I was recently asked by a (much) younger therapist in Lawrence if it was true that I used to transport clients to and from therapy and had a client contingency fund for homeless youth and foster kids. I said, “Not only did I, but I also took Medicaid, at least before it was KanCare.” That got me to thinking about those days and how sad it makes me to have moved on from them. It’s like surrendering the joyful but unproductive things of youth. I even wrote a book about my years working in foster care, Treating Families and Children in The Child Protective System (Brunner-Routledge, 2004) Apparently you can buy a used copy now for $5.00. It was never a great seller. I only realized after it came out how few people are interested in foster kids, and those who are, tend to get over it quickly. In the Editor’s Foreword, Jon Carlson, PsyD, ABPP writes of this, noting “Most of us, you see, get burned out, overwhelmed, zapped, and angry beyond belief when we work in this area [of foster care]. Seeing children abused by both families of origin and then by the justice system leaves us feeling powerless and hurt. Dr. Crenshaw, however, has a different explanatory model that allows for effective results with less damage to the therapist.” Looking back over two decades, I find that Jon was, shall we say, overly optimistic in his view of my work.
Foster care remains an abject failure, or as I put it in the book with a nod to Winston Churchill, “The worst system for dealing with child abuse, except for all the others.” In the early 2000s however, I still believed that therapists could make a difference, one life at a time, if they put enough energy into those desperate young clients left clinging to whatever rope they could grab on to through the stormy seas of foster care or homelessness. I still believe that, but having recently made a brief foray back into that market, I am reminded that the effort required, most of it unfunded, is well past what most therapists can or will make. Which is why that younger therapist seemed so puzzled. “How could you ever afford the time, money, or energy to do all that?” She asked.
“We couldn’t,” I answered. “It saddens my heart, but try as I might, I’ve never found a way to make that formula work. Which, I guess, makes me no better than the system itself.” As I told her the story, it opened up a lot of thoughts and old feelings for me, and since I’ll never write a book about foster care again, I thought I’d share a few of them here.
In about 2004, the organization I co-owned at the time, purchased an old Corolla and insured it for commercial carriage. While it had more than one purpose, the use I found most helpful to this cause was the ability to transport a limited number of clients, usually foster children and homeless youth, to therapy sessions. Without that car, many of these kids couldn’t make their appointments due to their overseeing agencies’ lack of staffing and transportation. Not only did this make for a hodge podge of missed appointments, it was expensive. You can’t charge a no-show for anyone on Medicaid or a child in foster care, so you either eat the missed revenue or you go out and pick the kid up. This was done with the full knowledge of families and/or foster care contractors and was much appreciated by all, to the point that it was at times, expected. Not quite what we were going for there, but we made it work. On occasion, it even included adult family members of the client who lacked cars but needed to be included in therapy to reintegrate the child back into his or her home. As I recall, I actually transported a couple of kids to either CINC court hearings or CRB meetings (no really) because their social worker(s) were unavailable and had sent a sub to the hearing and the foster parent was at work and so on. It was always something. That old car did its duty in an era when we had to case manage our own cases, as if we were a community mental health center, where that was already routine. My foray into transportation services ended after that vehicle was totaled by another staff in an (injury free) accident in September 2007 with no one else on board (thank God). The next year, we discontinued our contract with the foster care system and by 2008 we had ceased providing this kind of outreach or case management, without which service provision for such teens became impractical.
I’d almost forgotten about the old Corolla until late last year. In March 2019, I got it into my head that our practice was strong enough and financially successful enough to venture back into working with foster kids and other young people on KanCare. It had a been a great training experience for me and I thought it would be for a young, energetic clinician. So, I sought out and hired someone who had experience in the system and who cared about that population. Our first hurdle was just getting this provider on the KanCare panels. It took months and only the intervention (read: constant nagging) of the State KanCare oversight office made it happen. United Health Care was the easiest of the three (props!). Aetna, which is under a plan of corrective action with the State, was the most difficult. If you Google this you’ll see I’m not the only one blogging about that experience and even an editorial or two was written about it. It often seemed the contractors were running their operations out of some old laundromat in a strip mall and the dryers didn’t work.
Once we got her on the panel, we had plenty of foster care referrals. The contractors were in dire need of therapists for teens, particularly older ones aging out of the system. But, just as we found back in the day, the contractors had a hard time getting kids to the office for their appointments, even when the therapist leaned heavily on them. I even considered buying another old Corolla and putting the transportation idea back into service, but couldn’t justify the expense. Besides, commercial insurance had gone way up along with warnings about liability even when covered. And of course, the previous Corolla situation hadn’t turned out well, with the accident and all. Nor did my 2019 return to foster care. Faced with a poor reimbursement rate, the provider left for a higher paying job. Nobody blamed her. It was a wise business decision. When it comes to foster care, bailing out usually is.
A tradition I have continued since that time, and admittedly stole from other community agencies with better budgets, was a client contingency account to provide funds for child and adolescent clients to support treatment plan targeted interventions. Over the years it bought some interesting items, including about thirty prom/winter formal dresses or tux rentals for young people who could not have afforded them otherwise. Before that, I’d tried a prom dress exchange in 2005-6 to which charitable teens had donated their used dresses for redistribution. However, this proved an unpopular option with young people, and in time, I came to understand why. What kid wants to know that her prom dress came from someone else’s hand-me-downs–maybe even someone from her own school? Why should a homeless teen or foster child be made to feel even more marginalized than they already are in a world full of people with homes and full closets? So I discontinued the exchange in favor of online purchase and, in the case of tuxes, rental. Even though we purchased the dresses on eBay and most of them were gently used, there was something different about that experience than feeling like you were digging around in another person’s closet. Someone was taking the time to get you the dress you wanted, not the one someone else had wanted two years ago. I was impressed with how careful kids were in their selections, always wanting to keep the costs down so the fund was available for other kids. We sometimes see teens as selfish. I saw those kids as anything but.
One should not get into this business to be thanked. That’s not really the role of the therapist any more than it is a parent or adult friend. One gives of themselves to kids because it’s the right thing to do, and as one would expect, thanks is rarely the outcome. But, two or three years ago I did hear from a foster kid from many years back who had looked me up on the Internet. I can’t remember if she was a dress recipient or not. I did keep track of that in the clinical notes, but those are deleted seven years after a minor turns eighteen per HIPAA and I’m not with that agency any longer. In any case, she wrote to me something I’ll always cherish:
“Im not sure if you remember me but my maiden name is Jane Doe and you had such an impact on my life and the woman i have become! I am the mom of 5 wonderful kids and i dont know how my life would of been without your guidance when i was a teenager! I miss our talks and just want to let you know i think of you often! Thank you so much hope to hear from you soon.”
As it happens, I think of “Jane” almost every day. She gave me some beautiful art prints that won purple ribbons at the state art contest. At first I refused them, as they seemed like gifts far too valuable to ethically accept. But, Jane insisted. When I refused again, she began to cry, gently but with intent.
“Wes,” she said. “I don’t have anyone else to give them to.”
I told her that when I had enough money to afford it, I would frame the pictures and they would always hang in my office as a reminder of our work together. And they have, eventually becoming more than that — and even more than a good story for kids who aren’t so sure about therapy. They have become a reminder of why it matters how we treat our young people, and how they can grow up to be so much from our gift of so little. It could be a used dress or a ride or just accepting their gift of art. It all adds up.
Not every story comes out that beautifully, but I’m happy to say I’ve seen more than my share over the years of those that do.
Maybe I’ll take another crack at this whole foster care, KanCare, project. Let me know if you’re a young therapist looking for clinical hours who wants make that effort. And maybe has an old Corolla?
Beautiful, Dr Crenshaw. Thank you for your Service. I live in New Zealand and we have similar ongoing issues with our child protective services, just so incredibly sad.
Dr Crenshaw I wanted to let You know, I purchased your audiobook, “I always want to be where I’m not”. It’s one of the very few books I have read or listened to more than once. Dr Hallowell’s books upon ADHD and also another less ADHD oriented “the road less travelled” by Dr Scott Peck are others and now yours. Thank you Sir. Warm regards from Auckland, New Zealand. (Recently diagnosed with ADHD, a very late bloomer )