Mental Health Among Children in Foster Care

It’s not news that mental health among children in foster care is an area that’s ripe for improvement. The statistics are simply staggering. Of the 400,000-plus children in foster care in America, it’s estimated that nearly 80 percent suffer from a significant mental health issue. That’s nearly four to five times the incidence that’s found within the general population. Considering how many of these children endured abuse, neglect or trauma (or all three) prior to being placed in foster care, mental health may represent the most obvious opportunity to improve the quality of life for this extremely fragile population.

The range of mental health issues that is evident among foster children is vast and varied, and includes post-traumatic stress disorder (PTSD), panic and anxiety disorders, major depression and drug/alcohol abuse. And while it would seem natural that these issues might emerge as a child ages and reaches adolescence, what may be surprising is how early they arise, and how prevalent they are in the very young — those under the age of six.

Unfortunately, mental health tends to be polarizing, a lightning rod fraught with controversy and remarkably differing priorities among those who are most impacted by decisions — children, parents, grandparents, foster parents, clinicians and the court system. These differences appear pronounced in areas like access to services, cost effectiveness and public policy. A common feeling is that these parties exist not merely on different continents, but perhaps on different planets. Is it any wonder that the American Academy of Pediatrics considers “mental health as the greatest unmet need for children and teens in foster care?”

This is especially troubling in the way that mental health is impacting early childhood. While some of what we see today may seem counter-intuitive or counter-productive, it’s important to understand what work in the mental health field must ultimately achieve.

There are many factors that are contributing to a situation that is unsustainable. Among those factors that are adversely impacting mental health for very young foster children are pronounced complex trauma, frequent changes and transitions in living arrangements, fractured family relationships, and inconsistent access to mental health services. The net result of this Molotov cocktail is a scenario where there are far too many psychotropic medications in play. Children in foster care simply cannot thrive under such conditions. Nor can their families.

Medication alternatives can help foster children develop positive coping skills at a young age

The explosion of psychotropic medications over the past 10-15 years, while initially pursued with altruistic intent, has created an environment that would be better served by employing other alternatives. These medications — which include mood stabilizers, anti-psychotics, anti-anxiety medications and stimulants — have created a situation where they’re too often considered as the first option of intervention, instead of as the last resort they were designed to be. While the direction of using these medications should be straightforward, to improve the quality of life and help people manage specific conditions, the over-prescription of these drugs is having unintended consequences. Instead of achieving these objectives now, the sooner the better, and with as little negative impact as possible, the overall impact on the system may be less than ideal. We may be working within the constructs of mental health, yet violating the spirit of seeing long-term solutions.

What appears to be a more prudent path is to expand education about good old-fashioned interventions that are helpful, caring, responsive, supportive and consistently applied. As is true with comparable situations, the earlier the intervention, the better the outcomes we are likely to see. Pediatric experts agree that infants as young as six months old can interpret situations and sense the shifting moods of their parents, yet only one in four adults behave in a way that suggests they believe this to be true. If an infant’s perspective is defined and shaped by their interaction with their caregivers, it goes without saying that the very young are resilient and can adapt to any situation – be it positive, negative or somewhere in-between.

In other words, we shape a child’s future mental health well-being by laying a foundation for wellness, by helping them perceive, understand and navigate their world in positive ways. This is especially true with children who might otherwise be at-risk due to other considerations. By creating a home life where love, respect, and dignity are considered essential principles of parenting and human interaction, we are truly fostering a positive self-image in the mind and demeanor of a child, even an infant. That positive self-image will translate downstream into a child who’s well-adjusted and comfortable in their own skin, and less prone to being angry or acting out in an aggressive, even dangerous, manner.

Imagine that – addressing basic human needs in a positive environment will likely yield improved outcomes. What a radical concept!

SAFY works to provide early intervention services to help young children and foster families thrive

Most of those working in the mental health field concur there are four paths they consider when charting the development of a child — cognitive functioning, physical health and growth, behavioral/ emotional functioning and social interaction functioning — any (or all) of which can be impacted by external factors. Chief among those factors are issues like nutrition and food security, fear of abandonment, medical neglect, access to educational resources, and exposure to drugs or an abusive family dynamic, as well as the level and consistency of a nurturing environment or demonstrations of affection. The more aligned these factors are in creating a positive situation, the better the child’s social and emotional well-being will be. The earlier an intervention occurs, the more likely it will have a lifelong impact. Common sense, while perhaps not always widely applied, will produce sensible outcomes.

It is within this context that forward-looking organizations like SAFY — a provider of adoption and foster care services which helps 15,000 people each year — are working to make sure that we’re part of the solution moving forward. We are committed to preserving families and securing futures. The approach we’re taking at SAFY is simple but essential — focus our energy on improving mental health interventions in early childhood so we can deliver quality outcomes, so that we can qualify as a viable partner in a dynamic environment for a population that all too often is forgotten or under-represented.