Policies, Practices, and Parents with Mental Illness

by SAMHSA

(Page 12 of 20)

A number of federal policies and state practices have potential ramifications for parents with mental illness and their families. The consequences of these policies and practices for families in which parents have mental illness are largely unstudied.

Several key issues are described below, based on review of available written materials and the comments of key informants. Key informants are researchers, consumers, policy-makers, and service providers who work in fields related to parenting and mental illness. The review is supplemented by research findings where they exist.

Adoption and Safe Families Act

The federal Adoption and Safe Families Act, Public Law 105-89 (ASFA) was signed into law on November 19, 1997. This legislation was passed by Congress with bi-partisan support and is the first substantive change in federal child welfare law since the Adoption Assistance and Child Welfare Act of 1980, Public Law 96-272.

ASFA is intended to address the issue of foster-care drift and to achieve a balance of safety, well-being and permanency for children in foster care. ASFA requires that state child welfare agencies make "reasonable efforts" to prevent the unnecessary placement of children in foster care and to provide services necessary to reunify children in foster care with their families. In certain circumstances, ASFA allows for the "reasonable efforts" statute to be bypassed, when it would not be reasonable to reunify children with their parents.1

The intention of ASFA is to promote safety and permanency for children who are alleged or determined to be abused and neglected, and to ensure that children do not languish in out-of-home placements, but are moved swiftly to either reunite with a parent or move to a permanent alternative living situation. ASFA seeks to promote permanency by establishing expedited timelines for determining whether children who enter foster care can be moved into permanent homes promptly--their own familial home, a relative's home, adoptive home, or other planned permanent living arrangement. "Reasonable efforts" to provide services for the family may be bypassed if: The child has been subject to aggravated circumstances (as defined by state law) by the parent; The parent has been convicted of certain crimes; and, The parent has had involuntarily termination of rights to another child

Two new timelines are imposed. First, permanency hearings must be held for children no later than 12 months after they enter foster care (six months earlier than the prior Child Welfare Act of 1980). Second, state child welfare agencies must review existing caseloads and track new children entering into care so that termination of parental rights (TPR) proceedings will be initiated for children who have been under the responsibility of the state for 15 out of the most recent 22 months. Once the TPR petition is filed and the proceedings are initiated, a court must determine first whether there are grounds for termination of the parents' rights and, second, whether it would be in the child's best interest to do so. (Children's Defense Fund, 2000). (Eventually both parents' rights must be terminated for a child to be free for adoption.) "Fifteen of the last 22 months" is a maximum timeframe; the state has discretion to file a TPR petition whenever it sees fit in the best interest of the child (Baker, 2000).

ASFA includes three circumstances that can preclude filing a TPR petition, even if the child has been in care for 15 out of 22 months: the child is in the care of a relative; the state agency documents a compelling reason why filing is not in the best interest of the child; or the state agency has not provided to the child's family the services deemed necessary to return the child to a safe home consistent with the time period in the case plan. All fifty states and the District of Columbia have passed legislation to address the mandates required by ASFA. Receipt of federal child welfare funding was contingent upon the adoption of ASFA by state governments.

While the intent of ASFA is to protect the health and safety of children, the implementation of the law also seems, in many instances, to be detrimental to the interests of parents with mental illness. An attorney interviewed as a key informant indicated that in many cases, ASFA makes reuniting families where a parent has a mental illness more difficult. While family and environmental stability clearly contribute to positive outcomes for children, severing ties with birth parents also has costs. It is not always clear that these costs are outweighed by the benefits of foster care placement or adoption, or that terminating these relationships is always in the child's best interest.

Key informants working in this area noted that the chronic nature of mental illness combined with the limited number of specialized programs targeted to work with these families may make it more difficult for parents to regain custody of children before the 15 month window has passed. Fifteen months is an extremely narrow time frame when you factor in the often uneven course of mental illness and recovery, and the time needed for comprehensive family evaluation, treatment planning and adequate participation in services. Our research suggests that relatively few programs exist specifically to assist parents with mental illness and their families. Thus, the attempts of child welfare agencies to provide "reasonable efforts" to prevent removal of children or promote reunification of families may be difficult, if not impossible.

Key informants recommended that if a child is removed from a parent's custody, appropriate services must begin as soon as possible to avoid unnecessarily lengthy periods of separation between parent and child. All parties involved with the parent and family, i.e. lawyers, caseworkers, therapists, must work towards the common goal of finding and accessing services. If a parent is currently unable to care for his or her child, key informants advise that relatives be used as placement resources whenever possible, as this provides an exception to the requirement that a TPR be filed after 15 months of foster care placement. However, this may be contraindicated in situations in which relatives themselves have been abusive as parents, or are purposely seeking to undermine their family member's capacity to parent.

SUMMARY: ASFA may have unintended consequences in its implementation. The incentives for permanency planning may motivate child welfare agencies to focus on out-of-home placement and planning for children in the allotted time frame, rather than to tackle the oftentimes complex needs of parents with mental illness. Fifteen months may not be enough time for thorough family evaluation, comprehensive planning, service implementation, and necessary progress to be documented. Compounding this, it appears that state child welfare agencies may often be unable to comply with "reasonable efforts" to prevent placement, or to promote reunification when services for families where a parent has a mental illness are limited. Child welfare staff, law enforcement personnel, attorneys, guardians ad litem, and the judicial system may be subject to the same misunderstandings and lack of knowledge about mental illness as the general public.

RECOMMENDATIONS: Given the emphasis on the developmental needs and well-being of children implied by the ASFA 15-month time frame, care must be taken to provide effective services to all family members immediately. Children's best interests, and parents' needs may be met by comprehensive, specialized, in-home services, so that separations are not necessary or so they can be minimized. The oftentimes-chronic nature of parental illness and uneven course of recovery require interventions to be both flexible and individualized to meet the unique needs of families. Efforts to find and access services for families must be coordinated and integrated at all levels of care and across systems of care. Child welfare and mental health policymakers and administrators must provide and coordinate resources to support the cross-system needs of children and their parents who have mental illness. The relationship between mental health and child welfare is a focus of the Substance Abuse and Mental Health Services Administration (SAMHSA) Child Health Service Act of 2000, underscoring the necessity of understanding and enhancing relationships between the two systems on behalf of children and families living with mental illness.

Training is a critical component for all of areas of the service system. Better education regarding mental illness, the relationship of mental illness to parental competence, safety and risk issues for children who have a parent with mental illness, and the impact of the termination of parental rights on children and adults are training areas that need to be provided for within the judicial system, the child welfare system, and the mental health system. Ultimately the costs of severing family ties must be empirically documented and weighed against the benefits of out-of-home placement and permanency planning on a case-by-case basis for families in which parents have mental illness. Research is needed to evaluate the costs and benefits of one choice over the other.

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