Thousands Of Young People Likely Affected By “Out-Of-County” Barriers To Care

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Thousands Of Young People Likely Affected By “Out-Of-County” Barriers To Care

Foster youth placed “out-of-county” face significant barriers to accessing needed mental health services. Analysis of recent child welfare and mental health data demonstrates that children within this vulnerable population are more than six times less likely to receive intensive home and community-based services than foster youth served in-county placements. Young Minds’ president Patrick Gardner breaks down the data as part of our ongoing efforts to understand and fix this long-standing problem.

According to the most recent numbers (July 2014) shared by the California Child Welfare Indicators Project (CCWIP) at UC Berkeley, almost one in five foster youth were sent to placements (a foster home, group home, etc.) across county lines or “out-of-county.” Specifically, out of the 66,604 foster children in the State, 13,147 were served out-of-county in July 2014.

Historically, foster youth placed out-of-county have faced significant disparities in access to mental health services. This problem was identified as early as 1998 and more recently analyzed in the 2011 Data Mining Project report, prepared for the California Child Welfare Council. The latter report found that out-of-county foster youth were 10-15% less likely to receive any mental health service than their in-county peers. Among those foster youth who did receive mental health services, those in out-of-county placements received less care and less intensive treatment relative to what was provided to youth with in-county placements—even though they were also shown to have greater needs.

How many foster children do not receive adequate care because they are placed out-of-county is not documented. However, studies indicate that between half to two-thirds of foster youth have mental health care needs, so we can estimate the number of children that may be affected ranges from 6,573 to 8,769 at any point in time.

Recent data collected pursuant to the settlement agreement in Katie A. v. Bonta provides additional evidence that foster children placed out-of-county are seriously disadvantaged. Consider the following: the largest reported monthly number (to date) of children involved in the child welfare system who were provided Katie A. services is 6,698 for June 2014. That same month, the number of out-of-county youth provided Katie A. services was 186. If out-of-county youth were served proportionately to in-county youth, the number would be 17.6 percent of 6,698 or roughly 1,180 children. Thus, in-county children are provided Katie A. services at a rate of more than 6½ times the rate of out-of-county youth. Stated another way, about 1,000 out-of-county youth likely are not receiving Katie A. services simply because they have been placed out-of-county.

Clearly, placing foster children out-of-county often imposes real hardships on children needing access to mental healthcare. The problem stems from a system design flaw in Medi-Cal’s mental healthcare waiver. Recognizing this, the California Child Welfare Council unanimously approved an action plan intended to resolve the out-of-county problem. Although considerable delays have ensued since then, at a recent California Child Welfare Council meeting the State recommitted to taking quick action. As advocates for youth with mental health needs, we all have a stake in ensuring this issue is addressed, and soon.  If you or someone you know have had, or heard of, problems getting access to mental healthcare as, or for, a foster youth sent out-of-county, please contact us at

With your involvement, we can fix this problem!

Read past posts about the “out-of-county” issue here.
Read YMAP and the National Center for Youth Law’s report (2011) regarding this issue here.

By |2019-04-24T13:54:30-07:00January 21st, 2015|Featured Posts, Out-Of-County, Policy Action|0 Comments

About the Author:

Patrick Gardner
Patrick Gardner is the Founder and President of Young Minds.