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.


Drug and Alcohol Treatment Trends Show Little Change 2006-2010


If you are at all interested in drug and alcohol abuse and treatment trends, a wealth of data is available in the 2010 National Survey of Substance Abuse Treatment Services (N-SSATS) report, based on an annual census of substance abuse treatment facilities conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA). This information provides a picture of the presence and nature of alcohol and drug treatment in the country that may be useful for predicting and planning for future treatment needs. Highlights from the survey include,

  • The number of clients in treatment facilities increased by 4 percent between 2006 and 2010, although the number of facilities remained stable
  • 92 percent of facilities reported clients receiving treatment for both alcohol and drug abuse in March of 2010
  • A breakdown of  treatment centers by type indicates  the majority of clients are served in private nonprofit treatment facilities (53 percent), just under 1/3 (32 percent) are served in private for profit treatment centers, 6 percent in facilities run by the local government, 4 percent in state-operated facilities and 4 percent in federally run facilities
  • There was little change in the type of treatment received from 2006 to 2010 – outpatient services treated 90 percent of clients,  residential treatment accounted for 10 percent, and 1 percent of clients received hospital inpatient treatment
  • Approximately 8 percent of treatment clients were under age 18 between 2006 and 2010. The break-out of  type of care mirrored that of the total population above – 88 percent of clients in outpatient care, 12 percent in residential treatment and up to 2 percent in hospital inpatient treatment

 Additional data on utilization rates, services and therapeutic approaches and licensing/accreditation are available in the full report,  National Survey of Substance Abuse Treatment Services (N-SSATS): 2010 Data on Substance Abuse Treatment Facilities.




Citation:  Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS): 2010. Data on Substance Abuse Treatment Facilities. DASIS Series S-59, HHS Publication No. (SMA) 11-4665. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.



The Serious Business of Succession Planning

Is your nonprofit ready if your Executive Director gave their notice tomorrow?  Has the executive team and board engaged in serious conversations about succession planning and the long and shorter term issues related to a change of leadership?  How would your nonprofit manage an unplanned, unforseen change at the highest level?

Nonprofit boards and executives should not shy away from creating a succession strategy for fear of personal affronts or hurt feelings – the importance of this kind of planning to the organization’s strategic plan cannot be understated.  In turn, succession planning should never be used as a veiled threat or first mentioned during a power struggle between the board and director. It is not personal or petty; rather it is simply part of good system maintenance to insure the uninterrupted performance of your service or advocacy organization.

A recent study out of Wichita State University Center for Community Support and Research indicates that the majority of nonprofits (72 percent) in that region had executive leadership at or close to retirement age. Many also required assistance in the areas of emergency back-up planning, succession policy and planned departures, as well as general leadership development and talent management.   Approximately 33 percent had used an interim director at some point, with half of those agencies reporting said director was selected from within the organization.

A note to consultants – the Wichita study found that just under half (46 percent) of the responding agencies would be likely to pay for outside help in the areas of succession planning and transition assistance.  Are you offering these services to your clients?

Leading (and Following) with Optimism

Do you practice optimism?

Admittedly, I am not an exceedingly optimistic person and (based on a few family anecdotes about my smaller self) that may be by nature rather than choice. However, I recall a period of my adult life when I was disconcertingly pessimistic in nearly every way. While that perspective may have made me feel secure in my abject readiness for the next shoe to drop or piece of the sky to fall, it certainly did not make the people around me feel confident or comfortable.

Luckily, time, experience and many discussions with people who have more of both those things than I, encouraged me to begin cultivating a kind of purposeful optimism. I accepted the reality that bad things would happen, that mistakes would be made and injustices would occur regardless of our attempts to do everything right. Over the next few years plenty of shoes hit the ground impacting people and places I cared about, but in most cases, with time, everyone survived or even better – thrived.

Dan Rockwell at the Leadership Freak Blog posts about a conversation with a colleague who was challenged by his professor (management consultant extraordinaire) Peter Drucker, for a seeming lack of optimism toward client organizations. A couple of decades later that very colleague, Dr. Justin Menkes, wrote a book about realistic optimism, or the kind of grounded, reflective, authentic optimism a leader should practice.

That post had me thinking all weekend about optimism and authenticity, both in our leaders and as leaders ourselves. In leadership, even in dire circumstances, there has to be some recognition of what is going right. This means being able to find a sliver of what your staff and volunteers are doing best even in the proverbial worst-case scenario. A wake-up-call meeting around the newest red numbers in the face of the latest funding cuts does not need to leave those around the table demeaned or disengaged. Focusing only on the negative, or next ten negatives lurking around the corner, makes staff (or client agencies) tense, fearful, defensive and even angry – none of which are going to help motivate them for the hard work that will be required to face the bad news head on and come out better for it.

What do you think about realistic optimism? What kind of optimism do you (or others) actively model in your organization?