In a recently released article in Pediatrics, Drs. Kristin Turney and Christopher Wildeman (10.1542/peds.2016-1118) review the mental and physical health of children in foster care, in comparison to other children not in foster care. The authors used the 2011-2012 National Survey of Children’s Health, which included over 93,000 children whose parents or caregivers at the time of the interview responded to a survey about the child’s mental and physical health. The authors point out that approximately 5-6% of children in the US will be in foster care at some point, and for African-American children that rises to 10% and for native American children to 15%. In other words, while only 1% of children are in foster care each year, many children’s lives are impacted by foster care – this is a burden we must share and understand.
I encourage you to take a minute to read this article. Of course it is hardly surprising, and certainly would not be considered a spoiler, to say that the physical and mental health of children in foster care is less optimal than that of peers who have not experienced foster care. But rather than blaming the obvious – multiple disadvantages including neglect, abuse, poverty and fractured family have contributed – the authors take a deep dive into the data and examine child and family characteristics, different household living arrangements in great detail, and their impact on differing diagnoses including mental and physical disorders.
I really don’t want to give it all away for you (and this doesn’t!), but mental health diagnoses stand out. Compared to children in all other living situations, children in foster care have a greater likelihood of ADHD, depression, anxiety and behavioral problems. When compared to children with 3 or more indicators of social disadvantage, children in foster care continued to have a greater likelihood of these mental health conditions. The authors are careful to note that their “…goal was not to ascertain whether foster care placement has an effect on children…”
Yet it is very difficult as a reader not to wonder if foster care is at the very least an exacerbating factor. Certainly the mental health of the biological parents and the impact of the neglectful or abusive events leading up to the removal of the child to foster care cannot be disregarded. But Drs. Turney and Wildeman have demonstrated that foster care itself is negatively associated with the child’s mental health beyond social disadvantage, and that living situation (specifically the relationship of the child’s caregivers to each other and to him or her) is also strongly associated with the child’s mental health.
The message I take home is that social service agencies absolutely must include mental health services as mandatory care for each child and caregiver. Waiting for symptoms is like waiting for the tsunami to reach shore – we know the risk and action is needed. Mental health care takes time and money, but both the short term and long term effects of not providing treatment are unacceptable. By making mental health treatment routine and not an option, stigma and barriers may be reduced. Case workers are overburdened and agencies are perennially short on funds, but this intervention would be likely to pay for itself many times over.