that the group home operator projects will be provided during the period of time for which the rate is being established,” and payments are made on a per child, per month basis.4

Less problematic youths may be assigned to conventional foster homes, a situation that provides foster parents with the incentive to work the system for higher rates of reimbursement. The 1991-92 San Diego County Grand Jury expressed these concerns in The Crisis in Foster Care. Among the Jury’s findings: “Caseworkers, investigators and attorneys believe that some foster parents routinely complain of behavioral problems, insist that those behavioral problems require mental health therapy and then seek additional funds for regular transportation to the therapist and special care needs.”

A trip to an industry-affiliated physician or mental health specialist provides the psychiatric diagnosis. With that diagnosis comes a higher reimbursement and the meds to treat it. Where it gets interesting is in the increasing number of private agencies that essentially act as middlemen between foster parents and the departmen of social services. As such, their financial reimbursement rises as well, as they keep a significant percentage of the payments for administrative expences.

The post-lawsuit years

After the dust had settled from the lawsuit, the situation deteriorated significantly – at least for the intended recipients of the funding increases.

In January 2010, in a New York Times commentary aptly entitled “Financial Difficulties Strain California’s Foster Care System,” journalist Gerry Shih explained: “In a tale all too familiar in cash-strapped California, the foster care system has been coming apart from inadequate state financing for at least 20 years, officials at the county level say. In the past two months, a succession of key court decisions in favor of care providers lifted hopes that the judicial rulings might finally turn things around, but the lawsuits have simultaneously shed light on a system that has been cut to the bone.”

The San Joaquin County Grand Jury, in its 2013 report, aptly entitled Fractured Oversight Fails to Serve At-Risk Youth, found that while the State’s Rate Classification Levels were paying out per child rates nothing short of $6,649 to $9,419 per month for youth in the RCL ranges of 9 to 14, the regulatory and oversight roles had “deteriorated to the point of allowing some Group Homes to go unmonitored or un-inspected for periods of up to four years.”

The Jury found that while some providers appeared concerned and provided appropriate treatment, “some Providers appeared to serve At-Risk Youth with an unusual emphasis on increasing their profits.” Around this time, there was a renewed interest in outcomes, as former foster youth – having been emancipated onto the streets with precious little support – let alone any meaningful preparation for life – began to attract the attention of the California’s Grand Juries and the press, as they continued to swell the ranks of the homeless and prison populations.5

With renewed attention focused on these issues, there was one other “discovery” made with respect to foster care outcomes. The Los Angeles Times headline says it all: Most L.A. County youths held for prostitution come from foster care.

The Way Forward

With hearings behind them, and the unanimous support of California’s legislators, some modest reform proposals are moving forward, and the State appears to be poised toward leading the nation into a more progressive era.

This year – and in a truly bi-partisan manner – federal hearings were held into the subject of group homes. During a hearing held on August 4, chairman of the Senate Finance Committee Orrin Hatch addressed the Committee, saying:

I believe that we should do whatever we can to reduce the reliance on foster care group homes. There is a point when we should refuse to spend scarce taxpayer dollars to subsidize a placement that we know results in negative outcomes for children and youth. As I have said in the past, no one would support allowing states to use to federal taxpayer dollars to buy cigarettes for foster youth. In my view, continuing to use taxpayer dollars to fund long-term placements in foster care group homes is ultimately just as destructive.6

Clearly, many legislators on the federal level have grown weary of throwing good money after bad, and to the tune of many billions of dollars on an annual basis. In recent years, federal hearings have been held into psychotropic medications in foster care, as well as into child trafficking, a problem that has finally emerged as a mainstream issue of direct relevance to foster care. These issues have been elevated into the public consciousness by the national news media. Some of the best kept secrets in foster care are secrets no longer.

How You Can Help

The National Center for Youth Law has spearheaded a reform campaign that promises the potential for meaningful oversight over the administration of psychotropic medications in foster care. With the support of other advocacy groups, as well as the Bay Area News Group, California’s legislators have risen to the challenge of reform.

The National Center for Youth Law has provided a model letter (in DOC format) on the organization’s Facebook page that you can easily adapt to meet your needs. Take a few moments out to lend support to what may someday be looked upon as an historical accomplishment by sending a letter of support for the legislation now sitting on Governor Brown’s desk awaiting his signature.


RELATED MATERIAL

California Moves To Stop Misuse Of Psychiatric Meds In Foster Care, National Public Radio, September 02, 2015.
NPR explores the efforts of the National Center for Youth Law and others in reforming California’s use of psychotropic medications to manage foster children.

Assembly passes three bills to curb psych drugs in California foster care, San Jose Mercury News, September 8, 2015.

California Assembly to vote on diminished bill package to curb psychotropic drug use on foster children, San Jose Mercury News, September 6, 2015.

California Lawmakers Approve Plan to Tackle Misuse of Psychiatric Meds, Youth Today, September 2, 2015.

Private foster care system, intended to save children, endangers some, Garrett Therolf, Los Angeles Times, December 18, 2013.

A Way Back Home: Preserving Families and Reducing the Need for Foster Care, United States Senate Committee on Finance, Hearing, August 4, 2015.

No Place to Grow Up: How to Safely Reduce Reliance on Foster Care Group Homes, United States Senate Committee on Finance, Hearing, May 19, 2015.

‘Dr. Phil’ McGraw Testifies in Congress on Psychotropic Drugs in Foster Care, Lifting the Veil Blog, May 2, 2014.
Dr. McGraw was a signatory to a letter signed by 117 national and state organizations, urging an initiative intended to reduce the over-prescription of psychotropic medication to foster children.

California: Lawsuit Filed Against Interim Care Foster Family Agency, Lifting the Veil Blog, August 8, 2015.

Bipartisan Federal Effort Targets Foster Care Group Home Reform, Lifting the Veil Blog, August 1, 2015.

California Legislators Take Aim at Psychotropics in Foster Care, Lifting the Veil Blog, March 27, 2015.


REFERENCES

1. The organization as it is currently structured came into being on July 1, 2014, having been formed by the merger of the California Mental Health Directors Association and the County Alcohol and Drug Program Administrators Association of California. Precisely defining the interlocking relationships between various organizations presents some difficulties, however, and in brief, the County Behavioral Health Directors Association of California in effect plays the role of a coordinating or “umbrella” organization. It is self-described as the “state-wide umbrella organization that draws together the four regional councils of child and adolescent psychiatrists in California. Its purpose and mission is to represent the interests of the four regional organizations in California’s legislative process, public policy making, and clinical service administration as it finds them relevant to the mental health of California’s child, adolescents and families. CAL-ACAP is incorporated as a 501-C6 compliant organization and is represented by the lobbying firm of Shaw, Yoder & Antwih in Sacramento.” The California Academy of Child and Adolescent Psychiatry is a regional offshoot of the National Academy of Child and Adolescent Psychiatry, an extremely influential organization on the national level. It describes itself as its membership being composed of “the child and adolescent psychiatrists who belong to the American Academy of Child and Adolescent Psychiatry (AACAP) as national members and locally, to their respective regional councils. The regional councils each have representation on the Executive Council of CAL-ACAP and governance is through votes of the elected/appointed representatives.” The Northern California Regional Organization of Child and Adolescent Psychiatry, covers an area ranging from San Jose north to the Oregon border and east to the edge of Davis, California. The Central California Regional Organization of Child and Adolescent Psychiatry, covers Davis, Sacramento, and the Central Valley cities and towns of California to the Nevada border. The Southern California Society of Child and Adolescent Psychiatry covers Los Angeles and its environs. The San Diego Academy of Child and Adolescent Psychiatry covers San Diego and its environs. In 2014, the aggregate membership represented more than 800 child and adolescent psychiatrists across the state of California.

2. The California Academy of Child and Adolescent Psychiatry claims interest in some other bills on its Form 635 filing as well, however, they are not strictly opposed any of the bills so much as they express “concern” or a desire to see certain amendments made. These include AB 1299 – a highly specific bill concerning when a foster child’s mental health care would be transferable to another jurisdiction. (It would make it extremely difficult to track children in care and their mental health providers as they cross jurisdictional boundaries – a task the counties are already incapable of adequately performing.) Presumably, its lobbying activity with regard to this bill is one of seeking to enact specific changes that address its concerns. Also among the bills is AB 1025, a rather ambitious and wide-sweeping bill that “would require the Mental Health Services Oversight and Accountability Commission to revise its guidelines and regulations regarding prevention and early intervention programs in K–12 schools, as specified.” AB 1025, otherwise known as the Pupil health: multitiered and integrated interventions pilot program, would create a three-year pilot program “to encourage inclusive practices that integrate mental health, special education, and school climate interventions following a multitiered framework.” The bill would further provide targeted interventions “for pupils with identified social-emotional, behavioral, and academic needs, such as therapeutic group interventions, functional behavioral analysis and plan development, and targeted skill groups.” AB 1299 is slightly less ambitious. It seeks to “overcome the barriers to care that exist under existing law, which place responsibility for providing or arranging for mental health services to foster children who are placed outside of their county of original jurisdiction, on those same counties.” AB 519 provides that, “Improving the stability of adoptive and guardianship families by requiring the State Department of Social Services, county adoption agencies, county child welfare agencies, and licensed adoption agencies to provide potential adoptive families and guardians information, in writing, regarding the importance of working with mental health providers that have specialized adoption or permanency clinical training and experience if the family needs clinical support and the desirable clinical expertise the family should look for when choosing an adoption- or permanency-competent mental health professional.” AB 133 provides that, “It is in the interest of California’s children, families, schools, and communities that the State of California support local decisions to provide funding for evidence-based services to address the mental health needs of children in publicly funded preschools and elementary schools.” SB 276 would require the department to seek federal financial participation for covered services. It is a cost-shifting, revenue maximization measure that would appear to ensure payments to providers for a wider range of students. SB 614 would require the State Department of Health Care Services to establish “a statewide peer, parent, transition-age, and family support specialist certification program, as a part of the state’s comprehensive mental health and substance use disorder delivery system and the Medi-Cal program.” By no means has the organization expressed recent opposition concerning the passage of any of these bills. Indeed, even a cursory reading would suggest that the organization and its affiliated stakeholders would stand to gain from these proposals, even if they were all passed without substantial amendments. These leaves open considerable room for speculation as to whether the Form 635 filing is packed with some red herrings to divert attention from the primary thrust of its lobbying efforts. Any speculation along these lines, however, must be tempered by the realization that Form 635 filings require that all lobbying activities are reported.

The California Academy of Child and Adolescent Psychiatry also lists “JLAC Audit request re: AB 114” as among the legislative matters in which it holds an interest to the extent of lobbying. A press release from Senator Jim Beall, dated April 22, 2015, explains: “An audit request by Senator Jim Beall to find out how school districts are using mental health funding and whether they are meeting their obligation to provide mental health services to students was approved today by the Joint Legislative Audit Committee.”

Carefully comparing the the County Behavioral Health Directors Association of California’s CBHDA 2015-2016 Legislative Update As of 9/14/2015 with the California Academy of Child and Adolescent Psychiatry’s Form 635 filing is quite rewarding. So, too, is comparing the membership rosters of the various organizations opposing the key reform measures.

3. Uri Berliner, “Care Group is Overpaid, State Finds – California Crest Homes’ Excess Put at $2 Million,” San Diego Union-Tribune, (March 30, 1995); Uri Berliner, “Mining Riches from Troubled Kids,” San Diego Union-Tribune, (June 5, 1994); Uri Berliner, “Board Set to Ask for Investigation of Group Homes,” San Diego Union-Tribune, (June 15, 1994).

4. California Alliance of Child and Family Services v. Allenby, 589 F.3d 1017 (9th Cir.2009) overturning California Alliance of Child and Family Servs. v. Allenby, 459 F.Supp.2d 919 (N.D.Cal.2006) and remanding the case back with instructions to rule in favor of the Alliance. By this time, the Alliance’s ranks had begun to diminish relative to its 2006 filing; a motion filed in in 9th Circuit in September 2010 states that: “The Alliance’s member agencies operate 87 group home programs, with a licensed capacity of 3,720 beds.” Respondent California Alliance Of Child And Family Services’ Response To Appellants’ Motion For Emergency Stay, C.A. NO. 09-17649, USDC Case No. 09-04398-MHP. (9th Cir.2010).

5. See for example Ventura County Grand Jury, Youth in Shadow, June 14, 2010 (“The inability of states to accurately report the number of youth currently in care or who age out each year, and the inability to determine how well they are doing two, three, or four years after leaving care is discouraging and dissuades accountability”); Orange County 2006-07 Grand Jury, Pre-Post Emancipated Youth (“Data suggests that many of the emancipated youth suffer homelessness, run-ins with the judicial system, drug use, and pregnancy. They struggle to get and keep jobs and are unprepared to run their lives without help”); San Mateo 2009-10 Grand Jury, Mentoring Emancipated Foster Youth (“Studies show that emancipated youth need a safe place to live, a high school diploma, health care, access to higher education, and quality employment in order to become self-sufficient adults. In addition, and perhaps most important, emancipated youth need a sustained commitment from a loving, safe and supportive adult or family to stay involved in their lives as long-term mentors”); Orange County 2006-07 Grand Jury, Where Are Orange County’s Foster Children (finding a shortage of group home beds for Orange County youth, who had been shipped out-of-county because Los Angeles was paying higher rates for youth of its own”); San Diego Grand Jury, Transitional Age Youth, 2010 (“Approximately 425 youth age out of San Diego County foster care each year. In foster care, aging out is the process of a youth transitioning from the formal control of the foster care system towards independent living. With the exception of incarcerated youth, foster youth are the only group that is involuntarily separated from their families through government intervention”); Santa Barbara County 2007-08 Civil Grand Jury, Child Welfare Services: A System of Care That Lacks Stability (“In the most recent year ending June 2007, 12 out of 38 emancipated foster children in Santa Barbara County became homeless within the first six months”).

6. A Way Back Home: Preserving Families and Reducing the Need for Foster Care, United States Senate Committee on Finance, Hearing, August 4, 2015.