We need to pay attention to foster youth

Foster care in the United States does not have a positive reputation, to say the least. Many immediately conflate foster children with a high rate of unpredictable behavior, and feel pity for adoptive parents who take “troubled children” into their homes. Their concerns are confirmed by anecdotal evidence, as well as by the low rates of success experienced by former foster youths. Kids in foster care tend to behave differently than other children, because they are largely treated differently than other children when it comes to mental health care. While it is true that foster youths tend to have higher rates of mental health problems than most other children, they do not necessarily have adequate resources to cope with their issues.
These youths are oftentimes separated from their entire lives- siblings, schools, friends, and extended families as well as their parents, which leaves caseworkers as their only advocates in the world of mental health care. And with growing evidence that caseworkers are spread far too thin, it should come as no surprise that the state of mental health care for foster youths is horrifyingly substandard. To create a healthier world for our nation’s vulnerable children, we must immediate work towards dismantling our current system of neglect, and create a standardized national health care system for foster youths that follows procedural guidelines, is subject to scrutinized oversight, and provides structured continuity of care.
The current state of foster care is well-known to be problematic- costly, ineffective, and desperately in need of change. The system seeks to support youths who do not have the support of the biological parents, but often fails to provide the consistency that children yearn for. Almost half of the estimated 500,000 children in the system live with strangers that they are not related to. These children, on average, are placed in different homes about three times. According to ABC News, there are documented cases of a youth moving up to thirty times during their stay in foster care. A large portion (approximately 24%, according to ABC) of foster youths leave their biological parents to live in kinship care, a form of foster care in which relatives care for the children. Even these children can suffer from lack of continuity in their health care, because crossing state lines to live with a different family member often requires finding new mental health care providers who are able to work with the child. When a suitable provider is found, they may not have access to the full breadth of a child’s health care history, as it may have been lost or previously poorly documented.
I recommend creating a standardized system that provides continuity of care for foster youths by securely storing and sharing detailed records of their care with each new case worker, foster parent, and health care provider that the youth depends on. Some states, like Texas, have already implemented useful strategies that make it easier for youths to verify their health records. For example, foster youths in Texas have a state issued “health passport” that provides a summary of their health history and needs. However, even the health passport is not a full medical record, and isn’t used in all fifty states. For the health passport to be truly effective, it would need to be relevant across state lines, in case a foster youth moved to a relative’s home in a different state. And, currently, only Texas and a handful of other states have begun to standardize their health care information. Until such a system becomes standard in each state, a foster youth who moves from another state to kinship care in Texas with a relative will still not have the detailed health passport that they need to receive appropriate and adequate care.
With a nationalized “health passport” style system that accurately depicts their medical needs, foster youths could enjoy more medical oversight from the court system, as judges would be able to accurately determine whether the use of psychotropic medication was adequately supervised by the doctors prescribing it. For a variety of reasons, the current system has lent itself to foster children being prescribed psychotropic drugs at a much higher rate than other children their age. Furthermore, doctors prescribe these drugs to foster youths without guarantee that the combination of the psychotropic drugs with their other medications is appropriate, or that the youth will have reasonable oversight from a psychiatrist while taking the medication . Caseworkers and doctors are clearly actively engaged in providing mental health care for foster youths, as is evidenced by a 2004 article published by Psychiatry Online that shows 94% of foster youths receiving mental health services in their lifetimes. However, the same report shows us that the mental health care that foster youths have access to are often extreme. Rather than utilizing community-based services, like outpatient therapy, 77% of foster youths in the study to residential or inpatient based services. Of those, about half of youths had never received community services before entering residential care for their mental health or behavioral issues. This is not an appropriate way to moderate the psychiatric and behavioral abnormalities of children, but the lack of organization of the health care records of foster youths makes it more difficult for courts to provide oversight of the quality of care. With proper organization, a social worker may have the time to read through a foster youth’s medication list and notice that there is no record of community-based treatment to support it. That gives the social worker the opportunity to recommend services to complement the use of psychotropic medication so that issues are managed at their root, and not simply masked by medication.
Creating a system in which a child’s health care is maintained carefully and valued can make the child feel safe and comfortable during a stressful and inconsistent time. When children in foster care feel as though their mental health is important to the adults in their lives, they are able to make observable changes to their behavior- as significant as breaking drug or self-harm habits. Furthermore, foster youths in a study funded by the National Institute of Mental Health indicated that their dissatisfaction with their medications often went unheard. A highly organized health passport system could help children in foster care push their medication concerns to the forefront, as their prescription list would need to be revisited frequently. This would allow the children many opportunities to discuss their displeasure with their medications- each time their doctor or caseworker checks in with them to monitor their mental health progress.
Taking these measures to protect foster youths from irresponsibly administered health care can improve our society by contributing to a decline in homelessness and incarceration. A national system that uses health passports would be conducive to judges and caseworkers becoming better advocates for foster youths. Judges play a valuable role in deciding the outcome of behavioral problems that manifest themselves as disruptions in school or criminal behavior in foster youths. Seeing medical history that reflects a child’s mental health care history and medications could make a difference in whether the child receives help or punishment for their behavior. Once a foster youth is involved in the criminal justice system, they can find themselves in juvie repeatedly for minor delinquencies and violations of arbitrary rules of probation. Youths that have been incarcerated tend to be involved with more serious crimes as they age. If we are serious about making sure that foster children have healthy and successful futures, it is crucial that their behavioral issues are treated with the expectation of improvement and rehabilitation, like children who have the support of their biological parents. Rather than punishing and jailing these children, judges with the information provided by a comprehensive mental health passport could recommend community-based therapy that would give foster youths adults to look up to and emulate.
Foster care does not need to be the predicator for homelessness and incarceration that it is now. As a society, we could focus on the roots of these problems- one being the mismanagement of mental health- and help change the outcome of these children’s lives. Organization and oversight can go a long way to make these children feel as though their needs are important to the adults that manage their well-being. Providing a system that is organized with the intention of providing consistency for foster youths will ideally help foster children with mental health or behavioral problems continue their mental health care after aging out of the system as an adult. This new culture of valuing health care in foster care will hopefully inspire former foster youths to maintain the habits and mindsets that will help them find employment, housing, and educational opportunities, in turn lowering their incarceration and homelessness rates.