When Your Child Needs Intensive Treatment

You shouldn't have to choose between disrupting the adoption or going bankrupt.

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“I sit here in the quiet of the morning,” wrote Julie Morgan*, “thinking about how to tell my daughter that we have to give up custody of her.”

At the time, the Morgans were locked in a heated battle with two states, fighting to find a way to pay for the residential care her adopted daughter, Angie*, so desperately needed. The Morgans adopted Angie in one state, but then moved to another. Neither state would claim responsibility for financing Angie’s serious mental health needs unless Angie came back into the foster care system.

Too many adoptive parents are forced into deciding between giving up custody of their child so he or she can receive intensive services, or maintaining custody at the price of bankruptcy and personal endangerment. Families who open their homes to waiting children should never be compelled to make such a devastating choice. Julie shares her family’s story in the hopes that other adoptive families will be spared the anguish her family endured.

The Morgans adopted Angie and her five siblings at the same time. Julie and her husband already knew how to advocate for their medically fragile birth child and felt prepared to help the siblings toward a brighter future. Within the first month, however, the Morgans made the gut-wrenching decision to relinquish Angie’s brother because he was abusing the younger girls (counter to the agency’s assurances that he was not abusive). Angie learned again that promises get broken, and her behavior began to deteriorate.

“[Angie] was destined for a tough life,” says Julie. Prenatal alcohol exposure has caused learning problems, mental retardation, and fetal alcohol syndrome (FAS). She spent eight years in an abusive home and another four years in foster care before joining the Morgans. Angie also suffers from bipolar disorder. Rage is never far below the surface. Because she feels worthless, Angie directs anger toward herself and others. During one violent episode, Angie threw Julie down a flight of steps. Julie, who still bears scars from her daughter’s rages, has learned that Angie cannot control her behavior and needs constant supervision.

It became apparent that a family home could not provide the tight supervision Angie needed to keep from hurting herself or others, so the Morgans decided to place Angie in residential care, where the surroundings would provide the control Angie lacks. But the family also realized that Angie still needed a family. She needed the constancy of parents who could advocate on her behalf, and the security of a family who would be there for her as she struggled to work through her problems. “My daughter still needs a family,” said Julie, “even if she is too unsafe to live at home.”

For six long months, Julie sought help to offset the cost of Angie’s care. The state from which the Morgans adopted Angie pays for the children’s adoption subsidies, but refused to cover the cost of residential treatment. Julie approached her home state, but met many roadblocks there too. The county mental health group finally asked the Morgans to relinquish custody of Angie– disrupt the adoption– so that the two states would be compelled to decide how to handle the logistics and cost of Angie’s care.

Constantly in crisis, Julie at one point worried that the psychiatric hospital where her daughter was living would release Angie ahead of schedule (as the local mental health group asked the hospital to do), to force the Morgans to abandon her. The group knew Julie would not risk her family’s safety by taking Angie home, and then the county could charge the Morgans with abandonment and bring Angie into state custody. The psychiatric hospital rejected that request, but Julie’s family still needed to find money for another placement for Angie, or choose between caring for Angie at home (not a feasible option) or relinquishing custody (an equally devastating choice) to force someone else to pay.

By this point Julie had taken Angie’s story to the Attorney General’s office in both states, her state’s community health organization, various adoption and mental health service organizations, the federal Health Care Financing Administration, and even the White House. She found sympathy, but not the help she needed until an area manager for her state’s community health department stepped in to mediate an agreement between the local mental health organization and the Morgans.

By focusing on Angie’s needs, the Morgans and the mental health organization at last reached an agreement through which Angie could obtain needed services while remaining in her family. Angie’s condition would be monitored, and it was known that the agreement could change, but the Morgans were thrilled to know that Angie was in a safe place and that she could still be a part of their lives. Julie believes that if Angie had lost her family, she would have lost any reason to try to get better.

Angie’s mental health issues may keep her from living with her family, but that does not mean she should not belong to a family. Families who adopt troubled children must have access to all services– including residential care– that their children need. When families are forced to relinquish children so they can get services, everyone loses. Angie still has a family. States must work to provide enough resources so that every child can be so lucky.

*Names have been changed.

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Mental Health Resources

Bazelon Center for Mental Health Law - Based in Washington, D.C., the Bazelon Center is a nonprofit legal advocacy organization that produces publications related to, and advocates on behalf of, the mentally ill. On the web, go to.

Centers for Medicare and Medicaid Services (CMS) – A federal agency previously known as Health Care Financing Administration, administers Medicare, Medicaid, and state children’s health insurance programs.

National Alliance on Mental Illness - NAMI is a self-help and advocacy organization that helps people with mental illnesses. They have 1,200 affiliates throughout the U.S. and Canada. To learn more, visit their website or call 1-800-950-NAMI.

National Disability Rights Network - Formerly known as Protection & Advocacy (P&A) Systems. NDRN was established through federal mandate to protect the rights of people with mental health and developmental disabilities.

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