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Does Adoption Support Work?

It has now been three-weeks since Mordecai broke his foot. His insurance, granted to him as a newborn by Washington State, won’t approve a walking cast for his foot. He is literally walking around in a broken cast borrowed from friends. And after I wrote this the cast broke completely…so I will be calling his doctor in the morning. Again.

Mordecai was placed in our home for adoption October 1, 2002. He was a beautiful baby with wavy black hair and big brown eyes. He was four weeks old. We knew a fair amount about Mordecai’s history; his birth mother was quite forthright in telling the agency about his prenatal environment. It was obvious that she loved him and wanted the best for him. Mordecai came to us through the foster care system here in Washington. Prior to Mordecai’s adoption being finalized in July of 2003, we signed an Adoption Support agreement with Washington State. {Adoption Support is a way to allow families to adopt “hard-to-place” kids who couldn’t do so otherwise, either because of finances or lack of health insurance.} In the agreement, a legal document, the state agreed to:

a. Provide medical and dental services through title XIX Medicaid program

b. Provide out-patient psychiatric and other counseling services

c. Pay a monthly cash payment of $328.12 per month

{and just in case you think we are getting rich off of our adopted children, Mordecai is the only child we have with adoption support}

d. Other costs of  finalizing the adoption…

And for the past eleven and a half years, they’ve done a pretty good job. They have  paid for Mordecai’s four surgeries (three on his hand and the removal of his tonsils and adenoids). They paid to have him evaluated at the Fetal Alcohol Diagnostic and Prevention Network, where he was diagnosed with “static encephalopathy alcohol exposed“. They have paid for his well-child and sick visits to the doctor.

Now, at age 11 (and starting last year, really at age 10) we are beginning to see what we strongly suspect is some mental illness. I won’t go into the details online, for his sake, but there are very serious safety implications for everyone in this house. His primary care doctor, who has been his doctor since he was a newborn, believes he needs to see a psychiatrist. The psychologist who recently examined him and declared him “disabled” by the Social Security’s standards believes he needs to see a psychiatrist. The State of Washington? Nope. He can go see a counselor at  Catholic Community Services, like we did today.

Unfortunately, by Catholic Community Service’s standards, having a diagnosis of  FASD (Fetal Alcohol Spectrum Disorder) does not qualify you for counseling. Why not? Because it is not currently in the DSM-IV (Diagnostic and Statistic Manual of Mental Disorders). Nope, not a “mental illness”.

According to the MOFAS website:

While a Fetal Alcohol Diagnosis may facilitate the appropriate recognition of the underlying organic brain damage involved in individual’s difficult behaviors and assist in the treatment with the child and family, there is no effective way to link the medical health side of FASD with the mental health issues that arises in approximately 90% of these individuals. (emphasis mine).

So, 90% of these kids will have mental  health issues…but there is no “effective link”?

 Okay. But certainly he qualifies for counseling, right? His aggressive, threatening behavior and rages alone should qualify him. Right? Just barely. Unfortunately, Mordecai’s symptoms didn’t “fit in” to any of the categories on the drop down menu on the computer of the woman from CCS that I saw today. Oh, friends, I wish I were joking about the drop-down menu, but I’m not. He barely, barely qualified by their standards…so in three weeks (what’s three weeks when we’ve been waiting months?) he gets to see…a counselor. Not a psychiatrist, not a psychologist. A counselor.

There is no way to deny that Mordecai is getting sub-par care through his adoption support. Today he walks around with an unprotected broken foot, because the state won’t approve a cast. Today, I was told he barely “qualifies” to see a counselor. The psychiatrist his doctor believes he needs to see is out of our reach. We can’t possibly pay cash, and the state of Washington doesn’t want to pay.

So  here I sit.

A son with a broken foot, in need of a some serious mental health intervention.

A mom with a broken heart, fighting a broken medical system, for her son.

{Edited to add: In December we switched our health insurance to a company in the Affordable Care Act. In recent years we have spent as much as  $30,000 per year on healthcare between premiums, deductibles and co-pays. Because of the switch, there is no “primary” and “secondary” insurance for Mordecai. Just Provider One through his adoption support. And I began the search for a mental health provider last September when we had private insurance, but was unable to get in due to long waiting lists. Seattle Children’s Hospital won’t treat him for mental health issues due to contracts lost when the Affordable Care Act went into affect.}







  1. Ruby McGill

    If he WAS diagnosed with a different mental illness (although you know it has been precipitated by the FASD) would he then qualify for counselling? Does the school have a psychologist who could help you towards getting such a diagnosis? He is at the ‘right’ age for many of the mental health problems that can include the behaviours you describe. Our foster child (whom we cared for from 4 days old) – who is now 24 – was diagnosed with bipolar disorder at age 12, and we were fortunate that the school psychologist was involved and pushed for us to get a diagnosis. We were able to get an initial diagnosis during a manic period, by taking her to our local Children’s hospital, from where she was referred to an inpatient clinic for four weeks where she was treated and monitored. My thoughts are with you, as not only are these behaviours very frightening, and dangerous, but they put everyone at risk. I hope you can get some answers, despite the broken medical system you are fighting.

    • bakersdozenandapolloxiv

      Yes, he “needs” to qualify for a different mental illness which, judging from his symptoms, I believe he has. Yesterday’s visit was some sort of “screening”, but nothing nearly as detailed as when Apollo saw a psychiatrist for his sleep issues…Yes, he is definitely at the “right” age for many of these issues to pop up. We don’t know much about the history of his birth family, so we don’t know if he is at risk for mental health issues because of genetics. He has talked to a counselor at school, but I don’t think they have an actual psychologist.

      • kris

        I would double check with the school system about a school psychologist. Many have them but kids typically just see the school counselor. When my youngest had his evaluations done this year the school psychologist (along with the counselor and other folks)did the evals. The psychologist does not work at the school full time she works among many schools. Can’t hurt to call the school and find out.

      • K

        School psychologists serve as diagnosticians for Special Ed referrals. They aren’t at the school daily like a counselor is. They are typically assigned several schools. You can formally request that the school have him evaluated for emotional needs, and it has to be done in 60 days. Also, as an adoptive parent, I’m pretty sure you have the right to renegotiate your adoption support. We’re in the process of doing that now…

  2. Robyn

    Does the Affordable Care Act help you to switch insurers? Sounds like your current insurer is really letting you down. Is there something we, your readers, can do? Got a twitter address for the insurer, and a simple request we can tweet-bomb at them? It’s surprising how well some institutions respond to that kind of social media mobilization.

    Keep at it. Mordecai is lucky to have a mom who’s such a great advocate and who loves him so much!

  3. sarah


    I get so frustrated from the medical community, and I have no problems doing what ever to get the help I need. I needed help for one of my kids, and after being turned away once, I asked what he would need to have to qualify. I had been focusing on what I thought was bad. Once I focused on what they thought we started to get more help. I have also seen 2 different Bhavioral therapists, 3 occupational therapists, and 3 speech. I discovered that there are emphases people get while going to school to be a therapist. I had to find the ones who emphasised in sensory/meth exposure.

    I have never precalled or taken my adopted son to where insurance says to go. I just go and tell them to bill the state. I know they have to pay for it, and I never have had them refuse. If I called first they would probably tell me no….

    Didnt you say he needed to go to the er for a cast? Why not go now? Besides the irritation. I have had proviers tell me he wouldnt be covered for what ever, and I tell them to bill any way. Then wa states pays for it because they cannot deny a foster / adopted child medical.

    I know you dont do this for the money, but he should qualify for Disability, which would be a golden ticket for getting him covered. Seattle area is nasty for support of foster parents (I currently have a child through seattle), maybe you should contact the agency you worked with for help? Just have a list of key words, so you can get help. :)

  4. Penny

    This is so sad. From a mother with an adult child with mental illness, keep fighting! Mine was constantly misdiagnosed all thru her teen years and never got any real help. It’s been a nightmare. I’m praying for you and Mordecai.

  5. Tanya Redfield

    My heart just breaks for you and Mordecai, and I am actually furious with the insurance…how can they let a child walk around on a broken foot? And as far as the FASD, what are they going to do…wait until there is a terrible incident and THEN qualify him for help? Or worse yet, wait until he ends up doing something that puts him in juvenile detention, where the state will then be paying for EVERYTHING? I pray nothing that bad happens for you, but in so many cases they don’t address the issues in the beginning and they end up being heartbreaking issues for everyone involved later on, and actually cost the states much more… it’s very frustrating! I have been close to kids in this situation and it is so hard for those involved to fight and fight and never seem to be able to get the help they need for their child. And the poor kids just end up slipping through the cracks without a real chance at addressing their problems. Hang in there and fight the good fight…I’ll be praying! And yes, look into qualifying for SS disability for him, or whatever else you can find…. I also know you aren’t in it for the money (that much cash barely feeds a growing boy, much less provides all the other things he needs! You aren’t making a profit!) but don’t be ashamed to take anything you can get to help both Mordecai and your family to get him the help he needs!

  6. Jean

    Can you drop him from that insurance and put him on your husband’s? When I took an older child into my home, I paid cash for his needs. I didn’t want the state involved.

  7. Ellen Nuechterlein

    Call your local State Senator or Representative. I have heard of people getting advocacy for far less than this. It can’t hurt, it might help! Squeaky wheel ….

  8. mkle

    Oh Renee… I’m so sorry. We have been in the same place… Both our (adopted) kids have FASD and both have mental illness. I thought maybe our state, Colorado, was just backward in terms of the (lack of) support for these kids… I thought Washington would be far ahead of us. Apparently not… I wish I there was help I could offer… we’ve been down the road of rages, aggression, needing to find a psychiatrist and feeling like there was nothing out there. We finally found a good psychiatrist through our Children’s Hospital (and Medicaid paid!). When she moved on we started paying out of pocket for our kid’s mental health care.

    I’m sure you already know this, but do be careful in terms of the counselor… So many do not understand FASD, and can even suggest strategies that make things worse instead of better. My suggestion is to read all you can (yeah, like you have a lot of time to read! ;) because you will probably need to educate the counselor about FASD. On the bright side, as our son got older and matured the anger and aggression went away and his mental illness stabilized to a large degree. Now at 22 he is sweet, charming, and a joy to have around…

    Hang in there, there is a light at the end of the tunnel!


  9. mkle

    And to answer the question in the title of this post.. No, adoption “support” does not work… at least from what I’ve seen as an adoptive, and former foster, parent! (Yes, your post definitely hit a nerve with me… )

  10. Kathy Barber

    It doesn’t seem to be working in Texas either. My stepdaughter adopted two of her half siblings children with FASD and prenatal drug exposure, and the then 3 year old was in the hospital, with IV, ready for a surgical procedure under full anesthesia and it had to be cancelled because a caseworker had not signed the right paper. Putting an adult through that would be bad enough but to do it to a toddler is torture.

  11. Melpub

    I am really sorry to hear you are going through this, but have a few suggestions. First, contact prominent pediatricians who know what kind of child psychiatrist or adolescent psychiatrist to find, and how to find one, when cash is short. Perri Klass comes to mind:
    She is a wonderful writer of novels who is also a physician, a pediatrician, and has written amazing case histories. I also think you might consider getting in touch with your congressperson. I think you could be very proactive–downright pushy–about insisting to whomever you contact that you need help and don’t take no for an answer.
    BUT I also think your first consideration must be to protect your family. If your adopted son is dangerous and you have no treatment, then take steps to contain him, including, if necessary, moving him temporarily to a home.

  12. Melpub

    One more thing: I have a mentally ill brother, and his treatment was so expensive that my parents were forced to make him a ward of the state. Legally, although not actually, they abandoned him. Only then could he get any treatment.

  13. jean

    You need to be aware of the mental health advocacy organizations such as the National Alliance on Mental Illness (NAMI). There is a NAMI affiliate in Seattle, and I’ve linked them here:

    This is a very exhaustive list of what parents can do for their children with mental illness. Perhaps some of it will be of help to you:

    You must be an advocate, absolutely, but you don’t need to reinvent the wheel. It’s a tough road, and there are people who can guide you. I will pray that you find supportive parents and organizations to help you help your son.

  14. Kelly

    Our son, recently adopted through foster care, is covered by Medicaid, but also on our insurance. Is that not an option for you? We couldn’t find acceptable doctors for our older daughter who is on Medicaid as a secondary for her disability issues. Many won’t accept it anymore. Praying for appropriate health care for him .

  15. Jodee

    My ex husband is also FASD and was adopted at age 5 or 6. Both of his birth parents died and he and a younger brother went into the system. They were not adopted together but my in-laws made sure to include the younger brother as much as they could and took him on vacations and he came to visit often when they were little. When my ex was 13 or 14 they were forced to turn him back over to the state simply so he could get the mental health he desperately needed. They had to go through the whole adoption process again to have him placed back in their home. He is now 44 and has struggled his entire life because he feels like they “gave him back because they didn’t want him”. Absolutely NOT the case at all but unfortunately, that’s the way his brain works.

    Be careful with CCS. When my youngest was little we went to a psychiatrist there and she tried to convince me that I needed to have my daughter removed from my home. Luckily I didn’t do it because it would have been nearly impossible for me to get her back even though I wasn’t doing anything wrong. I was simply trying to get help in dealing with a very difficult child. I have asked repeatedly if there is any way that her father’s FASD could have any effect on her and have always been told no. In talking with his parents now, I’m wondering how much of what they diagnosed as FASD was really something else.

    We will keep praying and let me know if you want to borrow the boot.

  16. C Smith

    Like Kelly our son also has dual insurance, his state Medicaid is primary and we can use our insurance for things it doesn’t cover. It can get complicated but it’s better than nothing.

  17. Kate

    Just wanted to add that the DSM V came out in the last year, with important updates (I believe it was the first update in a decade). I have NO idea if they apply to your situation, but if I were you I’d get my hands on a copy and carry it to appointments. Maybe you will find coverage after all. Praying for you. Jesus is bigger than this entire mess, and amazingly, he loves Mordecai even more than you and your husband!

    • Kate

      Just to be theologically clear–I meant Jesus loves Mordecai more than you love him, not that Jesus loves Mordecai more than he loves you. English can be so tricky…

  18. JustAnotherTwoCents

    A broken bone is considered a medical emergency. Take him to the ER at this point. Unfortunately and sadly with the world we live in, child protective services can actually come back on you for failure to get proper medical treatment even though you are financially unable to do so. I’d suggest you handle this sooner rather than later.

  19. Dawn DG

    As a mom who has adopted 3 kiddos via the state of WA and also deal with adoption support for the last 15 years, you can make it work.

    I agree with previous posters, take him to the ER and get the cast, they will pay for it. The medical card is supposed to be your secondary insurance (that is what our contract stated) unless you are in the midst of changing insurances then they are supposed to cover everything.

    Do you know your adoption subsidy caseworker? Here is a link to the workers for you. You NEED to call them and talk to your caseworker. Tell them what is going on and that you need help. Personally, I have had good luck talking to them and them helping me get what my kiddos needed. You also can ask for a review if you need to increase the monthly stipend to help cover cost that the medical card won’t cover. I have had to do this and it may not be much of a help but when you are dealing with high medical costs, it helps. Remember their fiscal year is ending and July 1st is the new year so if you are needing extra services or a 1 time expense help (like a psychologist evaluation) this is the time of year that they are most likely to be able to do so. I agree the stipend is not much. There is a lot here I can tell you, but it will take a lot more space. You are more than welcome to email me privately about it.

    Also here is a link to a pdf file about mental health and adoption subsidy I had nothing but TERRIBLE experiences personally with CCS. However, it is a starting point. You NEED to get in touch with NAMI. They are invaluable NAMI can help you navigate the waters of mental health issues. The issues are tough to deal with and YOU will need the support to navigate this. NAMI is a wonderful resource. However the resources for mental health in Whatcom County are severally lacking, I speak from experience here.

  20. Molly

    Renee, my husband is a podiatric surgeon here in Seattle. He would be happy to treat Mordicai. Contact me if you would like.

  21. tiffanyatouchofgrace

    I can’t even imagine the frustrations associated with adoption. I live in WA, but have not adopted, although I have thought it may be something I want to do. This post though does scare me a bit.
    My brother had mental issues and my parents spent so much time working with the state to get him the proper diagnosis and help. Unfortunately nothing ever helped. I pray for all of you that you’re able to get the proper help for him. The state needs to do more. I’m so so sorry.
    Thank you so much for sharing with us on the Shine Blog Hop.

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