This article describes a successful pilot project in New York City that effectively reduced the number of transfers or replacements of children in family foster care through the placement of mental health clinicians onsite at two foster care agencies.
One of the more confounding experiences in human services is the difficulty child welfare providers have had in accessing quality mental health services for foster children. The Jewish Board of Family and Children's Services, a large mental health and social services agency in New York City, regularly joins with child welfare professionals to advocate for better, more streamlined access to mental health care for children in foster care. Yet, despite the importance these child welfare professionals attribute to the mental health needs of foster children, and the burgeoning acknowledgment of the impact of trauma on abused and neglected foster children, access to mental health services has remained elusive.
Mental health is a critical issue in the foster care system. Craven and Lee (2006) found that 30% of children in the system suffer from emotional / behavioral / developmental problems. Austin (2004) cites Stephen Hornberger, Director of Behavioral Health at CWLA, in noting that 40-85% of children in foster care have mental health disorders, depending on the study. Burns and colleagues (2004) reported that 47.9% of children in the child welfare system had significant emotional or behavioral problems; the incidence increased for children in nonrelative foster care or group homes. Lyons and Rogers (2004) indicate that half of children in the system have clinically significant emotional or behavioral problems, and postulate that this high level of mental health problems makes the child welfare system in fact a behavioral health care system.
If so, it is not a behavioral health system with adequate treatment levels. Lyons and Rogers (2004) note that most child welfare systems have insufficient community-based services. Austin (2004) states only 3% of mental health providers work with children in foster care. Other researchers (Prince & Austin, 2005) found that even though most children in foster care demonstrated emotional disturbance, most did not receive mental health services. Several studies found that ''youth of color" in foster care (Fish & Chapman, 2004; Leslie, Hurlburt, Landsverk, Barth, & Slymen, 2004; Burns et al., 2004; Zinn, et al., 2006) were less likely to receive mental health services. Very young children, the largest group to enter foster care, may be most vulnerable due to longer stays coupled with poor developmental outcomes including mental health problems (Vig, Chinitz, & Shulman, 2005).
Dr. John S. Lyons of Northwestern University examined mental health needs of children in child welfare in New York City in 2000, when 33,000 children were in foster care (there are half that number today). While his report (2000) was never released, his findings at that time showed:
* 80-90% of children in foster care had mental health needs,
* More than 31% had symptoms consistent with serious emotional disturbance (SED),
* 20% of the SED group had Oppositional Behavior and Impulse Control Disorders; one-third had psychiatric hospitalizations,
* 75% of all cases had some adjustment-to-trauma difficulties, and
* the estimated rate of SED in this child welfare population is about twice that of the general population.
While better mental health outcomes for children in foster care seem to be related to placement stability, placement stability itself appears to be associated with behavioral, social, and emotional health of the children prior to placement. Zinn and colleagues (2006) found that 75.9% of children's most recent moves in an Illinois study of foster care placement stability were due to foster parents' inability or unwillingness to continue fostering. They noted that the inability of foster parents to manage the mental health or behavior problems of a large percentage of children most likely contributed to a large percentage of placement moves. …