Psychiatric Care of Children in the Foster Care System

Revised and approved by Council on September 20, 2001
To be reviewed

Approximately 500,000 children in the United States live in the foster care system. For most of them, their communities and families are characterized by inadequate education, employment, housing, health care and social supports. Numerous studies document that up to 80% of foster children have developmental or mental health problems. As a group they are over-represented in special education programs and in the juvenile justice system. Many have been exposed to such adverse biological and psychosocial risk factors as premature birth, prenatal drug and alcohol exposure, parents with mental disorders, including substance abuse, high levels of violence in their homes and/or communities and child maltreatment. The majority of foster children have been seriously abused and/or neglected by their biological parents. Placement in foster care, while necessary, further subjects them to additional stress by disrupting attachments to family, friends and community. Despite their disproportionate mental health needs, most do not receive psychiatric care until their situation reaches a crisis point and some not even then.

In consideration of the combination of adverse risk factors and documented prevalence of psychiatric, behavioral and developmental difficulties characteristic of foster children, the American Academy of Child and Adolescent Psychiatry recommends that:

  1. Children and youth in foster placement routinely have access to formal screening and, where indicated, comprehensive diagnostic assessment for symptoms and/or behavior indicative of a psychiatric disorder, both at the time of placement and as indicated thereafter.
  2. That the screening and/or assessment should be cognizant of both formal and overlapping diagnostic categories, including reactions to previous or ongoing abuse, and to the adjustment to stress attendant to the experience of placement itself.
  3. Treatment, if indicated, should include consideration and implementation of the full range of both psychosocial and psychopharmacologic interventions, and incorporate as broad a range of disciplines and modalities as indicated.
  4. Foster parents should be carefully screened for capacity to provide nurturance, structure and stimulation appropriate to the child's developmental level and needs. Foster parents should have access to respite care, be appropriately compensated, and should be included in the assessment, treatment planning, and in the treatment of the child. Education should be provided to both foster parents and staff in charge of foster programs.
  5. Diagnostic assessment and treatment recommendations should include and be under the supervision of a Board eligible/certified child and adolescent psychiatrist whose medical-based education and training best provide the knowledge and experience necessary to integrate the biological and psychosocial aspects of the child's problems and needs.

The AACAP urges that local, state and federal authorities address the great unmet mental health needs of these most vulnerable and traumatized of all children. While the cost is substantial, the benefits, both near and long-term, more than justify the investment.