Mental Health Services for Children Placed in Foster Care: An Overview of Current Challenges

Article excerpt

Given the evidence from studies indicating that children in care have significant developmental, behavioral, and emotional problems, services for these children are an essential societal investment. Youth in foster care and adults who formerly were placed in care (foster care alumni) have disproportionately high rates of emotional and behavioral disorders. Among the areas of concern has been the lack of comprehensive mental health screening of all children entering out-of-home care, the need for more thorough identification of youth with emotional and behavioral disorders, and insufficient youth access to high-quality mental health services. In 2001, the American Academy of Child and Adolescent Psychiatry (AACAP) and the Child Welfare League of America (CWLA) formed a foster care mental health values subcommittee to establish guidelines on improving policy and practices in the various systems that serve foster care children (AACAP and CWLA, 2002). Because of the excellent quality and comprehensiveness of these statements, the Casey Clinical Foster Care Research and Development Project undertook consensus development work to enhance and build upon these statements. This article presents an overview of mental health functioning of youth and alumni of foster care, and outlines a project that developed consensus guidelines.

Recent research underscores the urgent need to improve the access and quality of health and mental health care services for the large numbers of children in foster care (about 800,000, with a daily census of 510,000 as reported at the end of September 2006; U.S. Department of Health and Human Services [USDHHS], 2008). For example, Rubin, Halfon, Raghavan, and Rosenbaum (2005) found that an estimated one in every two chil- dren in foster care has chronic medical problems unrelated to behav- ioral concerns (Halfon, Mendonca, & Berkowitz, 1995; Simms, 1989; Takayama, Wolfe, & Coulter, 1998; U.S. General Accounting Office, 1995). Evidence suggests that these chronic conditions increase the likelihood of serious emotional problems (Rubin, Alessandrini, Feudtner, Mandell, Localio, & Hadley, 2004). Studies also suggest that of the 40% of youth in foster care, up to about 80% of these children exhibit a serious behavioral or mental health problem requiring intervention (Clausen, Landsverk, Ganger, Chadwick, & Litrownik, 1998; Garland, Hough, Landsverk, McCabe, Yeh, Ganger, & Reynolds, 2000; Glisson, 1994; Halfon et al., 1995; Landsverk, Garland, & Leslie, 2002; Stahmer, Leslie, Hurlburt, Barth, Webb, Landsverk & Zhang, 2005; Trupin, Tarico, Low, Jemelka, & McCIeI- lan, 1993; Urquiza, Wirtz, Peterson, & Singer, 1994). Young adults outside of foster care also suffer from mental health problems at high rates. According to a recent report of the U.S. Government Accountability Office (2008), in 2006, at least 2.4 million young adults ages 18 to 26 had serious mental illnesses.

Given the evidence from studies indicating that children in care have significant developmental, behavioral, and emotional problems (Clausen et al., 1998; Rutter, 2000), quality services for these children are an essential societal investment. Youth in foster care and adults who formerly were placed in care (foster care alumni) have disproportionately high rates of emotional and behavioral disorders. Among the areas of concern has been the lack of comprehensive mental health screening of all children entering out-ofhome care, the need for more thorough identification of youth with emotional and behavioral disorders, and insufficient youth access to high-quality mental health services.

Need for Greater Consensus on Policy and Practice

Despite recent findings that targeted assistance to youth, foster parents, and birthparents can exert salutary effects on youth and adult foster care alumni's mental health (e.g., Kessler, Pecora, Williams, Hiripi, O'Brien, English, White, Zerbe, Downs, Plotnick, Hwang, & Sampson, 2008), evidence-based practices are not being used routinely in foster care settings (Landsverk, Burns, Stambaugh, & Rolls-Reutz, 2006). …