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Kansas foster care contractor sees benefits of trauma-informed training

by Meg Wingerter, Kansas News Service

Editor’s note: Kansas privatized its foster care system in 1997 after a lawsuit revealed widespread problems. Twenty years later, the number of Kansas children in foster care has shot up — topping 7,100 in April — and lawmakers approved the creation of a task force to examine the system. The Kansas News Service investigated problems in the foster care system and possible solutions. This is the fifth story in a series.

The foster care system in Kansas has problems, but a national child welfare group sees one area where it could lead the way for other states.

Tracey Feild, director of the child welfare strategy group at the Annie E. Casey Foundation, said work on childhood trauma by KVC Kansas, one of the state’s two foster care contractors, could be a model for others. The Casey Foundation sponsors the annual Kids Count report and other child-focused research.

KVC partnered with Child Trends, a nonpartisan national research group, to find out if training foster parents and caseworkers about childhood trauma would result in fewer moves for foster children. Childhood trauma includes experiences such as such as being exposed to violence, experiencing economic hardship or living with parents or guardians who abuse alcohol or drugs, are mentally ill or served time in prison.

KVC and Child Trends found that if adults understood the effects of traumatic events, children were more likely to stay in one home during their time in foster care. Children working with better-trained adults also were observed to have better behavior.

It makes sense that children whose foster parents and caseworkers understand their trauma fare better in the foster care system, Feild said. If parents and caseworkers know the reasons why children are acting out, they can stay calm and work through the issue instead of labeling the child as defiant, she said.

“That’s what you always hear about disruptions: ‘The child’s defiant. He won’t listen to me,’” she said. “Everybody has their own suitcase of reactions. You have to try to keep your suitcase closed and look at what’s going on in the child’s suitcase.”

Saint Francis Community Services, the state’s other contractor, also uses trauma-informed care, spokeswoman Vickee Spicer said.

Kids who experienced multiple traumatic events often struggle to trust adults, control their emotions or even understand their feelings, said Kelly McCauley, associate director of KVC’s Institute for Health Systems Innovation. The institute studies child welfare practices and offers training and consultation.

“We are often serving children who have significant levels of trauma,” she said. “For these kids, just getting through the day can be so much more difficult.”

The conventional wisdom was that foster children would get better once they were placed in a safe environment, but more recent research suggests that’s not always the case, McCauley said. Trauma can affect brain development and leave children in a fight-or-flight mode, which can lead them to overreact in situations that aren’t a threat, she said.

“It’s not because they’re bad kids. It’s not because they’re troublemakers or being willful or defiant,” she said.

“For these kids, just getting through the day can be so much more difficult.”

KVC staff and foster parents learn how to set healthy limits and guide kids toward good behavior, McCauley said. Children with a history of trauma need clear, positive behavior expectations, stable routines and the freedom to make choices within healthy limits, she said.

“With kids who’ve experienced trauma, overly punitive discipline can be very triggering,” she said.

Kids work with therapists to learn to tell their story, including their trauma and how they intend to move beyond it, and practice techniques to relax and express emotions in healthy ways, McCauley said. Some children in the foster care system often have a dark view of their future, she said, noting that one 18-year-old she worked with didn’t believe she would live to turn 19.

“Another part of it is helping them see that they don’t have to be defined by their trauma,” she said.

Meg Wingerter is a reporter for the Kansas News Service, a collaboration of KCUR, Kansas Public Radio and KMUW covering health, education and politics. She may be reached on Twitter @MegWingerter. Kansas News Service stories and photos may be republished at no cost with proper attribution and a link back to kcur.org.

See more at http://kcur.org/post/kansas-foster-care-contractor-sees-benefits-trauma-informed-training.

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Public meeting set for community comments on old Kaw River bridge uses

A public meeting on what to do with the abandoned Kaw River bridge from Kemper Arena to Kansas City, Kansas, will be held from 5:30 to 7:30 p.m. Thursday, June 22, at Hale Arena at the American Royal, 1701 American Royal Court, Kansas City, Mo.

A bike and walking trail are among the ideas for the bridge, along with other facilities.

The public meeting is a joint project of the Unified Government and the city of Kansas City, Mo. They received a Mid-America Regional Council grant to pay for a study.

Consultants on the project include el dorado inc., architects; TranSystems, engineers; and inSITE planning and Ecological Placemakers. Engineers also are determining the structural integrity of the bridge.

Hale Arena is located on I-670 to Exit 1B on Genessee and Wyoming street, south on Genessee to the arena. Residents attending the meeting may park in Lot B and on Genessee Street.

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Kansas lawmakers boost some spending on mental health system

by Meg Wingerter, Kansas News Service

In voting for a $1.2 billion tax increase to bolster the budget for the next two years, the Kansas Legislature avoided a projected $900 budget hole and began restoring past cuts to the mental health system.

The final budget bill that lawmakers approved earlier this month includes funding to partially restore cuts to community mental health centers over the past decade, but offers a mixed picture for the two state psychiatric hospitals. The bill also designates $4.7 million to reopen 20 beds at Osawatomie State Hospital or to pay another facility to make them available through a contract.

Gov. Sam Brownback has received the bill but has yet to take action on it. The governor’s initial budget proposal from the start of the session would have cut about $20 million from Osawatomie and Larned state hospitals by declining to replace lost federal funding.

The state-run psychiatric hospitals are for Kansans with serious mental health issues who have been deemed a danger to themselves or others. Since 2015, Osawatomie State Hospital has run 60 beds below its capacity of 206 and no longer takes voluntary patients.

The Kansas Department for Aging and Disability Services initially closed some units at Osawatomie State Hospital to allow for federally mandated renovations but didn’t reopen them after federal officials decertified the hospital and cut federal payments in December 2015 due to unsafe conditions. That has cost the state about $1 million a month in Medicare reimbursements.

During a recent visit to Osawatomie State Hospital as part of the recertification process, inspectors found new issues. But KDADS officials say those are being resolved and inspectors will return for another visit.

Although KDADS had requested steady funding for Osawatomie State Hospital in the upcoming fiscal year, the Legislature appropriated about $5.1 million less, possibly believing the hospital would soon regain federal payments. Lawmakers did instruct the Kansas State Finance Council to review funding for Osawatomie State Hospital later in the upcoming fiscal year, however.

De Rocha said she doesn’t anticipate that budget cuts will be needed at Osawatomie State Hospital before federal payments resume or lawmakers return to appropriate more money.

Reopening 20 beds

Earlier in the legislative session, KDADS Secretary Tim Keck told lawmakers that he would be cautious about reopening beds at Osawatomie State Hospital because of the need to hire more staff. For several years, KDADS officials struggled to maintain adequate staffing levels at the state psychiatric hospitals but recently launched efforts to recruit new employees and improve work conditions and patient care.

Angela de Rocha, spokeswoman for KDADS, said department officials haven’t decided whether to reopen any beds at Osawatomie State Hospital in the near future, but she expects at least some of the 20 beds will be provided by contractors.

Amy Campbell, who lobbies of behalf of the Kansas Mental Health Coalition, said opening 20 beds at Osawatomie State Hospital won’t solve the problem of Kansans waiting in emergency rooms or jails for a psychiatric hospital bed. But she said the funding for the beds is a positive step.

Lawmakers might have to come up with more money for Osawatomie State Hospital quickly when they return in January if federal payments don’t resume, Campbell said, but their investment in mental health suggests they don’t intend to shortchange the state hospitals.

“It doesn’t give me much heartburn, when you consider the money they’ve put on the ground to support these other programs,” she said.

While it isn’t clear when Osawatomie State Hospital might regain federal payments, it likely will remain in state hands, at least through 2018.

Keck had proposed the idea of privatizing the hospital in 2016, but met with a backlash from lawmakers, who inserted provisions into several bills to forbid selling off the state hospital without their permission. KDADS issued a request for bids to operate the hospital and received one, from a company with a history of safety issues at its Florida facilities. KDADS officials didn’t bring a proposal before the Legislature this session for approval, and De Rocha said they continue to evaluate the bid.

More for mental health centers

Community mental health centers will benefit from an increased fee on some insurance plans, which will help replace a 4 percent cut to Medicaid providers. Brownback made the cuts, which were estimated to produce $56 million in savings, to close a budget gap in 2016.

If the fee produces more than enough to replace the rate cuts, mental health centers also could receive up to $3.5 million to divide. Lawmakers also appropriated $4 million from the state general fund for the centers.

The new money won’t entirely restore the $20 million that mental health centers have lost since 2007, but it will ease some of the pressure on them, said Kyle Kessler, executive director of the Association of Community Mental Health Centers of Kansas.

The centers have to treat all patients who comes to them with serious mental illnesses, regardless of their ability to pay, Kessler said. Because they can’t treat fewer patients, they’ve dealt with funding shortfalls by leaving positions open, holding off on pay increases and cutting support services. Additional money could help with retaining staff and offering patients more comprehensive services, he said.

“We can’t stop serving people because there’s no funding,” he said. “We’re serving more people than we have before, under more difficult circumstances.”

However, Brownback vetoed a bill that have would allocated funding from new lottery ticket vending machines to crisis centers and clubhouse programs, which help people with serious mental illnesses to learn job and life skills.

The mental health centers didn’t get as much funding as they sought this year, but Kessler said he was “encouraged” by lawmakers’ interest in mental health issues this session. He and other association members testified before committees more often than in the past, and found receptive ears in both parties, he said.

“The future looks bright. We have a lot of work to do, but this is a good start,” he said.

Lawmakers also showed an interest in mental health during the 2016 session when they appropriated more money for the state hospitals, Campbell said, but repairing the damage from a decade of reduced investment will take more than a few years.

“It’s taken us more than 10 years to get into this crisis,” she said. “It would be overly optimistic to get out in a year.”

Other legislative actions related to health this session will:

• Appropriate $3 million from a federal block grant for the Healthy Families, which uses home visiting to prevent children abuse and neglect.
• Appropriate $20.3 million to increase wages for workers providing home and community-based services to people with physical or mental disabilities.
• Direct the Kansas Department of Health and Environment to contract with someone to inspect dialysis clinics.
• Require KDHE to develop standard processes for the three managed care organizations administering KanCare.
• Allow pharmacists to give vaccines to anyone 12 or older.
• Allow pharmacists to substitute “biosimilars” for name-brand biologic drugs.
• Require child care centers to use safe sleep practices with infants.
• Give priority to nursing students who intend to work in mental health when awarding scholarships.
• Require parents give consent before a health facility placed a do-not-resuscitate order on a minor.
• Allow first responders and bystanders to administer antidotes to people who overdosed on opioids.

Meg Wingerter is a reporter for the Kansas News Service, a collaboration of KCUR, Kansas Public Radio and KMUW covering health, education and politics. You can reach her on Twitter @MegWingerter. Kansas News Service stories and photos may be republished at no cost with proper attribution and a link back to kcur.org.

See more at http://kcur.org/post/kansas-lawmakers-boost-some-spending-mental-health-system.

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