200 Children Win Right to Home Mental Care

About 200 Los Angeles County children have won the right to intensive in-home mental health services--in some cases including around-the-clock counseling by one-on-one aides--under a new ruling by a federal judge.

Mental health advocates cheered the decision and said they believe it eventually will be extended to benefit children throughout California who suffer from extreme mental and emotional disorders.

Most of the children who will benefit from the new service have moved from psychiatric hospitals to group homes, usually becoming more disturbed as they went, according to mental health advocates who sued for the change.

U.S. District Judge William Keller last week ordered the state Department of Health Services to institute the intensive home therapy program for Medi-Cal patients under the age of 21 who have failed in traditional psychiatric programs.

Whether the agencies involved will comply with the temporary restraining order, or put it on hold by appealing, remains unclear.

“This decision gives these children, finally, a chance for a better life,” said Melinda Bird, an attorney for Protection & Advocacy Inc., one of four public interest law firms that sued for the change.

Bird noted that two of the five clients in the case attempted suicide during litigation. “With these new services, I think we have a real chance of preventing tragic situations like that in the future,” Bird said.

At attorney representing the state Department of Health Services said the agency does not oppose intensive home therapy. It simply needs more time to plan for what could be a complicated and costly program, said James F. Ahern, the deputy attorney general representing the agency.

The lawsuit by the public interest groups was meant to benefit a small but growing group of deeply disturbed children and teenagers. Often, the youths were abused or neglected by their parents, and their mental health continued to deteriorate as they moved through the foster care system.

When even the most intensive group homes and psychiatric hospitals could not help the children, it became clear that alternatives were needed, said Marilyn Holle, another Protection & Advocacy lawyer. The federal government provided for such intensive care in its 1989 expansion of Medicaid mental health programs for children, Holle said. The law has been applied unevenly in various states.

The decade-old requirement says that states must provide for children’s mental and emotional disabilities at home if such care is judged medically necessary and cannot be provided in any other setting. Such children typically are extremely depressed or agitated. Some have below normal cognitive abilities. Others are suicidal.

Bird estimated that as many as 2,000 children in Los Angeles County might meet the general criteria for home care, but that only about 200 will actually fit into complex treatment programs.

The new programs will effectively convert homes into micro-treatment centers, with caretakers bolstered by a phalanx of child mentors, behavioral aides, tutors and psychotherapists. The children might live with their own parents, foster parents or in group homes.

The behavioral aides might be assigned to throughout the day and even overnight, to help with counseling and behavior modification.