New Data: Prevalence of Mental Health Diagnoses, Prescriptions Among Foster Care Youth

The 2013 report Diagnosis and Health Care Utilization of Children who are in Foster Care and Covered by Medicaid, from the Substance Abuse and Mental Health Administration (SAMHSA) is loaded with useful data, including those showing a stark contrast in the prevalence of mental health diagnoses between Medicaid-covered youth in foster care and their peers outside the child welfare system.  While recent research indicates that the increase in psychiatric diagnoses and office visit rates for U.S. youth outpace those of adults (based on comparison of data from the latter half of the 1990s and 2007-2010),  mental illness and psychiatric disabilities appear to be more prevalent among children in foster care than in the general population (a trend also found in countries outside of the United States).

The SAMHSA report divides findings into age groups (and is available at their website in PDF form), but some of the overall trends include:

  • Mental health diagnoses (49 percent) rates among foster care youth covered by Medicaid was higher in 2010 than their counterparts not in foster care (11 percent)
  • Children in foster care had more outpatient visits and longer lengths of an average inpatient stay than those not in foster care

Among adolescents (ages 12-17):

  • Attention-deficient, conduct and disruptive disorder were the most common diagnoses in 2010, occurring in 38 percent of foster care youth compared to 11 percent of their peers outside of foster care
  • 40 percent of 12-17 years olds in foster care used prescription medication related to a mental health diagnosis

In light of these trends, it might be worth noting that a December 2012 report from the Government Accountability Office raised concerns to the Department of Health and Human Services’ over appropriate treatment of mental illness and use of prescribed psychiatric medication for children in Medicaid or in the foster care system (the majority also covered by Medicaid). Their report found that youth covered by Medicaid were twice as likely to take anti-psychotic medications than privately insured youth, but may not have received counseling or additional mental health treatment other than the medication.



Report Citation: Center for Mental Health Services and Center for Substance Abuse Treatment. Diagnoses and Health Care Utilization of Children Who Are in Foster Care and Covered by Medicaid. HHS Publication No. (SMA) 13-4804. Rockville, MD: Center for Mental Health Services and Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 2013.


Lessons on Systems Change from The Center on Substance Abuse and Child Welfare

The impact of parental substance abuse on children’s stability and well-being is a concern that crosses systems.  Data suggests that parental drug and alcohol use is related to abuse and neglect and increases the likelihood of a parent’s involvement in the justice system – including the possibility of incarceration. The National Center on Substance Abuse and Child Welfare (NCSACW) provides In-Depth Technical Assistance (IDTA) to a handful of sites across the country in the areas of substance abuse, child welfare and the courts to result in better outcomes for families involved in these systems.  For approximately 18 months, the IDTA team works with local, state or tribal entities to coordinate strategy and services across systems through the use of evidence-based programs and on-site technical assistance in order to grow capacity for improved child and family outcomes.

The report, In-Depth Technical Assistance (IDTA) Final Report 2007-2012 provides an overview of the IDTA program model, related site accomplishments, and the lessons of system change at various levels. Some findings include,

  • 50 percent of the sites implemented (or enhanced) a recovery specialist model in their programs;
  • 68 percent developed and/or implemented cross-system training plans;
  • 60 percent developed and/or implemented screening protocols that resulted in lowers costs, reduced redundancy and a more efficient referral process;
  • 27 percent used cross-system data collection and tracking processes, such as case reviews and drop-off analysis, to inform policy and program decisions. (Note: according to the SAMHSA website, a Drop-Off Analysis is “a method used to assess linkages among child welfare, treatment agencies and courts. The method helps to identify connections that families need to make between systems to obtain services and achieve their child welfare case goals.”)

In addition to program findings, the brief discusses numerous lessons learned around systems change, particularly: issues in achieving long-term policy and practice changes and avoiding the fracture of collaborative relationships post-project,  leadership focused on engaging and sustaining partners,  use of data to identify areas of and opportunities for change, and realistic timelines for implementing system change and shared accountability.

Youth in Therapeutic Foster Care More Likely to Use Alcohol, Illicit Drugs

Therapeutic foster care (TFC) differs from traditional foster care as it is most often used as an alternative to a child being placed in a medical or juvenile justice system facility due to serious behavioral or physical conditions that require residential care.  Rather, they are placed with skilled foster parents trained to care for these intensive-needs youth.

Data from The National Survey on Drug Use and Health, an annual survey from the Substance Abuse and Mental Health Services Administration (SAMHSA) indicate that youth in therapeutic foster care (also known as treatment foster care) had higher rates of use of alcohol, marijuana and illicit use of prescription drugs in the past 30 days compared to the national average of their peers’ past month substance use. These data are not a surprise considering the correlation between increases in parental drug use and increased foster care numbers. Also, children from homes with substance abuse  and addiction often have behavioral problems and a history of high risk activity with some becoming runways until they land in the system through the juvenile detention or child welfare pipeline.

While foster youth being at higher risk of addiction is not a new trend, it is troubling because youth who have moderate to lengthy histories in foster care are more likely to have histories of neglect, sexual or physical abuse, alcohol and drug use and a pattern of risky behaviors.  Often, kids in therapeutic foster care have already seen multiple placements, and may be facing their last chance of avoiding a residential unit at a detention facility. TFC programs – whether run by county government or contracted to nonprofit or for-profit providers -should have extensive substance abuse prevention and intervention components tailored to this high risk population, from screenings for the kids to support and training for the foster parents.



Individualized Services, Lower Caseloads & Higher Adoption Rates: The Wendy’s Wonderful Kids Program Evaluation Report

The Dave Thomas Foundation for Adoption (DTFA) and its Wendy’s Wonderful Kids initiative strive to increase adoptions of foster children in the United States and some provinces in Canada. A recent evaluation of the program found that it is more successful in attaining the goal of adoption than traditional casework and adoption models.

The Wendy’s Wonderful Kids (WWK) program, funded partially from donations from Wendy’s restaurants, administers grants through DTFA to adoption agencies across the country who then work with local professionals to place children in the foster care system with adoptive families. The process is highly individualized, with much attention paid to getting to know the children and placing them with recruited, well-vetted families according to the history, strengths and unique needs of the youth. In this model, WWK staff carry a caseload of 12 to 15 children.

The evaluation found that overall; the youth in the WWK program were more likely to be adopted (1.5 times more) than youth outside the program and those who had mental health diagnoses were three times more likely to be adopted than their counterparts in the control group. Also, as the age of the child increased, so did the likelihood that they would be adopted compared to youth receiving traditional services; for example, the report states that youth entering the program at age 11 were twice as likely to be adopted and those referred at age 15 were three times as likely to be adopted. Taking this data at face value it appears the model used by the WWK works exceptionally well with youth sometimes considered more challenging to place in adoptive families (those with special needs, teenagers, etc.).

Demographics of the intervention group, a more detailed breakdown of the findings and information on the WWK program model are available in the Evaluation Report Summary and other evaluation materials at the Child Trends website. A fact sheet of the findings is also available.

Citation of Evaluation Report: Malm, K., Vandivere, S., Allen, T., DeVooght, K., Ellis, R., McKlindon, A., Smollar, J., Williams, E. and Zinn, A. (2011). Evaluation Report Summary: The Wendy’s Wonderful Kids Initiative, Child Trends, Washington, D.C.