Discussion of the implications of health reform on behavioral health integration.
Testimony of Rena Dosantos, MSW Candidate at Columbia University
Before the Committee on Child Welfare Reform
Introduction
Good morning, members of this esteem committee. My name is Rena Dosantos, and I am a Master of Social Work (MSW) candidate at Columbia University with a bachelor’s degree in Social Work (BSW). I currently work with the Enhance Family and Foster Care (EFFC) unit at Child Guidance Services (CGS), as a Case Planner where I support birth parents working toward reunification with their children.
Today, I want to discuss the critical mental health needs of birth parents involved in the child welfare system, the evolution of mental health care, and the policy changes needed to integrate behavioral health services more effectively into the child welfare process. My testimony will also address how the Mental Health Parity and Addiction Equity Act and health reforms can support better outcomes for families by ensuring that mental health care is equally accessible to birth parents.
1. Overview of the Evolution of the Mental Health System
The mental health system in the United States has evolved significantly over the past few decades. Early treatment was primarily institutionalized, with limited community-based care available for those outside of inpatient facilities. However, over time, the focus shifted toward deinstitutionalization and the promotion of outpatient care and services within the community. Despite these advances, gaps in care remain, particularly for marginalized groups such as birth parents involved in the child welfare system.
Birth parents often face mental health challenges like depression, PTSD, and substance use, which directly impact their ability to reunify with their children. The mental health system has not kept pace with the unique needs of these parents, particularly when it comes to accessible and affordable mental health services. It is critical that the child welfare system’s approach evolve to address these needs in a more integrated and systemic way, ensuring that mental health care is a priority for all families involved.
2. Introduction to the Mental Health Parity and Addiction Equity Act (MHPAEA)
The Mental Health Parity and Addiction Equity Act (MHPAEA), passed in 2008, was a landmark piece of legislation aimed at ensuring that mental health and substance use disorder treatments are covered by insurance plans at the same level as physical health conditions. The law mandates that insurers cannot impose stricter limitations on mental health benefits than they do for medical or surgical benefits.
For birth parents involved in the child welfare system, the MHPAEA provides a critical avenue for accessing necessary mental health care, including treatment for conditions like depression, anxiety, and substance use disorders. However, despite the Act’s intentions, many low-income families still face barriers to accessing mental health services due to a lack of insurance, limited Medicaid coverage, and challenges in finding providers who accept Medicaid. The child welfare system must ensure that these barriers are addressed by advocating for full access to mental health services for birth parents, which is essential to reunification efforts.
3. Implications of Health Reform on Behavioral Health Integration
Health reform, particularly the Affordable Care Act (ACA), has greatly expanded access to behavioral health services. By providing Medicaid expansion in many states and mandating mental health coverage, the ACA aimed to make behavioral health care more accessible to those who need it. Yet, challenges persist. Many birth parents in the child welfare system are still uninsured or underinsured, and navigating the complexities of health insurance remains a significant barrier to treatment.
Behavioral health integration has become a key component of the ACA’s vision for improving care coordination and reducing costs. For birth parents, integrated care models—where mental health, substance use treatment, and social services are coordinated—can provide a more holistic approach to addressing the root causes of family separation. However, these services are often underfunded and lack coordination across agencies, which makes it difficult for birth parents to access the full range of services they need to reunify with their children.
As child welfare systems continue to adapt to these reforms, they must incorporate more behavioral health integration. This includes ensuring that mental health services are integrated with family support programs, housing assistance, and employment services to offer a comprehensive approach to reunification.
4. Redirecting Foster Care Funds to Support Birth Parents
The financial resources allocated to foster care placements are staggering, with foster parents receiving $1,400 per month to care for normal children, which is also called the regular rate. $3,500.00 per month which is called the special rates, for children that’s a bit hyper active, or have minor behival issues. and up to $5,000.00 per month which is called the exceptional rate. for children that have severe behavior, emotional, mental health issue, along with IEP, and other psychology and physical impairments. While these funds are essential for providing temporary care for children, the resources spent on foster care could be more effectively utilized by investing directly in birth families.
If even a portion of these funds were directed toward providing comprehensive mental health care, housing support, and educational services for birth parents, it would greatly improve the likelihood of successful reunification. By addressing the root causes of family instability—mental health, housing, and education—we can create more permanent and stable homes for children, ultimately reducing the need for foster care placements and promoting long-term family well-being.
5. Recommendations to the Committee
To address these critical issues, I recommend the following:
Prioritize Behavioral Health Integration: Integrate mental health services into the child welfare system as a central part of reunification plans for birth parents.
Increase Funding for Mental Health Services for Birth Parents: Ensure that birth parents have access to the same level of mental health care as foster parents and children, supported by both the Mental Health Parity and Addiction Equity Act and the Affordable Care Act.
Redirect Foster Care Funding: Reallocate a portion of the substantial funds paid to foster parents to support birth families, including mental health, housing, and educational services.
Advocate for Systemic Change: Work to eliminate barriers to mental health care access for birth parents, ensuring they are able to benefit from health reform policies such as Medicaid expansion and behavioral health integration.
Conclusion
Reunification is not just about placing children back in their homes; it’s about ensuring that birth parents are equipped with the mental health, housing, and educational support they need to provide stable, nurturing environments. By investing in these services, we can break the cycle of trauma and ensure that children can grow up in safe, permanent homes.