Government Subsidies for Attachment Therapy
Nonetheless, there is an ongoing, assiduous effort on the part of therapists and parents to obtain third-party assistance, usually government, for their use of AT. AT conferences even have workshops where participants are taught both how to meet the letter of the law and still get third-parties to pay for AT.
There are seven principal pathways along which government money can flow into AT treatments:
Title IV-E of the Social Security Act
Social Services Block Grants
training and professional education
The Adoption Assistance and Child Welfare Act of 1980,1 amends the Social Security Act to provide federal subsidies2 to states for financial assistance to “special-needs” adoptions: Adopt a child with a severe, recognized problem, or even “at-risk” for having such, from a state agency and you get money. All in all that is a good thing; the law’s intent was to encourage, through subsidy, adoptions that might not otherwise take place.
States administer the Title IV-E program. Some resist making awards because it requires matching funds.3 Funds are limited by annual congressional appropriations, so subsidies granted to some applicants on a first-come/first-served basis may mean that later applicants with greater special needs, such as physical handicaps, may not receive funds at all; in other situations, subsidy amounts may be reduced or limited. Parents who succeed in qualifying can receive upwards of $1,200 per month per child.4
The are a number of means to qualify a Title IV-E subsidy to pay for Attachment Therapy. Reactive Attachment Disorder (RAD), being in the DSM-IV, is one of those severe problems for which an adoptive parent can get Title IV-E assistance.5 A RAD diagnosis could be deliberately confused with “Attachment Disorder,” which does not appear in the DSM-IV and is not professionally recognized. Other legitimate diagnoses could be made (e.g., ADHD, PTSD, ODD, PDD, bipolar, autism), but the treatment given may be AT instead of a recognized regimin for the stated diagnosis.6 (AT claims that AD must be treated before or along with other conditions.)
Parents are urged and counseled by the AT community to stubbornly refuse to take “no” for an answer on Title IV-E subsidy requests. Social workers who deny requests, and the supervisors who support them, are belittled for their “ignorance” and “bureaucratism,” even their “lack of compassion.” Formal hearings are requested “on appeal.” Repeated applications are made following denials. Sometimes caseworkers are warned that they could be held responsible if a child exhibits criminal behavior in the future.
Since AT violates laws in many states, as well as federal regulations, caseworkers and their supervisors should be prepared to stand their ground when they encounter AT-related demands from clients. State offices should issue specific policy directives against AT upon which caseworkers can rely. The federal government should require such policy directives from state agencies.
Some Title IV-E caseworkers are inclined to accept the reasoning and practices of AT. Such individuals should be identified and re-educated; if incorrigible, their work should be closely supervised or they should be re-assigned.
Social Services Block Grants
States use Social Services Block Grants7 (SSBG) to fund services to prevent or remedy neglect or abuse of children, including paying for the foster care costs for the board and care of children not eligible for federal Title IV-E foster care assistance.8
State departments of social services administer SSBG programs. There are all sorts of ways that federal and state funds can be diverted to AT9 when a state department, for whatever reason, is AT-friendly.10
Private adoption placement agencies are an ideal way for AT to flourish. Many have state charters or licenses (usually called Child Placement Agencies, or CPAs) and are paid by the state (with SSBG funds) for some or all of the placements they do. Some CPAs may have nothing to do with AT, but a number specialize in AT-related placements.11 Of those that do, they “identify” attachment-disordered children and try to place them with AT in mind.12
Respite care is commonly paid for after finalization of an adoption of a “special needs” child. AT “therapeutic foster parents” specialize in an AT-based form of respite that is especially harsh13 and many are certified to provide state-subsidized respite.14
Some AT providers have insinuated themselves into the service offerings of otherwise legitimate mental-health providers, thereby giving them access to Medicaid and insurance payments. Unless caseworkers or claims adjustors are aware and alert, payments for AT treatments can easily be authorized.
Generally, Medicaid has not been established as a source of funding for AT. However, some AT operations are approved for receiving Medicaid funds. One was, at least until recently, the Cascade Center for Family Growth in Orem, Utah.15 Another is a chain of clinics in the western US, Casey Family Clinics (allied to similarly named clinics in the East). The Casey clinics in the West are involved with AT (they had a speaker at 2002’s ATTACh Conference, and are on many AT provider lists) and they definitely receive Medicaid money. Wellspring in Connecticut definitely gets Medicaid money; they offer “Dynamic Attachment Therapy” for families.
Training and Professional Education
There are many Attachment Therapists, and especially Therapeutic Foster Parents, who conduct training and “awareness” seminars in AT. There are whole conferences devoted to AT.16 Many county departments of social services send social workers and other child-welfare employees to such sessions, paid for with public funds, of course.17 CEUs for license retention are frequently offered for these courses. At present, there are no offerings on the subject of AT which are critical or skeptical of the practice. Therefore, the conference/seminar fees and associated travel expenses, paid for from government funds are a direct subsidy of AT.
Some courses are for parents as well as professionals, paid for with grants from the federal government in some instances.20 Even the military has engaged a prominent advocate to promote the use of AT for military dependents.21
AT workshops are also held at the conferences of other organizations. For example, the North American Council on Adoptable Children (NACAC) had several AT & TFP activists speaking at their national conference in August, 2002. (It urged potential attendees to look into getting reimbursement as “training” from their employer for the conference.) NACAC has received a Adoption Opportunities grant from the U.S. Department of Health and Human Services to train local social workers to “educate” parents with respect to Title IV-E. (NACAC also endorses and sells at least one book promoting AT.)
On AT support-group listserves on the internet, parents are urged to go to court and claim “wrongful adoption” against the agency that placed an Attachment-Disordered child with them. They are told that if an agency doesn’t advise them up front that a child likely suffers from Attachment Disorder, then the agency is liable for the costs of AT for the child. They say that even in the unlikely event that an agency made such a disclosure, the claim can always be that the severity of the disorder was not made plain. It is not known if any lawsuits pursuing such theories have been filed and if so what judgments may have been rendered for the plaintiffs. Of course, the usual objective of the legal tactic is not to go to trial, but to secure a pre-trial settlement. Be it settlements or judgment, they are easily paid, at least indirectly, out of government funds.
Government-funded research into attachment issues is an emerging area of financial support for AT. Since there are insurmountable ethical problems with Attachment Therapy, you will not find knowledgeable research organizations, such as at the National Institutes of Mental Health, looking into AT.22 However, other grant-making agencies may not be aware of these problems and can inappropriately fund, or participate in, AT research activities, unless alerted by others.
One incredibly troubling research project has been discovered in Lancaster County, PA. That county’s Head Start program had been participating with a study of AT being done by a senior psychology student from nearby Millersville University. Head Start provided 62 children from the Ephrata and Manheim Head Start Centers to be assigned to experimental and control groups, with the former receiving twice-a-week AT (holding) sessions for 10 weeks. The project, supposedly developed at the request of Lancaster County’s Children and Youth Services, is to be used as a basis to apply for grants to adopt it on a larger scale.23
An easily overlooked pathway for government subsidy for AT is through health insurance. Insurance is a common benefit for employees, and increasingly mental-health coverage is being included. Fortunately, most insurors will not cover AT treatments, but some will. Insurance claims for AT ultimately are paid by the employer through premiums. When the employer is the government, and it selects an insuror that pays AT claims, that means that taxpayers are picking up the tab for AT treatment.
There is at present a political effort to require all third-party payers to reimburse for treatment of DSM-recognized disorders.24 In Washington State, for instance, it is already a law that insurance must pay for any therapy prescribed by a licensed health professional. This opens the door for all insurance rate-payers to pay for AT through a RAD diagnosis. Since RAD is often speciously diagnosed, and since the APA itself has formally issued a warning against the use of AT for that diagnosis, the AT community is making a separate effort to get Attachment Disorder recognized in the DSM, using their descriptions and definitions. If these separate efforts are both successful, Attachment Therapists will have full access to third-party payments, enforced by law.
Back to text. Also known as PL 96-272.
Back to text. Totalling about $1.2 billion in FY 2000. [Source: NACAC]
Back to text. Federal financial participation (FFP) in a state’s IV-E program is the same as the FFP in the state’s Medicaid program. The federal share therefore varies from state to state, ranging from about 50% to about 80%. [Source: Adoption Policy Resource Center]
Back to text. Postings on HopeforRADKids listserve.
Back to text. RAD is Diagnosis 313.89. Properly diagnosed, it is rarely encountered. Frequent awards for this diagnosis is a red flag; even a single diagnosis, not involving a foreign adoption, is suspicious.
Back to text. Treatment plans for these diagnoses should be scrutinized to filter out AT. A declaration should be signed by the adoptive parent that says the funds will not be used for AT or to replace other funds which are used for AT.
Back to text. Also known as Title XX of the Social Security Act.
Back to text. In FY 1999, more than $800 million in SSBG funds were spent on services to children and youth, including adoption, foster care, child protection, independent living, and residential services. Nearly $323 million of that was spent for foster care services to over than 288,000 children (one-half of all children in “out-of-home” care). Another $83 million of the total supported residential treatment. [Source: Child Welfare League of America].
Back to text. In states where there are lax restraint/seclusion laws and there are also active AT communities, state programs can be expected to be targetted. For example, in Ohio, home base for AT activist Gregory Keck, the state has established a generous entitlement program (so generous it ran through a $3.7 million two-year appropriation in less than 10 months) called the Post Adoption Special Service Subsidy (or PASSS). Keck’s Attachment and Bonding Center of Ohio claims that PASSS funds pay for AT there and urges parents to seek the subsidy.
Back to text. Though there is reason to believe things have changed, Utah’s Division of Family Services was at one time one of the most friendly to AT. In one case, it even made holding therapy a condition of adoption, ratified by a judge, and the child later died as a result. The adoptive father used the required training given him by attachment therapists and killed his 4-year-old daughter in a holding session. He served five years in prison as a consequence, and shortly after his release testified against the therapy before the Utah legislature.
A leading center for AT in the United States is The Attachment Center at Evergreen (ACE) in Colorado. ACE advertises that they have a “program clinician” who “serves as primary therapist for ACE clients in the Colorado foster care system who are treated without having placement families.” [Source: ACE] This would be contrary to the primary notion of Attachment Therapy, which is to promote attachment to a caregiver. (Though it is claimed, incredibly, that the attachment or “bond” by the child to the therapist can be transferred to the caregiver!)
Another county in Colorado, Weld, has provided an AT parent support group at taxpayer expense. [Source: We Can]
Back to text. Maine Adoption Placement Services, for example, whose branch in Colorado was run by Deborah Hage, an energetic AT therapist and author.
Back to text. One such, Lund Family Center in Burlington, Vermont, recently advertised about a child for whom they were “looking for a family that is knowledgeable about attachment-related issues, willing to participate with him in attachment therapy, and prepared to do whatever it takes to help him cultivate life-long attachments.” Lund acknowledges that this placement was being facilitated by funds from a three-year federal grant.
Back to text. Nancy Thomas is arguably the leading AT “parenting specialist.” Auditors should be on the look-out for providers who claim to use “Nancy Thomas techniques.” [See her video on AT respite, entitled “Give Me a Break”] An article in Adoptive Families [Robinson, “Respite care: getting the break you need,” 1995, 28(6):56-57] promotes such “therapeutic respite care” by claiming “especially for older, attachment-disordered children, [it] can delay institutionalization and prevent adoption disruption. Without it, there will be more children in need of permanent homes.” The article suggests that community-based services, paid for with Title IV-B and Title V funds, could be used to provide therapeutic respite care.
Back to text. This certification also permits them to circumvent state regulation and supervision as day-care providers. Consequently, AT “therapeutic foster parents” can engage in behaviors that could result in license-revocation and/or criminal charges if done by a usual day-care provider. As early as 1992, Arizona used a DHHS Adoptions Opportunities Grant to found its Aid to Adoption of Special Kids program (AASK), which included “a respite program…to train respite providers to care for adopted children with behavioral and attachment disorders.” [Source: NAIC]
Back to text. That of the annual meeting of the Association for the Treatment and Training in Attachment of Children (ATTACh) is a well-attended one.
Back to text. Fairfax County, Virginia, got a $300,000 federal DHHS grant to send workers for training at Colorado’s Attachment Center at Evergreen, one of the leading entities in AT (and where Connell Watkins, one of Candace Newmaker’s killers, was previously Clinical Director). [Sources: USNWR, 14 July 1997; Fairfax County]
Back to text. One appalling occurrence was at a program in Buffalo, NY, set up by a family judge there, which explicitly promoted an AT seminar in 2001 (at $75/attendee). [Source: Erie County]
Back to text. Weld County, Colorado, has received at least two such grants. Fairfax County, Virginia, [Source: USNWR, 14 July 1997] At least one state, Iowa, has explicitly made training for RAD available ($60,000 in 1999). [Source: State of Iowa] A federal grant to the University of Southern Maine was used to “sensitize mental-health practitioners to adoption issues,” which included considerable discussion of “the use of attachment therapies in interventions for families in crisis.” This was not all bad, however, as there was a brief discussion of contraindications for attachment therapies, especially with reference to holding therapies and techniques. [Source: Creating Kinship]
Back to text. For example, Nancy Colletta, PhD, an Arlington, Va., psychologist who does such training under a federal grant from the Administration for Children and Families. [Source: APA Monitor] Prominent AT advocate Daniel Hughes in June, 2002, presented an AT seminar paid for by a Social Services Block Grant to the Maine Department of Human Services. [Source: State of Maine]
Back to text. Bryan Post taught Attachment Therapy for theFamily Advocacy Program at Fort Sill, Oklahoma (home of the Army’s artillery school).
Back to text. This fact leads quite naturally to charges that NIMH and the rest of the mental-health “establishment” are suppressing this “promising” therapy.
Back to text. Refer to the Pennsylvania Head Start program’s website.