CASA Volunteer Provides Invaluable Medical Advocacy

In 2005, the Texas Legislature passed far-reaching reforms that impact medical care for foster children. The newly created Chapter 266 of the Texas Family Code, titled “Medical Care and Educational Services for Children in Foster Care,” covers “all health care and related services” provided to children who are under the managing conservatorship of the Department of Family and Protective Services (DFPS).¹ The definition of “medical care” also encompasses the use of psychotropic medications.

To ensure that foster children receive proper medical care, Chapter 266 requires that a judge review a summary of the medical care provided to the foster child at each hearing, including:

“Because of the complex issues involved in the lives of foster children, it is important that a comprehensive evaluation be performed before beginning treatment for a mental or behavioral disorder. Except in the case of an emergency, a child should receive a thorough health history, psychosocial assessment, mental status exam, and physical exam before the prescribing of psychotropic medication.”

Texas Department of State Health Services, Psychotropic Medication Review Parameters for Foster Children – Introduction and General Principles, February 2005.

Emergency medical care;
Medical and mental health treatment;
Medications prescribed and the child’s progress with the medication;
Compliance (or failure to comply) with the medical treatment plan;
Adverse reaction to or side effects of any medical treatment;
Specific medical condition of the child;
Activities to be avoided (or engaged in) to promote the effectiveness of treatment; and
Other information required by DFPS rule or by the court.²

Judicial review of a foster child’s medical care is mandatory, giving CASAs an historic opportunity to engage in medical advocacy on behalf of the children they represent.

Enter Dean Dearmont, an active CASA volunteer with CASA for the Highland Lakes Area in Kingsland. Dean was a successful businessman for 38 years before retiring to the Hill Country in 2000.³ Because he felt that he related well to children and had experience that would be useful, he decided to get involved as an advocate. Dean became a CASA volunteer in November 2004. He accepted assignment to a case that eventually gave him an opportunity to provide essential medical advocacy on behalf of a CASA child.

When Dean first met his CASA child, the boy was living in an emergency placement. The staff there had written all of the child’s prescribed medications on a blackboard and, according to Dean, there was “a lot of stuff going into the child’s body that just couldn't be good for him.” Like many foster children, this child had experienced numerous placement changes and had had several different CPS caseworkers assigned to his case.

With the guidance of his CASA casework supervisor, Barbie Ott, Dean began asking questions—lots of questions—about the child’s medical and psychological needs. He also did independent research regarding the various medications the child was taking at the time. Dean spoke to the child’s psychologist, psychiatrist, therapist, and foster mother. He even sought advice from his own grown children, who are doctors.

Thanks to Barbie Ott, Dean was provided information on medical advocacy and the legislative reforms contained in Senate Bill 6. He also read through a copy of a presentation on how to ensure that a foster child receives appropriate medical care, which was presented by Senior Attorney Richard LaVallo of Advocacy, Inc., at last October’s Texas CASA annual conference.⁴ A copy of some of the report information was sent to the child’s psychologist. Barbie played an important role in helping to educate her volunteer, empowering Dean with the necessary knowledge to properly advocate for his CASA child’s medical needs. According to Barbie, “education is the key because knowing what questions to ask is so important.”

The judge on the case was another positive factor thanks to his support of CASA’s efforts to ensure that the child was receiving proper medical treatment. Judge Rob Hofmann is known for taking a pro-active approach to all of his cases, requiring that the CASA’s report address two very important questions:

What medications is the child currently taking?
Do you think the medications are appropriate for this child?

According to the staff of CASA for the Highland Lakes Area, Judge Hofmann does a good job of explaining his expectations to the CASA volunteers, which is something Dean has come to appreciate. “The judge holds everybody accountable and expects folks to do their job in his court room.”

While most CASAs are not trained medical experts, they can certainly share their personal observations and the information they obtain from talking to the child and the people who have regular contact with the child. Many of the items contained in the summary of medical care provided to the court by DFPS can be addressed by volunteers who have actively engaged in medical advocacy on behalf of their CASA child. By law, DFPS must provide a copy of the summary not only to the court but also to “the guardian ad litem or attorney ad litem, if one has been appointed by the court.”⁵

As a result of Dean’s advocacy, his CASA child received a new and thorough psychological evaluation which ruled out bi-polar disorder and ADHD. To date, the child’s medication for bi-polar disorder has been reduced by 80 percent. This summer, once school is out, the psychiatrist plans to remove the child from all of the medications to determine if there is a need for any additional medical treatment.

In January 2006, Dean Dearmont received the United Way Capital Area Volunteer of the Month award through a program sponsored by AMD and the United Way Volunteer Center.⁶ On February 16, 2006, he was officially recognized as a “Volunteer of the Month” by City of Austin Mayor Will Wynn and the Austin City Council. The Certificate of Congratulations he received says it best:

“Mr. Dearmont is relatively new to being a Court Appointed Special Advocate, but he’s thrown himself into the responsibilities of keeping his CASA child’s best interests at the forefront. Mr. Dearmont drove almost 5,000 miles his first year as a Guardian ad Litem, visiting each of his child’s five placements. He also oversaw testing that resulted in the child’s medications being reduced. And, he’s worked tirelessly to see that his child got caught up to grade level in school. Mr. Dearmont helps recruit other volunteers and also is a financial supporter of CASA for the Highland Lakes Area. This certificate is presented in recognition of his exceptional dedication and spirit of volunteerism…”

(We wish to thank Barbie Ott and CASA for the Highland Lakes Area for providing much of the information used in writing this article.)

(Endnotes)
¹ §266.001, Texas Family Code.
² §266.007(a), Texas Family Code.
³ Volunteer of the Month, January 2006: Dean Dearmont,http://www.unitedwaycapitalarea.org/newsandevents/2006/0106_vom.cfm.
⁴ An Overview of SB 6’s Medical Care Provisions: How an Advocate Can Ensure that a Foster Child Receives Appropriate Medical Care, Richard LaVallo, Senior Attorney, Advocacy, Incorporated.
⁵ §266.007(b)(3), Texas Family Code.
⁶ Regional United Way Honors Local CASA Volunteer, The Daily The Daily Volunteer
Tribune, Wednesday, February 8, 2006, p. 5.