When adoption goes wrong

Giving up custody to get kids the mental health care they need

By Patrick Yeagle

August 11, 2011 / IllinoisTimes

Wally and Dawne Busch of Petersburg eagerly adopted their son Alan at the age of two in 2000, knowing that they would be in for some challenging times. They knew that Alan, now 13, had been abused by his biological mother, and they weren’t surprised when, around the time he hit puberty, he began to develop severe emotional and behavioral issues, which often manifest in violent outbursts, threatening Alan’s safety and that of everyone around him.

He threatened to kill other children at school, threatened to hurt the couple’s other children, mutilated his own body and talked often about killing himself. But the Buschs say their most troubling challenge hasn’t been Alan’s behavior. It has been trying to help their son in an environment that they say pushes families to give up custody of children to the state in return for mental health services.

The Buschs adopted Alan and his sister, Stephanie, with assurances from DCFS that the state would pay for the children’s medical needs, including mental health care. Despite counseling and therapy, Alan’s behavior became too dangerous for the family to keep him in their home, according to Wally Busch, so in October 2010 the family had Alan committed to a short-term psychiatric hospital with plans to send him to a long-term residential care facility at his psychiatrist’s recommendation. Lacking the hundreds of thousands of dollars needed to pay for Alan’s treatment, the Buschs approached DCFS about paying for long-term care, but the agency declined.

After Alan spent a week in the psychiatric hospital, the Buschs received a call saying he was ready to come home – that he was no longer a danger to himself or others. Fearing for the safety of their family and of Alan himself, the Buschs took their attorney’s advice and decided not to pick Alan up from the psychiatric hospital. DCFS charged them with neglect, classifying the Buschs’ choice as a “psychiatric lockout.”

The neglect charge against the Buschs was dismissed in court, but their choice to not bring Alan back home essentially meant they had given up custody of Alan to the state. He remains in state custody at a residential treatment facility, though the Buschs retain parental rights such as visitation.

Custody relinquishment
The Buschs’ story is typical of a situation called custody relinquishment. It involves an adoptive family becoming overwhelmed by the challenges of a mentally ill or emotionally disturbed child. Usually after trying several methods of counseling and therapy that don’t seem to work, the family decides that expensive long-term residential care is the only option left, but securing funding from the state proves difficult or impossible. The family then decides the only option to secure treatment for the child is leaving him or her in the hands of the state. The decision to “lock out” a child usually comes at the suggestion of a family’s attorney, psychiatrist, or even a state agency, but it often results in the family losing custody of the child.

It’s difficult to tell how many custody relinquishments happen each year, but statistics on psychiatric lockout seem to indicate a worsening problem. Screening, Assessment and Support Services (SASS), a division of the Illinois Department of Human Services, says in an internal report that the number of psychiatric lockouts statewide more than tripled from 30 in 2003 to 104 in 2010. The Community and Residential Services Authority (CRSA), a state agency which guides parents through the maze of child welfare services when they have trouble, indicates in its 2009 and 2010 annual reports that custody relinquishment happens frequently enough to be a significant concern.

“Parents who attempt to access services through lockout in many instances end up relinquishing guardianship to the state and are often treated systemically as abusive or neglectful parents,” CRSA notes in its 2009 report. “CRSA staff do not believe that lockout is an effective mechanism for service planning and the CRSA board has long believed that parents should not be forced to give up guardianship and parental rights to their children simply to get their service needs met.”

The reports note that “referral to CRSA often implies a breakdown or a gap somewhere in the state service system.” CRSA cases increased from 355 in 2009 to 374 in 2010, with about half of cases from both years coming from families seeking residential care for a child with severe emotional disturbances or behavioral disorders. Of CRSA’s 355 cases in 2009, 32 came from Sangamon County.

John Schornagel, executive director of CRSA, which is based in Springfield, says custody relinquishment cases are the ones that “fall through the cracks” between the services offered by the half-dozen child-serving state agencies, including those that provide post-adoption services.

“I wish lockouts didn’t happen,” Schornagel says. “As a group of agencies and as a state, we need to find a solution to custody relinquishment. Certainly, DCFS has a good clinical division, and they’re capable of handling adopted kids who are at risk for adoption disruption. But for parents to have to go through the living hell of abandoning their kids to the system simply to get their mental health needs met is just the wrong way to go. There must be a better way.”

Schornagel says that of the more than 10,000 cases CRSA has handled in its 26-year existence, only 44 have required the CRSA board to step in and issue non-binding recommendations to resolve a conflict between state agencies and adoptive parents seeking services. Most cases get resolved before they get to the psychiatric lockout stage, Schornagel says, adding that many conflicts can be resolved if parents contact his agency for help securing services before a psychiatric lockout ever becomes an option.

CRSA reports identify other issues that hinder families’ efforts to obtain state services for mentally ill or emotionally disturbed children, including a lack of services available in a geographic area, state agencies deflecting clients to other agencies, ever-changing diagnostic criteria that require constant changes to services and programs, and the inability of schools to pay for appropriate educational plans for children with special needs.

Schornagel says the custody relinquishment problem is largely the result of changes made to DCFS in the 1990s because of a federal court order that required DCFS to put foster children into permanent homes within two years of entering the foster care system.  He says “disrupting adoptions” will continue as long as there is such a short time frame for getting kids into permanent homes, combined with parents who “aren’t fully prepared and trained for the clinical kinds of challenges they’re going to face” when adopting.

Kendall Marlowe, spokesman for the Illinois Department of Children and Family Services, says the majority of adoptions do not result in custody relinquishment. He notes that Illinois had nearly 52,000 children in its foster care system in 1997, but that number has been reduced to fewer than 17,000 currently, mainly due to increased efforts to place foster children into permanent adoptive homes. About 26,800 children in Illinois receive a monthly adoption subsidy from the state, which Marlowe says is probably the best available estimate of currently adopted kids in Illinois – excluding adoptions done through private agencies.

About 99 percent of adoptions remain stable after two years, with 95 percent remaining stable after five years, according to a DCFS report.

Speaking generally and not about any specific case, Marlowe says long-term residential treatment like that sought by the Buschs is usually reserved for only the most mentally ill children. DCFS received 75 requests for residential placements in 2009, he says, and only seven of those cases received approval from DCFS director Erwin McEwen.

Many of the problems exhibited by adopted kids are common to all kids, Marlowe notes.

“Adoptive families are not the only families that struggle when kids move into adolescence, and many of the behaviors we associate with mental health conditions are very common among adolescents, including issues of sexuality, identity and attachment,” Marlowe says. “It can be too easy at times to perceive an adolescent’s struggle with maturity to be indicative of mental health conditions. Often, even when elements of mental health conditions are present, the more effective solution is therapy and intervention which involves the entire family. … Families often don’t want to hear that the entire family needs to be a part of the solution.”

Addressing the charge of neglect that often follows a psychiatric lockout, Marlowe says DCFS procedures call for an automatic neglect charge after any lockout, but the charge is usually only upheld if “the family is not engaged in coming up with a solution” for the child to return.

Schornagel says the proactive solution to custody relinquishment would be better community-based support services like intensive therapy and counseling in a child’s own community. Community-based services keep children in a familiar environment – usually their own home – while costing the state less money than residential treatment and pre-empting many of the problems that lead to psychiatric lockouts.

While many state agencies are working to establish more community-based services, Schornagel says that process requires diverting money away from things like residential care, which deals with kids who are already in crisis.

“My perception, from where I sit, is that community-based services aren’t available in the quantity or the quality that are necessary to maintain a lot of these kids, and that’s why it all breaks down,” Schornagel says. “All of the agencies that I’ve worked with have been, over the years, trying to back away from residential placement and take some of the money they were spending on residential care and redirect that to community-based programs. It’s a slow process of moving the money from the back end to the front end, and I think we’re in the middle of that.”

Marlowe says more community-based services are a big part of the solution, but families must also be prepared for the challenges they will face when adopting.

“All of us in the field believe that if we build a stronger safety net, we will be seeing fewer family crises,” Marlowe says. “The system as a whole is trying to move from a mode of reacting to crisis to a more preventative approach. But not every family’s problems can be solved by Dr. Phil in 60 minutes like on Oprah. Growing into a mature, healthy adult is a process that requires support from family at every turn.”

Too little, too late
But for families already in crisis, it’s too late to build a stronger safety net. In 1998, James and Toni Hoy of Ingleside, Ill., adopted a two-year-old son named Daniel. He displayed developmental delays, had been abused by his biological parents, and had been born under the influence of drugs and alcohol. As Daniel grew older, he began to display violent and aggressive behavior, which became dangerous enough that Toni Hoy says she didn’t feel safe in her own home.

The Hoys tried several methods of therapy and counseling for Daniel, but nothing seemed to work. The final straw was when Daniel, then 13, pulled a knife on one of the Hoys’ other children and threw another child down some stairs.

In 2007, they approached the Department of Human Services (DHS) and the Department of Healthcare and Family Services (HFS) about paying for $180,000-per-year residential treatment the family could not afford. The state declined to pay.

Denied funding for treatment they felt Daniel truly needed, the Hoys chose not to pick him up from the psychiatric hospital. Like the Buschs, they faced a charge of neglect for their psychiatric lockout, and their son became a ward of the state, which eventually placed him in a residential treatment facility.

The Hoys eventually got the neglect charge dropped, but it remained in the State Central Registry of abuse and neglect findings. They sued DHS and HFS to obtain funding for Daniel’s residential care, settling their case in July 2011 with an agreement that the agencies would pay for Daniel’s treatment while not admitting any fault. The Hoys also regained custody of Daniel, who is now 16 and was recently transferred from residential care to a juvenile detention center for assaulting a teacher and damaging a car.

While the Hoy case doesn’t set a precedent for other cases because it was settled before a court ruling, Toni Hoy says she has advised several other families in similar situations, and their case may serve as a catalyst for an upcoming class-action lawsuit.

The Collins Law Firm in Naperville, which represented the Hoys in their case, is examining similar cases to construct a class-action suit that could force changes in how the state handles psychiatric lockouts, custody relinquishment and residential care. Attorney Aaron Rapier at Collins says that suit is still in the planning stages and will not be pursued until later, to avoid jeopardizing the Hoys’ settlement.

In the meantime, John Schornagel at CRSA says the state’s financial woes limit the speed at which agencies can move from reacting to crises toward preventing them.

“State agencies have all been cut back on a variety of services – administration and direct services – and a lot of the nonprofits that do the heavy lifting are in trouble because the state isn’t paying their bills in some instances and they’re cutting back on services they provide to the community,” he says. “It makes being proactive more and more difficult. … I don’t think there’s any bad guys here. The agencies are doing what they can to do a better job with a very, very challenging population. I think they’re beginning to win the war, but there’s always casualties.”


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