H.B. 590 Child Therapy Amendments: transcript

Thank, thank you Madam Chair, and I appreciate you, um, being patient with me while I was running late. Um, of course, I am joined by Dr. Amy Feldberg, um, who is a therapist and a foster mom. And so I'm going to speak briefly to it, but mostly we'll, um, defer to her to describe the issue that we're seeking to solve. So, HB five 90 just recognizes that there are opportunities sometimes to, um, make sure that kids who in foster care, who have established a good relationship with their therapist, are able to continue care with that therapist if they move to a different family. And this is something that Dr. Feldberg experienced, um, personally, and we had lot, a lot of conversations and, um, thought that approaching it through a statutory change was appropriate. I do wanna mention first substitute is on the system it just posted, and that is to address some concerns that other community members brought with some, you know, as, as in all bills unattended consequences, um, but hopefully addresses those concerns as well. So I'll turn the time over, uh, to Dr. Feldberg. Thanks.

Thank you so much for the opportunity to speak with you today. Um, as a representative indicated, I am Dr. Amy Feldberg. I'm a licensed clinical psychologist. I've been working with children since 1990 in hospital, school and outpatient settings. And I previously directed a Children's Justice center here in Utah. I'm here today to ask for your help in ensuring continuity of care for mental health services for the children of Utah House. Bill five 90 is intended to help three groups of people. First, the employees of the state of Utah who work to support children in foster care. Second, the parents and foster parents of the children who are involved in the foster care system. And third, and most importantly, the over 2000 Utah children whose life experiences result in their being placed in foster care. I began talking with Representative Dailey-Provost a few years back after having multiple conversations with DCFS workers who shared their frustrations with me regarding the lack of continuity of mental health care for children in foster care. They talked with me about how children would come into care, get connected with a therapist, only to have to leave that therapist when they left care and returned home. Why? The money that pays for mental health services for children and care is a different pot of money than that which pays for mental health services for children when they transition out of care. At present, there is nothing requiring DHHS to ensure that those children can continue with the therapist that they meet while in care. The flip situation is also true. Children who are receiving mental health services before coming into care are forced to terminate their relationships regardless of the length or the quality when they come into care. DCFS will only work with DCFS contracted therapists. The outcome research on mental health services is remarkably clear and consistent. The one and only factor that holds up in the measure of the impact of therapy is the relationship the client feels they have with a therapist. That relationship takes time and skill to develop once in place. The therapeutic relationship can be that safe place that traumatized children can use to heal and move forward. When those children are not allowed to maintain those relationships, we create yet another loss, yet another source of trauma. While my interest in this bill developed from professional professional conversations, I can also share a personal experience. Over the past year, I watched the damage that comes from the current lack of access to continuity of care. The child I'm sharing with you went through several foster homes before being adopted. After many years of stability and solid work with a highly competent therapist, that child, like many adopted children, began to struggle and was eventually returned to the foster care system. The one person who could have been the threat of continuity for that child, his long-term therapist was no longer allowed to work with him as DCFS refused to engage with that therapist. Even when the adoptive family offered to prepay for a year of mental health services in advance at no cost to DCFS, their message was clear. We only work with DCFS contracted therapists. This child has now repeatedly experienced significant behavioral problems in the foster home. And there's a new therapist who's challenged with building a relationship absent from the years of knowledge that could have continued to inform treatment, that child will age out of the system in a year, leaving him with very little time and care and years of support lost. Your support of House Bill five 90 will reduce the workload for DCFS workers who will not have to connect their clients to new therapists. It will provide greater consistency for parents and foster parents, and it will ensure that children who are at incredibly vulnerable time in their lives have access to continuity of care. Thank you for your time.

That's our presentation, Madam Chair. Thank you.

Is it okay if I defer to Absolutely. Dr. Feldberg, she's much more well versed in the system than I am. Yeah,

Absolutely. So if I can understand your question correctly, a child moves into foster care and does not qualify. So they've, they've been in a biological or adoptive home and they're moving into foster care and they don't qualify for Medicaid. Um, so not that the child doesn't qualify, um, and I just found it. It's online 1 0 9. This is In the sub? Yes. Okay. So it reads that if the child has an existing relationship with the therapist, that they'll take the steps to continue facilitating, which is a concept I totally agree with. Um, I'm just wanting to make sure that we get this right. Um, but then it says some of the ways that they'll do that are by facilitating the mental health therapist enrollment as a Medicaid provider, if applicable. And my question goes to, if they do not become a Medicaid provider, is that a service that the biological family continues to cover through their private insurance or is that something that the division then ends up paying out of pocket for? How does that work? So the intention, if I may Yes, please. The intention was certainly not that there would be an undue burden because if the child is in care, DCFS is charged with paying for that care for the mental health services. So it would be a single case agreement between DCFS and the therapist. The therapist would, of course have to accept the Medicaid rate. So they would not, we would not be expecting DCFS to pay a higher rate.

I'm not an attorney. Sorry, can Yeah, I would actually have to refer to, refer probably back to the drafting attorney to, to Answer that. That that's fine.

We can work to clarify, to clarify That. That's a great question representative. Thank you.

Thank you, Madam Chair. My name is Mariah Hurst. I am the executive director of the Youth Providers Association. The network of agencies who contract with the state to provide evidence-based treatment to kids in DCFS and JGYS custody. Things change really quickly here, and the sub just dropped, so it will change my presentation dramatically. So it's just really important for that carve out piece for kids in residential care or higher levels in integrated treatment models. It's really important to create a carve out for those so we fully support substitute one and appreciate the changes that were made for that. Yeah, And I, and I just, I wanna apologize for the really late draft. I mean, the drafting attorney literally did this less than a half hour ago, so she was, she worked miracles in getting that done.

Hello, I'm Sarah Strub and I am a licensed marriage and family therapist and the legislative chair for the Utah Association for Marriage and Family Therapy. This bill addresses a critical gap for children in our foster care system, the loss of therapeutic progress that often happens when a child enters or leaves custody. Um, to be brief for you, uh, this bill is about providing clinical stability, where possible and continuity of care where necessary. And we ask that you support this bill and continuity of care for our most vulnerable youth.

Thank you. Hello. Thank you so much for the opportunity to speak. Madam Chair, members of the committee. My name is Leanne Rupp. I'm licensed clinical social worker, and I'm here today representing social workers as the executive director of the National Association of Social Workers Utah chapter in support of House Bill five 90 sub one. This bill thoughtfully promotes continuity of mental health care services for children in and transitioning out of DCFS custody by facilitating arrangements that allow these youth to continue with their existing therapists. Ensuring consistent therapeutic relationships is critical for stability, trust, and long-term wellbeing, especially for children who have already experienced trauma and disruption in their lives. Continuity of care is a best practice in behavioral health and aligns with our profession's commitment to strength-based, person-centered and trauma-informed care. The provisions in this bill help reduce barriers that many children and families face in accessing ongoing mental health support as they move between systems of care. Thank you for your consideration at this important child-focused policy today. We encourage you to vote in favor of house Bill five 90 sub one. Thank

Hello, my name is Jessica Black. I'm the legislative chair for the Utah Mental Health Counselors Association. And, um, I am speaking today in strong support of HB five 90. Um, in clinical practice, we know that the therapeutic alliance is one of the most important predictors of successful treatment. And when kids are put into the foster system, um, you know, their life is often defined by disruptive transitions. Um, they will lose their homes, their schools, and often their sense of safety. So we are in strong support of this bill because it allows kids to have that continuity of care in moments that their child really, really needs it. Um, it also, uh, allows for single case agreements, which can be very important. Um, healing requires stability, and this bill really ensures that every kid will be able to, um, have the support that they need when they are going through these difficult transitions in their life. So, I urge you to favor favorably recommend this bill. Thank you.

It's a good substitute.

With Representative Bollinger. It's a good substitute.

Thank you. I just wanted to clarify, uh, representative gracious, and I'll work on the, the question, the ambiguity, and absolutely address that as the conversation goes forward. Really appreciate your support.

Thank you Mr. Chair. This is, um, You have an amendment online? I do. I have a brand New Amendment online house Bill five 90 is a bill that ensures that any child in foster care or in, uh, custody of division of Child and Family Services, who's established care with a men, a health mental health therapist can stay in, stay with that therapist even if they change families or change jurisdictions. Okay. If it's in the best Interest of the child, what if they move from Logan to St. George? If the family's willing to do it, then they can, they can maintain that relationship. All right. Does it have a, like a Zoom option? Uh, to the extent that state law allows for it? Yes. Okay. And Dr. Feldberg is here with me to answer questions if you need them.

I move that we favorably recommend first Sub two. No, no. House Amendment two, please. I move this amendment to, I move That we move Amendment two.

Um, that was a request on insurers to make sure that, um, they were able to stay, that the rates were not un negotiated.

You. I move that we favorably recommend first substitute house bill five 90 as amended.

Thank you Mr. Speaker. Um, HB five 90 addresses continuity of mental health care for children in or leaving custody of the Department of Family, uh, DCFS, department of Child and Family Services. Basically what we're trying to accomplish is to make sure that in cases where children who are in the custody of the state who have established mental health care services with a trusted provider, that, um, if, if all of the parties, um, of interest agree and wish for that child to stay in the care of that therapist, even if they move families or move, um, within custody in the of the state, they'll be able to maintain that therapy relationship with a given provider given, um, if the, if the new parent or agency who has custody is willing and able to make sure that the transportation and the logistics for that care, um, are maintained without Mr. Speaker, I'm open to questions.

Thank you Mr. Speaker. Motion to adopt amendment one in my name.

Yeah, it just clarifies that in these cases that the state is not paying a rate above that of the existing Medicaid rate.

Thank you Mr. Speaker. It's a friendly amendment and I do really, uh, sincerely appreciate the work of the good sponsor of the amendment. She is well versed, um, in this area and I appreciate her guidance and feedback.

Thank you Mr. Speaker. Just, uh, eager for the opportunity to make sure that we are maximizing the quality of care, especially for, uh, vulnerable children who have established a safe and healthy, um, therapeutic relationship. And make sure that we are giving our state agencies the opportunity to make sure that those relationships continue to the best interest of these children. Appreciate support of the body.

Thank you Mr. President HB five 90 for substitute. Just establishes requirements. So our, um, system of DCFS can ensure continuity of mental health for children entering and leaving custody of foster care. This is a challenge with our, our children that are being taken care of as they're in the system and as they're exiting it and or entering again, uh, it just makes it really hard to have that continuity of care. This bill recognizes the opportunity for kids in foster care to maintain their care with their therapist as they move from one family to another. This just makes it so our kids that are in the most difficult situation can get, uh, continue to get the access to medical care that they've been receiving. Uh, currently the CFS only works with departmental contractor providers. These providers are sometimes not available to the child when they leave foster care. So the bill requires that the insurance companies can continue to work on that mental health services and offer a single case agreement, allowing a child leaving DCFS custody to continue treatment with the same provider, even if it's out of network. And it's been worked with all the stakeholders and got, um, unanimous support through the process. And with that Mr. President, I'm open for any questions.

Thank you President, uh, sponsor agreed to yield. Senator Esee, I think said yes. Yes. Yeah. Just a clarifying question. President. Uh, on these every child deals with trauma differently. So this isn't mandatory for all children. Um, would that be correct?

Thank you Mr. President. This will only be related to children that are in foster care with DCFS and they're currently in therapy getting and receiving treatment. So when they move from one place to another, the care can continue with the same therapist and you don't cut the care. Thank you President. Thank you.

Gonna waive summation and call the question Mr. President.

Thank you Mr. Speaker. Motion to concur with the Senate amendments. That motion is an order representative. Would you like to speak to it Briefly? Uh, just had a request from insurers to make sure that there was clarity on the reimbursement rates for therapists.