Mental Health in the Foster Care System
Currently, there are approximately 437,500 children in foster care in the US. It is estimated that nearly 80% suffer from a significant mental health issue; that’s nearly four to five times more than the general population.
Additionally, youth in foster care are significantly more likely to have experienced abuse and/or neglect. This increases the likelihood of trauma symptoms. Approximately 46% of youth in the general population have experienced at least one traumatic event. For children in the foster care system, that number rises to a staggering 96%. 1 in 4 youth in foster care suffer from PTSD, which is double the likelihood of combat veterans.
This may not surprise us. After all, children are often transitioned into the child welfare system for traumatic reasons. But removal from the family unit is traumatic and destabilizing in and of itself. The disruption experienced in the system due to frequent placements, court appointments, etc., compounds that pain.
Relinquishment trauma, defined by Marie Dolfi, LCSW, is a “form of developmental trauma that occurs when a psychological wound happens to a newborn or child that has been cut off from their mother.”
Psychologist Paul Sunderland further describes relinquishment trauma as a “developmental post-traumatic stress disorder” where the experience of being separated from their parents drastically changes the child’s worldview.
Viva’s founder Dr. Julie Lopez, an adult adoptee, discusses relinquishment trauma in her book, Live Empowered! “Many [survivors of relinquishment trauma] remain unaware that their time in an orphanage or other sensory data they took in before the age of three may be impacting them now…this lack of knowledge can lead to years of misdiagnosis” (Lopez, 2019, p. 49-50).
When a child is removed from their family and placed in the system, any traumatic experiences may be amplified by experiences in the child welfare and juvenile court systems. This system-generated trauma is intensified by frequent changes in foster-home placement and changes in schools and peer groups.
Nationwide, placement stability continues to be a hurdle for agencies; less than 40% of states are able to achieve the goal of two or fewer placement settings for children in care. This means that the basic, human need for a safe and secure place to shelter is not being consistently met.
Further, child development research says that children need reliable attachments to caring adults in order to thrive and grow healthily. When children are moving from caregiver to caregiver, these attachments are hard to develop.
The instability that these frequent changes provide can intensify the feelings already present about relinquishment. Through the lens of being relinquished and then moving from home to home, children may develop the belief that others will consistently abandon them. It’s no wonder that multiple placements and instability have been found to prompt behavioral challenges, academic difficulties, and relationship struggles.
COVID-19’s Impact on Foster Care
Even before COVID-19 turned the world upside down, the frameworks that supported the foster care population were “frayed almost to the point of disintegration”, according to Comfort Cases founder Rob Scheer.
Prior to the pandemic, states were already struggling to meet the need for foster families. COVID-19 added strain on the already overburdened and flawed system. “[S]chools, social services, and community programs, that served as some kids’ only safety net no longer have the ability to catch them…Thousands of children that are now locked at home with abusive, neglectful, or unstable caregivers” Sheer explains.
Racism Within the System
The foster care system is uniquely imperfect. Child welfare, specifically foster care, has been shaped by systemic racism, oppression, social and economic injustice.
Who Sets The Standard For Good, Responsible Parenting?
White, middle-class women played a primary role in establishing the framework for the modern child welfare system. Amy Mulzer and Tara Urs from the City University of New York Law Review summarize that “the notions of pure, good white motherhood were used to set the bar for what was deemed safe and appropriate parenting.” This set the stage for “intrusion into the private family life of those whose parenthood did not conform to that ideal.”
This begs the question: what happens when families don’t fit the mold?
We can see the answer in the drastic over-representation of black and brown children in the system.
- According to DC Families for DC Kids, about 89% of children in foster care are African American with the largest percentages of foster care placements in DC coming from Wards 5, 7, and 8.
- In South Dakota, a Native child is 11 times more likely to be placed in foster care than a white child, according to statistics from the South Dakota Department of Social Services, as reported by the ACLU last year. Those statistics also showed that Natives comprise less than 9% of the state’s population, but 52% of the kids in South Dakota’s foster care system.
- Two studies in Texas found even though African American families tended to be assessed with lower risk scores than White families, they were more likely than white families to “have substantiated cases, have their children removed, or be provided family-based safety services.”
These statistics show us that there’s more than just child welfare at play in the child welfare system—there’s also regular racial discrimination and trauma. That trauma, on top of those caused by relinquishment and experiences with the system, is yet another burden.
Trauma-Informed Care for Youth in Foster Care
For many years, care has focused on “fixing” the behavioral issues of children, particularly those in the foster care system. It’s important that we shift from this perspective to one that examines the roots of their behavioral symptoms—traumatic experiences.
This is where Trauma-Informed Care, or TIC, comes in. According to the Trauma-Informed Care Project, TIC is rooted in “understanding, recognizing, and responding to the effects of all types of trauma.” This includes relinquishment trauma, which is often overlooked.
“Knowing that our trauma responses developed to help us survive, TIC practitioners look to resolve the root causes of those responses rather than the responses themselves.” That means when children display behavioral “issues,” TIC practitioners will closely examine their histories and environments to provide deeper healing strategies. For children in the foster care system, this may include the nature of their relinquishment, issues being faced in their placement homes, ongoing legal struggles, racial discrimination, grief, and more. Rather than placing a band-aid on their behavioral wounds, therapists who practice TIC will work to heal the traumas at their roots.
In addition to training in trauma-informed practice, clinicians who offer TIC may use the following modalities.
Brain and Body-Based Methods
Brain-based and body-based therapies like EMDR, NFB, trauma-informed yoga or sensorimotor psychotherapy are all effective in treating and healing trauma. Dr. Lopez, a proponent of brain-based therapies, notes how they allow us to tap into the specific parts of our brain affected by trauma to change how they function. This is particularly valuable when dealing with implicit, or nonverbal memories, such as those experienced in early childhood (Lopez, 2019, p. 87-120).
Play-therapy has proven to be particularly efficacious when working with youth in foster care. Play therapy allows children to express themselves through the natural use of play, regulate emotions, stimulate problem-solving, communicate psychological interests in their own unique and developmentally appropriate way. “[P]lay therapy allows children to process…trauma by allowing…the child to ‘play’ through [their[ fight/flight/freeze response while in a safe and nurturing environment,” says Viva Center therapist Logan Brantley. In other words, clinicians help children harness the power of their imaginations and creative impulses to build a sense of personal safety. This can help counteract fearful traumatic feelings and thoughts.
Addressing Gaps in TIC
There is plenty of research and information about the mental health of children in foster care; however, in some jurisdictions access to TIC is limited or non-existant. Studies suggest that while some agencies have attained high levels of TIC, there is still wide variability in the degree to which agencies have fully embraced it.
This means there is a great need for organizational readiness, assessment, and cultural change to support TIC. Organizations can combat this by investing in TIC courses for their staff, and examining their systems to create trauma-informed structures. They can connect with trauma-informed therapists, sharing knowledge and collaborating on solutions for more effective systems. And they can support efforts like the Trauma-Informed Care Project, which aims to educate both the larger system and practitioners about the effects of trauma on youth and their families.
As Dr. Lopez says, “empowerment is about arming yourself with knowledge. It’s about digging deeper when you suspect things aren’t always what they seem.” With knowledge and coordinated effort, we can improve the lives of children affected by foster care and relinquishment trauma.
What’ll your first step be?
Lopez, J. (2019). Live Empowered! Rewire Your Brain’s Implicit Memory to Thrive in Business, Love, and Life.
Grace Deleon is a Behavioral and Community Health student at the University of Maryland College Park. This past summer, Grace was a Clinical Operations Intern with the Viva Center, where she explored her passion for mental health advocacy and holistic, trauma-informed care. Her interest in foster care and child welfare stems from her work at local nonprofit organizations and her exposure to the foster care community at university.