The children in America’s foster care system face a tremendous amount of psychological stress. Many have been removed from traumatic home situations because of neglect or physical or sexual abuse. Their life in foster care often includes uncertainty, frequent moves, and other difficulties that cause psychological stress. Data collected by the National Survey of Child and Adolescent Well-Being (NSCAW) estimates that “approximately half of youths aged 2 to 14 years with completed child welfare investigations had clinically significant emotional or behavioral problems” (GAO-12-270T).
The Administration for Children and Families (ACF) states that when child welfare systems use a comprehensive approach to evaluating and addressing children’s behavioral and mental health needs, the children are likely to feel safer and care is likely to be more effective (GAO-13-15). Yet all too often these children are not receiving psychiatric services at all, let alone in a streamlined manner.
When investigating the use of psychotropic medications in foster children, the ACF reported that at the time of the survey, 18 percent of foster children surveyed were taking psychotropic medications. In addition, it found that “30 percent of foster children who may have needed mental health services did not receive them in the past 12 months” (GAO-14-362). The GAO (Government Accountability Office) report on this finding adds that while evidence-based practice is difficult to standardize, psychosocial therapies are believed to be helpful in assisting children overcome behavioral and psychiatric problems. However, according to the Institute of Medicine, there is a shortage of mental health providers in this country, negatively impacting access to services, especially for children and people with limited resources.
GAO reports have found that, regardless of whether they are in the care of the state, “most children who took psychotropic medication did not receive psychosocial therapy or counseling in the same year—61 percent of Medicaid children and 66 percent of privately insured children” (GAO-14-362). Furthermore, about a third of children taking psychotropic medications did not have any office visits to a mental health professional, missing vital medication management follow-up. This is an enormous problem of mismanaged care, one that reaches far beyond the foster child population.
In the foster care population, where a much higher percentage of children suffer from psychiatric disorders, the problem is even more pressing. As discussed in a previous piece, “Overuse of Medication in Foster Children,” the frequent relocations inherent in foster care often result in fragmented medical care. This creates a situation where multiple doctors are prescribing medications that have serious potential side effects and no follow-up is being performed.
This incredibly dangerous pattern can have a lasting negative impact on a child’s life. It is government’s duty to provide mental health care for children in its care. Therefore, action must be taken to expand the accessibility of psychiatric services for these children (and all others who need them), and evaluations must be performed to ensure that states are meeting their psychiatric needs.
Emily Rose DeMarco
Emily Rose DeMarco is a Masters of Public Administration candidate at the University of Pennsylvania’s Fels Institute of Government. She is also a registered nurse currently working in emergency medicine.