The country’s youth mental health crisis continues to increase demand for psychiatric beds. Yet, the availability of residential treatment facilities, reserved for youth with severe emotional disturbances, is on the decline. What impact does this have on youth—including those in foster care--with high levels of need, and how do we ensure access to treatment for the children who need it most?

This week, Naomi and Ian are joined by Scott Dziengelski, a consultant at King and Spalding LLP and former director of policy and regulatory affairs at the National Association for Behavioral Healthcare, to discuss his recent report, “Deinstitutionalization Redux: The Decline in Residential Mental Health Treatment for Youth.” The report highlights the concerning shortage of residential treatment facilities and bed space for youth who need care. In this episode, Scott explains the current move toward deinstitutionalization, the effect of negative media messaging around residential treatment centers, and the crucial policy and cultural changes needed to ensure youth with severe challenges receive the care they need.

Resources

-Deinstitutionalization Redux: The Decline in Residential Mental Health Treatment for Youth | Scott Dziengelski

-How Foster Kids Are Being Damaged by a Lack of Home Care Facilities | Naomi Schaefer Riley

-Why Foster Children Are Sleeping in Offices and What We Can Do About It | Sean Hughes et al.

Show Notes

-00:58 | How did you get involved in children’s mental health policy?

-02:20 | What does the spectrum of need look like for children’s mental health, and which children are served by residential treatment facilities?

-05:26 | How do you interpret the data around the rise in children’s mental health challenges?

-07:34 | What led to the decrease in availability of residential treatment facilities?

-10:34 | Why are people advocating for the deinstitutionalization of residential treatment facilities?

-13:23 | Two congressional hearings on residential treatment recently took place. What impact will these have on the availability of residential treatment?

-16:55 | How does tying educational funds to children help when residential treatment is needed?

-21:18 | What is your recommendation on Medicaid dollars following children in care? How do we shift the narrative on residential treatment facilities?

-25:37 | Which states are doing the best in regard to residential treatment facilities?

The dramatic rise in substance use disorders over the past decade has altered—indeed, destroyed—many American lives, but how does this epidemic affect children? And who is ensuring their safety?

This week, Naomi and Ian are joined by Sarah Font, child welfare researcher and associate professor of sociology and public policy at Penn State, to discuss a recent published statement Sarah wrote on behalf of AEI’s child welfare working group. “The US Is Failing Substance-Exposed Infants” critiques policies which limit Child Protective Services’ responsibility to aid substance-exposed infants, and how voluntary “Plans of Safe Care” put in place by some states are insufficient to address the dilemma. In this episode, Sarah details the effects of drug exposure in infants, whether and how positive toxicology screens in new mothers and infants are reported, and what practices in medicine and child protection need to change in order to prioritize the well-being of children.

Resources

-The US Is Failing Substance-Exposed Infants | Sarah Font et al.

-The US Is Failing Infants Exposed to Drugs and Alcohol | Naomi Schaefer Riley and Sarah Font

Show Notes

-0:01:00 | How should we understand drug exposure among infants?

-0:01:34 | What are the dangers to children of substance exposure in utero and when a child is under the supervision of parents who are addicted?

-0:03:28 | Why is there a reduction in foster care placements when there is an increase in reported abuse?

-0:04:44 | What are plans of safe care intended to accomplish?

-0:06:29 | What was the rationale behind Mass General Brigham’s new policy on substance abuse reporting?

-0:09:16 | How have we lost our focus regarding the effects of drug policy on children?

-0:11:44 | Is the normalization of drug use working as a gateway to children’s drug exposure?

-0:13:34 | What are some policy changes that should be considered by states and medical institutions?

-0:16:11 | What states or localities can we point to as models for others to follow?

-0:16:57 | What happens when hospitals contact CPS?

-0:19:00 | What prevention strategies exist?

How has the Supreme Court’s decision on Dobbs v. Jackson affected foster care and adoption in the United States during the past two years?

This week, Naomi and Ian are joined by Herbie Newell, President & Executive Director of Lifeline Children’s Services, one of the largest adoption agencies in the United States. Herbie discusses how the recent limits on abortion access in some states have impacted adoption agencies. He highlights the cultural shifts that have emerged since the Dobbs decision, including the decreased stigma surrounding adoption. He also addresses the slight increase in foster care numbers following the ruling, and how to interpret it, as well as how we can create a more positive outlook on adoption as an option for mothers, fathers, and children in the United States.

Resources

-Doing Adoption the “Right” Way Can Work for Everyone Involved | Naomi Schaefer Riley

-Elizabeth Kirk on Adoption Post Dobbs | Naomi Schaefer Riley | Ian Rowe

-What is it Like to Place Your Child For Adoption | Naomi Schaefer Riley | Timothy P. Carney

Show Notes

-0:00:57 | How has the atmosphere around adoption changed post Dobbs?

-0:03:59 | How has the view of adoption shifted in the pro-life community?

-0:06:31 | Has there been an increase in foster care post-Dobbs?

-0:09:44 | How should we think about adoption as an option for mothers and how can we reduce the stigma women choosing adoption face?

-0:13:20 | What pressures might women feel in the adoption process? How do we address them?

-0:18:23 | Does adoption stigma drive single-mother households? How do we better involve men throughout the adoption process?