Study looks at how mental health care affects outcomes for foster children

Sharita Forest

Jan 13, 2009 / News Bureau, Univ of Illinois

CHAMPAIGN, Ill. — Of the approximately half-million children and adolescents in foster care in the U.S., experts estimate that 42 to 60 percent of them have emotional and behavioral problems. Despite the prevalence of mental health problems among foster children, little is known about how pre-existing mental health conditions affect their outcomes in foster care.

A new study co-written by Jung Min Park and Joseph P. Ryan, professors in the School of Social Work at the University of Illinois, followed 5,978 children in foster care in Illinois for several years to determine whether these children’s placement and permanency outcomes were affected by their histories of intensive mental health treatment. The statewide sample included all children and adolescents 3-18 years of age who entered foster care for the first time between 1997 and 2001. They were observed through June 2005.

Based upon child welfare and Medicaid records, the study targeted children who received inpatient psychiatric care, because it was an easily identifiable marker of serious emotional and behavioral problems, and it represented especially high levels of mental health care needs. Five percent (296) of the children had at least one episode of inpatient mental health care prior to being placed in foster care.

“According to my previous study, children who received inpatient psychiatric care ended up in foster care within two years of their first inpatient episode,” Park said.

“Children who receive inpatient psychiatric care have a substantially greater risk for parent-child separation. Our current study shows that when those children enter the child-welfare system, they are more likely to suffer poor outcomes and be left behind in the system.”

The study indicated that children with inpatient psychiatric episodes were at greater risk for frequent placement disruptions and were less likely to reunite with their families of origin or be adopted.

About half of the sample experienced more than three placement changes during their first spell in foster care. Inpatient mental health episodes among white children increased the likelihood of placement instability for them by 75 percent, while such episodes decreased the likelihood of permanence by 24 percent among African-American children.

The study also suggested that there was limited access to and underutilization of mental health services among African-American children.

“Children with a history of inpatient mental health treatment, especially when placed in foster care, benefit from continued follow-up and referrals to community mental health agencies to reduce placement disruptions and facilitate timely permanence,” Park said.

Foster-care placements come at considerable cost to taxpayers: Placement in therapeutic foster care can cost $30,000 or more annually, and placement in residential psychiatric care considerably more.

“Early identification of service needs and related interventions for children and youth with intensive mental health needs can be cost-efficient by helping them achieve placement stability and permanence,” Park said.

During the observation period, about 70 percent of the children in the study achieved permanence by returning to their families or through adoption or guardianship.

The study appears in the Jan. 2009 issue of the journal Research on Social Work Practice.

slforres@illinois.edu

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Why certain bans and restrictions are good...

Earlier today I received an email expressing concern about our blog piece, The Russian adoption ban and the evangelical orphan crusade

The concern voiced by the reader had much to do about the high rate of alcoholism in Russia, the effects alcoholism has on pregnancy, the effects alcoholism has on future parenting -- and how such factors increase the likelihood a child put in-care will end-up  unemployed, homeless, and very likely stuck in the organ/sex trade industries.  [Valid, honorable reasons to want to offer adoption as a placement option for those children victimized by the problems associated with alcohol abuse and child abandonment.]

This private discussion left me thinking about the problems American foster kids AND adoptees must face when labeled with mental illness or a severe learning disability, at an early age.  These thoughts brought me back to this particular article, and what it had to say about the effect label-making has on a fostered/adopted child put in a less than ideal (abusive/negligent) foster/adoptive home.

Based upon child welfare and Medicaid records, the study targeted children who received inpatient psychiatric care, because it was an easily identifiable marker of serious emotional and behavioral problems, and it represented especially high levels of mental health care needs. Five percent (296) of the children had at least one episode of inpatient mental health care prior to being placed in foster care.

“According to my previous study, children who received inpatient psychiatric care ended up in foster care within two years of their first inpatient episode,” Park said.

“Children who receive inpatient psychiatric care have a substantially greater risk for parent-child separation. Our current study shows that when those children enter the child-welfare system, they are more likely to suffer poor outcomes and be left behind in the system.”

The study indicated that children with inpatient psychiatric episodes were at greater risk for frequent placement disruptions and were less likely to reunite with their families of origin or be adopted.

Let us not forget, high level mental heath care needs = high costs + the use (over-use) of psychotropic medications.  [See:  Overmedication in Foster Care and Black Box Warnings, and how use of prescription drugs affects future generations, as Living with the legacy of care describes. ]

Couple this news and associated risks and costs with the most recent article posted about  America's Foster Care Crisis, written by James Swift;  the future outlook for any child given a label while in his youth is as grim as it would be in any other economically weak (failing) nation. 

According to Neil Donovan, executive director for the National Coalition for the Homeless,  “There are some who say that the likelihood that someone will become homeless if they had been a part of the foster care system could be as many as 11 times greater than the average child,”.  In James Swift's article, Neil Donovan continues:

inappropriate dischargesessentially, when children are emancipated from foster care services before the age of 18drastically increase the likelihood of youth becoming, and staying, homeless.

The problem is, official studies and follow-up reviews of living status/conditions are not tracked.  Just like the exact number of children affected by disrupted adoptions, abuse in-care and abuse in the adoptive home is not known or studied, gauging the exact number of homeless youth in the United States is difficult, to say the very least.

I honestly think this grim outlook for anyone given a label, like mental illness, or "learning disabled" makes the USA one of the last places any sending country ought to consider for permanant placement, through ICA. 

Until post-placements are monitored and support services are given to those who most need safe back-up plans that offer the tools and skills needed to achieve true (financial) independence, the United States care-system (foster-care and adoption services) will continue to fail both the child and the tax payer.

Pound Pup Legacy