Prioritizing the Mental Health Needs of Children and Youth in the Child Welfare System

As the month of May draws to a close, we are reminded that mental health is integral to whole health - and children who have been removed from their homes need a system that will do the utmost to see to their safety and wellbeing. In recognition of the tens of millions of Americans living with mental health problems, on April 30^th President Obama declared May as National Mental Health Awareness Month. He also declared May as National Foster Care Month, in recognition of the children and youth awaiting permanency and the families, professionals and foster parents who care for them. These are two issues of critical importance to all families and, while important to spotlight in May, must remain a policy focus year round.

The link between mental health and involvement in the child welfare system is notable. Although most children with mental health challenges do not become involved with the child welfare system, and children in foster care do not necessarily have mental health disorders—children in foster care do have disproportionately high rates of social, emotional or behavioral health concerns. Child welfare systems that prioritize mental health and focus on protective factors can deliver better results for children and youth in foster care or for those children in families where there is a risk of removal.

Research in child welfare suggests that children do best in their own families and should remain home with their parents whenever possible. When that is not possible, children should be returned to their families or moved to another permanent home as quickly as possible consistent with safety concerns. There are many circumstances in which family strengthening attempts can prevent removal of a child from the home. These interventions can include home visits, housing assistance and family counseling among other options. Lack of access to these family strengthening services can prove disastrous for families. For example, in extreme cases some families have been forced to relinquish custody of their child to the child welfare system in order to gain treatment for their children who were experiencing serious mental, emotional or behavioral health challenges. Separation from the family is traumatic for children, and should be a last resort if effective attempts at family strengthening have not been productive.

Child maltreatment, including abuse and neglect can have negative impacts on children and youth—particularly if their developmental milestones are not nurtured and supported. Without proper support, these problems can linger throughout a child’s development, causing further physical, mental, emotional or behavioral issues later in their childhood or adolescence. Infants and toddlers who have been removed from their parents can miss developing a sense of trust gained from attachment to their parents. This sense of trust is essential in order for them to develop relationships with adults and peers as they mature. At later ages, children must: develop the physical skills necessary to gain a sense of autonomy, be able to exert some control over their environment in order to develop a sense of purpose, deal with new academic demands and navigate social relationships. Attention to a child or adolescent’s socio-emotional wellbeing is essential to ensuring their successful transition to adulthood.

Children and youth who experience trauma stemming from abuse and neglect can also face disrupted attachment and delayed development of capacities required for building relationships. Among children and youth who are reported for abuse:

• 32% of children from birth to five years old have developmental problems;
• Among school-aged children and adolescents, 10% are at risk of cognitive problems or low academic achievement, 43% have emotional or behavioral problems, and 13% have both;
• Adolescents engage in more risky behaviors than their same-aged normative peers—almost 50% have used alcohol at some time during their lives and over 20% have used other substances.

Research has shown that caregivers can buffer the impact of trauma and promote better outcomes for children even under stressful circumstances when the following Strengthening Families Protective Factors are present:

• Parental resilience
• Social connections
• Knowledge of parenting and child development
• Concrete support in times of need
• Social and emotional competence of children

To achieve the goals of safety, well-being and permanency for youth in the foster care system, policymakers can adopt policies that strengthen reunification, adoption and guardianship. Requiring family involvement in decision-making can aid in reunification, establishing state adoption credits can encourage more adoptions, and setting adequate subsidy and benefit levels can support guardianship.

There are a number of resources for policymakers, advocates and families on supporting the mental health needs of children involved with the child welfare system, including:

• Results-based policies to aid children and youth in foster care
• Results-based policies to promote children’s social, emotional and behavioral health
• Promoting Children’s Social, Emotional and Behavioral Health (report)
• National Child Traumatic Stress Network