Kansas foster kids suffer from shortage of mental health providers, high caseloads

TOPEKA — Amid a statewide mental health crisis, vulnerable children and teens in the state foster care system have been hard-hit by a scarcity of resources.

Pam Cornwell, trauma services clinical director for Saint Francis Ministries, estimates 80% of children in the foster care system have either mental or behavioral health issues, far outstripping the general population, which has about an 18-22% rate.

“It really makes sense when you think about what has to happen for a child to enter the child welfare system,” Cornwell said. “They’ve experienced some kind of abuse or neglect situation. That experience in and of itself can lead to or exacerbate underlying mental health or behavioral health issues that a child might already have.”

“It’s probably more unusual to have a case in child welfare where the child does not have the diagnosis than the other way around,” Cornwell added.

Cornwell and Matt Arnet, KVC Health Systems director of outpatient mental and behavioral health services, discussed mental health challenges of foster kids for a new episode of the Kansas Reflector podcast. Saint Francis and KVC are the two largest foster care contractors in Kansas.

For years, the state has struggled with mental health resources and the foster care system. With a lack of Medicaid expansion, along with a shortage of health care workers and mental health beds, Kansas ranked last in terms of meeting overall mental health needs in a 2023 Mental Health America report. 

At Saint Francis, workers have caseloads of up to 50 cases per person. At KVC, the rate is about 30 families per clinical worker.

Arnet said matters were further complicated when children needing specialized services, such as autism or intellectual disability support, were placed into foster care by families looking for support. Arnet gave the example of the autism waiver program, which serves about 65 individuals while another 400 are on the waiting list.

“Parents get overwhelmed and frustrated,” Arnet said. “Those kids enter into the foster care system hoping to get additional services that just don’t exist. It’s one of the myths that we are constantly pushing back against as we’re talking to providers in our acute hospitals and residential facilities in this state. There is no fast track to services. There’s no extra services that exist. There’s just new layers of complexity as you start adding in court systems and case management providers and all these other systems of care.”

Kansas youths also experienced a surge in mental health crises over the past few years, with child suicide attempts in Kansas leading to a 68% increase in emergency department visits between 2019 to 2021, according to Kansas Department of Health and Environment statistics.

Cornwell said another facet of the problem is the lack of pediatric psychiatrists in the state. Cromwell said with 69 of these psychiatrists and more than 700,000 children in the state, resources are stretched extremely thin.

“If only 22% of those children needed medication management, that would mean each of those pediatric psychiatrists would have over 2,000 clients,” Cromwell said. “That’s just not manageable to provide adequate care.”

Arnet mentioned a surge in substance abuse issues, including children attempting to self-medicate through substances. Before the COVID-19 pandemic, Arnet said about 60% of KVC referrals were addiction-related. Now the addiction-related referrals make up about 75% of referrals.

“We’ve definitely seen a huge surge in both children that are seeking substances, and they’re treating their symptoms of mental health or trauma with substances, but then also incidental contact with substances,” Arnet said. “Kids are taking things that they’re not sure what’s in it, and then it’s turning out that it’s something like fentanyl, or it’s been laced with opiates or something else.”

The two pointed at recent legislation as hope for improvement. During the 2023 legislative session, lawmakers passed a bill to smooth over the licensing process for therapists, psychologists, social workers and health care workers, among others.

An approved foster care bill of rights also informs children about their right to have a stable environment, experience the least number of placements possible, have access to adequate clothing and other belongings, conduct family visits, attend school and participate in court proceedings, among other things.