Children come into foster care today primarily because they've been abused or neglected by their parents. These children enter care with far more complicated needs than ever before.

Mental health problems are particularly widespread. Experts estimate that between 30 and 85% of youngsters in foster care have significant emotional disturbances. Adolescents living with foster parents or in group homes have about four times the rate of serious psychiatric disorders as those living with their own families. Mental health issues are often not reimbursed through the Medicaid coverage provided to children in foster care.

For information on physical health issues of children in the child welfare systems, please visit our Hot Topics page at http://www.hunter.cuny.edu/socwork/nrcfcpp/
info_services/child-and-adolescent-health-care.html

For information on early childhood development issues for children in the child welfare systems, please visit our Hot Topics page at http://www.hunter.cuny.edu/socwork/nrcfcpp/info_services/developmental.html

For information on issues affecting children and youth with disabilities in the child welfare system, please visit our Hot Topics page at http://www.hunter.cuny.edu/socwork/nrcfcpp/info_services/children-with-disabilities.html

Guides

• Checklist of Needed Services for Children in Foster Care
  This checklist from the Child Welfare League of America identifies necessary services for children in foster care.

Also see information about traumatic stress on our Disaster Relief and Emergency Preparedness page.

• Effects of Separation and Loss on Children's Development
  This brief reviews the short-term and long-term impact of separation from or loss of parents due to death, divorce, incarceration, or removal to foster care on children's psychological development. Sections describe the short-term effects for children experiencing separation and loss during their first year, during the toddler years of 1-3, during the preschool years of 3-6, during the grade school years, and during adolescence. Strategies for minimizing the effects of the loss are discussed for each age group, along with possible long-range effects of the loss.

• Mental Health in Child Welfare
  From the previous National Child Welfare Resource Center for Family-Centered Practice, two issues of Best Practice/Next Practice discuss disorders diagnosed in childhood, foster families as partners in treatment, guidelines for foster families, services and supports, creating effective systems of care, supporting parents with mental illness, racial disparities in use of services, caregivers, workers and supervisors. Summer 2003 and Winter 2004

• Helping Those Who Need It Most: Meeting the Mental Health Care Needs of Youth in the Foster Care and Juvenile Justice Systems
  Young people who are transitioning out of the foster care and juvenile justice systems often have serious mental health needs. They can have many strikes against them: families with histories of violence, mental illness, incarceration and/or substance abuse; learning disabilities or neurological conditions; and histories of abuse, neglect or trauma. Some have been driven into the juvenile justice system, or onto the streets, because of undiagnosed or inadequately treated psychiatric problems. These hard lives can result in mental health needs that the foster care and juvenile justice systems struggle to address, with limited success. Why do efforts to provide mental health services to these young people so often fall short? What can be done to improve the system? This report explores these questions and proposes some answers from young people who have experienced the system from the inside, and from practitioners who work with them.

• The Impact of Traumatic Stress and Alcohol Exposure on Youth: Implications for Lawyers, Judges, and Courts
  This paper from the Michigan Child Welfare Law Journal explains the impact of traumatic events on a child's development and the number of children involved in the child welfare system that have been exposed to trauma and alcohol abuse. It explores the practical implications for representing clients in child welfare and juvenile justice cases given the impact of childhood trauma on children's functioning. Strategies are discussed for communicating with and counseling youth with receptive language deficits or who have developed inhibitions that have a negative impact on communication, as well as strategies attorneys should use for investigating a child's history of trauma, addressing system trauma, and for assessment and pre-trial motions.

• Early Childhood Mental Health Consultation
  This monograph from the National Clearinghouse for Alcohol and Drug Information addresses young children's mental health by providing a blueprint for child care providers to use when hiring a mental health consultant.

• The Mental Health of Adolescents: A National Profile, 2008
  This brief from the National Adolescent Health Information Center at the University of California, San Francisco, with support from the Maternal and Child Health Bureau, highlights existing national data about adolescent mental health status, assesses shortcomings of current data, and offers recommendations to address these shortcomings.

• Caring for their Children's Children: Assessing the Mental Health Needs and Service Experiences of Grandparent Caregiver Families
  This report from Chapin Hall reveals that absent parents play an ongoing and under-recognized role in the well-being of grandparents and grandchildren, regardless of whether they are a consistent, sporadic, or rare presence in the home. With respect to mental health needs, one-third of grandparents reported symptoms of depression themselves, and two-thirds were caring for grandchildren whom they identified as having emotional or behavioral problems. However, half of the families had no involvement with a child welfare agency, and fewer than a third of the grandchildren and only a handful of the grandmothers were currently receiving mental health services. The unmet mental health needs of both grandparents and their grandchildren are discussed as well as the implications of these findings for practitioners and advocates interested in meeting the service needs of grandparent-caregiver families.

• Child Trauma and Resource Families
  Information about trauma, post-traumatic stress, and resources for coping with terrorism.

• Posttraumatic Stress Disorder
  The June 2005 issue of Practice Notes, from the North Carolina Division of Social Services and the Family and Children's Resource Program, focuses on posttraumatic stress disorder in children, and particularly children in the child welfare system.

• Mental Health Assessments for Infants and Toddlers
  This paper from Child Law Practice defines mental health in infants and young children as the capacity of the child from birth to three to experience, regulate and express emotions; form close and secure interpersonal relationships; and explore the environment and learn. It discusses the goals of infant mental health assessments, kinds of cases in which such assessments are useful, and who should conduct the assessments. Qualifications of evaluators are described and include infant mental health training, experience with infants/toddlers, and skill in evaluating and diagnosing young children. Components of infant mental health assessments are then explained, as well as the tools that are typically used during the assessment, the types of information that assessments can offer the court and advocates, and pitfalls and challenges in conducting infant mental health assessments. A list of warning signs that may indicate mental health problems in infants is provided.

• Youngsters' Mental Health And Psychosocial Problems: What Are the Data?
  This report from UCLA's Center for Mental Health in Schools details and evaluates the existing data from research on the prevalence and incidence of these problems and defines the research in this area that remains to be done. Includes some interesting data about children in foster care and kinship care including the information that preschoolers receiving mental health services were almost twice as likely as older children to be living with kin caregivers or foster parents – “a finding which means that caretakers who are not parents may need supportive services to ensure timely and appropriate help for the children in their care.”

• Factors Influencing the Placement of Children Solely to Obtain Mental Health Services
  In this 2003 report from the General Accounting Office (GAO-03-865T), it is estimated that in fiscal year 2001, parents placed over 12,700 children in child welfare or juvenile justice systems so they could receive mental health services. Many are adolescents with multiple problems and behaviors that threaten the safety of themselves or others. Agencies say that reducing costs, improving access, and expanding the range of mental health services for teens could help reduce the need for some child welfare or juvenile justice placements.

• Update: Latest Findings in Children's Mental Health, Vol. 2, No. 1
  According to findings of a 1997 survey conducted by the U.S. Center for Mental Health Services (CMHS), many teenagers with severe and complex emotional disturbances are found in residential care programs rather than psychiatric hospitals. Often, these are "system kids" who are shuttled in and out of temporary placements in various child-serving agencies. This publication is the result of a collaboration among Rutgers University, the U.S. Department of Health & Human Services, and the Annie E. Casey Foundation.

• Evidence-Based Practices in Mental Health Services for Foster Youth
  This report is a component of the California Institute for Mental Health Caring for Foster Youth initiative that has been funded and supported by the Zellerbach Family Fund. The project has focused on the promotion of mental health assessments and services for children in foster care throughout California, and has created two screening tools designed to support child and family service systems in these efforts. This report discusses some of the common myths and misperceptions about the mental health needs and best treatment options for children in foster care, and gives recommendations for improving the delivery of mental health services.

• The Effect of Lifetime Victimization on the Mental Health of Children and Adolescents
  This paper examines the cumulative prevalence of victimization and its impact on mental health in a nationally representative sample of 2030 children aged 2-17 in the USA. Sexual assault, child maltreatment, witnessing family violence, and other major violence exposure each made independent contributions to levels of both depression and anger/aggression. Other non-victimization adversities also showed substantial independent effects, while in most cases, each victimization domain remained a significant predictor of mental health. Results suggest that cumulative exposure to multiple forms of victimization over a child's life-course represents a substantial source of mental health risk.

• The Mental Health and Wellbeing of Children and Adolescents in Home-based Foster Care
  This research describes the nature and prevalence of mental health problems in children and adolescents living in home-based foster care in the Adelaide (Australia) metropolitan region. The authors found that children in home-based foster care experience high rates of mental health problems but only a minority receive professional help for their problems.

• Making Reform Real: Addressing the Mental Health Needs of Children in the Dependency System
  In May 2006, the Children's Law Center of Los Angeles brought together mental health clinicians, social workers, foster parents, relative caregivers, advocates, community leaders, and youth to identify and develop concrete, workable solutions regarding the timely and appropriate provision of mental health services for children and youth in the child welfare system. This report summarizes the discussion and recommendations of the Summit participants in regard to the ten critical areas that were the topics of discussion at the Summit breakout sessions.

• Mental Health Service Utilization and Outcomes for Children and Youth in the Child Welfare System
  This empirically-based curriculum from the California Social Work Education Center focuses on a number of issues related to mental health service utilization and outcomes among children in the child welfare system. It focuses on five areas: (a) demographic and system-related characteristics of children involved in both the child welfare and mental health systems; (b) clinical need for services, service utilization patterns, and association between mental health service utilization and child welfare outcomes; (c) policies affecting mental health service utilization by children in the child welfare system; (d) collaboration between child welfare and mental health systems; and (e) resources for collaboration and service provision for children and youth in both the child welfare and mental health systems.

• Emotional Well-Being of Children & Youth in Foster Care
  On September 20, 2005, the NRCFCPPP and CWLA hosted the first of a series of teleconferences for state foster care and adoption managers on mental health issues. To listen to the audio files and download the handouts, visit our archived teleconferences page.
  

• Strategies for Meeting the Mental Health Needs of Youth in Care
  The second teleconference in the NRCFCPPP/CWLA series was held November 29, 2005. To listen to the audio files and download the handouts, visit our archived teleconferences page.
  

• Promising Practices for Addressing the Mental Health Issues Impacting Parents of Children in Foster Care The third teleconference in the NRCFCPPP/CWLA series was held January 31, 2006. To listen to the audio files and download the handouts, visit our archived teleconferences page.
  

Bibliographies

• Emotional Well-Being of Children and Youth in Foster and Adoptive Care
  This bibliography is from the National Clearinghouse on Child Abuse and Neglect and National Adoption Information Clearinghouse. Compiled in August 2005. For newer titles added to the Clearinghouse (now the Child Welfare Information Gateway) database, click: http://basis.caliber.com/cwig/ws/library/docs/gateway/SearchForm

• Strategies for Meeting the Mental Health Needs of Youth in Care
  This bibliography is from the National Clearinghouse on Child Abuse and Neglect and National Adoption Information Clearinghouse. Compiled in October 2005. For newer titles added to the Clearinghouse (now the Child Welfare Information Gateway) database, click: http://basis.caliber.com/cwig/ws/library/docs/gateway/SearchForm

• Mental Health Needs and Services for Youth in the Foster Care and Juvenile Justice Systems( 2005)
  The purpose of this annotated bibliography of selected reference materials and websites from the California State Library Foundation and the State Library's California Research Bureau (CRB) is to assist policymakers in accessing useful reports, policy briefs, and other resources that examine the mental health needs of youth in the foster care and juvenile justice systems and the services provided to them. These resources, published in the last five years, provide information on a range of mental health issues and concerns facing these youth.

• Use of Psychotropic Medications in Child Welfare: the needs and challenges of informed consent, ordering, and tracking of psychiatric medications for children in state custody.
  This presentation was prepared by Christopher Bellonci, M.D., Walker Home and School and Tricia Henwood, Ph.D., Tennessee Department of Children's Services for a teleconference sponsored by the NRCFCPPP and the Child Welfare League of America.

• Mental Health Care Issues for Children and Youth by Barbara Rosenkranz (April 2006)

• Mental Health Care Issues of Children and Youth in Foster Care by Tina Polihronakis (April 2008)

Websites

• Meeting the Health Care Needs of Children in the Foster Care System
  In October of 2002, the Georgetown University Child Development Center completed a three-year study to identify and describe promising approaches for meeting the health care needs of children in the foster care system. In this study, the term health care encompassed physical, mental, emotional, developmental and dental health. The study was funded by the federal Maternal and Child Health Bureau, and supported in part by the Children's Bureau, Administration for Children and Families. In response to a national search for promising approaches, the study collected information on over 100 different approaches. Multiple products that represent the findings of the study are identified and described on this website.
  

• UCLA Center for Healthier Children, Families & Communities
  The UCLA Center for Healthier Children, Families and Communities has produced a number of materials, including several policy briefs, on health and mental health services for children in foster care.
  

• Center for Health Care Strategies, Inc.
  CHCS is working with states, health plans, and community organizations to improve the physical and behavioral health outcomes for these children by increasing coordination of care, implementing electronic medical records, and identifying best practices in behavioral health pharmacy management.

• Caring for Children in Child Welfare
  Children served in the child welfare system (CWS) are at greater risk of having psychological, social and developmental problems than children in the general population. However, little is known about which types of children in the CWS receive services and how services are delivered. This study will examine the mental health services received by children in the CWS, and the impact of placement types and changes over time within the context of state and regional policies regarding the use, organization and financing of mental health services. The website includes copies of the CCCW newsletter, a list of journal publications, and information about the progress of the study.

• Centre of Knowledge on Health Child Development
  This Canadian web site is dedicated to providing the latest and best information on child mental health problems and the influences that shape the developmental health and well-being of children and youth.

Last updated 05/04/2008