Every year, a quarter of a million children come into foster care in this country.


Every year, a quarter of a million children come into foster care in this country. Many of them will be placed in group homes or other group residential settings because there are simply not enough foster families to care for all of the children. Unlike birth parents, foster parents receive training before they welcome children into their home and support from social workers and other professionals throughout the process. Foster parents often also have access to respite care programs and find support through local organizations, such as churches, and online support groups (“Adopt US kids,” 2020).

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Some children entering into the foster system tend to have behavioral issues, temper outbursts, anxiety, depression, and maltreatment. Providing psychiatric services to children and adolescents in foster care require collaboration not only with the clinical team, but also the child welfare team. Team members include parents, foster parents, and the social worker, at minimum. The team may also include representatives from courts and others engaged by the child welfare system to conduct assessments (eg, psychological, neuropsychological) (Scheid, 2020). These children can get shuffled from place to place and could suffer from adjustment disorders. Trauma related diagnosis could also be given.


Child developmental screenings coupled with clinical and functional assessment practices are critical first steps in the intervention process.4 In addition, gathering information related to family and community assets can help to reinforce multidimensional and age-appropriate child assessments. The Treatment Outcome Package (TOP) that is designed to help child welfare systems gauge a child’s social and emotional well-being. TOP uses statistically validated questions to identify children’s strengths and challenges and track their progress over time using simple, web-based tools. It features a short checklist completed by the child and those closest to him or her — birth and foster parents, clinicians, teachers, caseworkers — paired with immediate results and easy-to-follow reports. TOP tracks and measures two things. It tracks how children are doing using more than 40 child well-being indicators, such as how well a child is sleeping or behaving in school, to help gauge whether a child’s behavioral and mental health needs are improving through a particular course of treatment. It also looks at specific providers’ track record of delivering particular services. The more we know about both, the better we can match kids’ needs with providers’ strengths (Feild, 2014).

Treatment Options

According to Psychiatric Times, Psychotherapy is generally considered first line when addressing trauma- and stressor-related emotional and behavioral conditions in children. Strategies with empirical support include trauma-focused cognitive behavioral therapy (TF-CBT); parent-child interaction therapy (PCIT), which is suggested for children aged 2 to 7 years to improve parenting skills and reduce children’s disruptive behavior; and attachment and bio-behavioral catchup (ABC), which has been tested in toddlers in foster care The National Child Traumatic Stress Network (www.nctsn.org) provides information on a variety of evidence-based and promising psychotherapeutic approaches for children exposed to maltreatment. This can be coupled with SSRI’s for treatment of depression and anxiety. Second generation antipsychotics and benzodiazepines for sleep disorders.

Cultural Effects

Strong cultural identity contributes to mental health resilience, higher levels of social well-being, and improved coping skills, among other benefits. Foster youth face and deal with trauma, changing home environments, and lower levels of social well-being than the general population. Often, due to this disruption, former foster youth have lower cultural identity strength than those who did not experience foster care. Child welfare practitioners must examine how they can best support strong cultural identity in foster youth (Stafanson, 2019).


About foster parenting Foster parents change lives—both the children’s and their own. (2020). Retrieved from https://www.adoptuskids.org/adoption-and-foster-care/overview/foster-parenting

Feild, T. (2014, august 15, 2014). New Tool Measures Well-Being of Kids Served by Child Welfare Systems. The Annie E. Casey Foundation. Retrieved from https://www.aecf.org/blog/new-tool-measures-well-being-of-children-served-by-child-welfare-systems/

Scheid, J. M. (2020, May 15,2020). Challenges and Strategies in Foster Care. Psychiatric Times37. Retrieved from https://www.psychiatrictimes.com/view/challenges-and-strategies-foster-care

Stafanson, A. H. (2019). Supporting Cultural Identity for Children in Foster Care. Retrieved from https://www.americanbar.org/groups/public_interest/child_law/resources/child_law_practiceonline/january—december-2019/supporting-cultural-identity-for-children-in-foster-care/

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