Youth in foster care have unique needs. They have had Adverse Childhood Experiences (ACEs) and, likely, trauma. Either Neglect, physical abuse, or sexual abuse has likely occurred. These children suddenly are dealing with being removed from their parents’ care and adjusting to new caregivers, potentially foster siblings, a new school... all while fielding strong emotional and physical responses to these changes! Kids and teens in foster care might react by acting out or shutting down. Transition Age Youth become too old for the foster care system but they may not be adequately prepared for solo adulthood.
I first worked with foster youth during my internship in Memphis, TN. Across the US, it is usually a requirement of foster youth to be “in therapy.” What I found was that these children’s “therapists” were only required to have a high school diploma. Yes, these kids with extremely unique needs who would likely benefit from a highly specialized professional were not even being treated by someone with the qualifications necessary to be a licensed mental health provider! I was shocked and outraged but no one else seemed to be batting an eyelash.
On top of getting poor quality therapy, foster kids notoriously are over-medicated. Rather than using a longer-term approach like therapy, a “quick fix” for their behavior is preferred.
If I ruled the world, foster youth would get top priority in access to evidence-based care appropriate for their needs. This therapy would focus on teaching the youth coping skills and helping their foster parents understand their unique needs and understanding them through a trauma lens. The most common concerns with foster youth are behavior problems and traumatic stress. Here are some research-backed therapies that would be appropriate for foster youth’s most pressing concerns:
PCIT is traditionally used for children ages 2 to 7 [can go up to age 10] with behavior problems (aggression, impulsivity, defiance). Caregivers are live-coached in the skill set while in play with the child. PCIT is based on attachment theory and behaviorism, both of which are helpful for foster parents to understand. PCIT has been used for youth who have experienced abuse.
TF-CBT is the gold standard therapy for working specifically on traumatic stress (for example, being diagnosed with Posttraumatic Stress Disorder) with kids and teens. In therapy, the youth create a “trauma narrative” that helps them to integrate the scary thing that happened to them into their broader life story. They also learn many useful coping skills to manage strong emotions and cope with thoughts and reminders of the trauma. Caregivers also learn skills to help the child.
Treatment Foster Care Oregon (TFCO)
TFCO is meant for kids and teens with more severe behavior problems. Youth might receive care outside of the home for a time but then the goal is to train caregivers to support their transition back into the home environment.
Obviously, a foster youth could also be dealing with developmental or mental health concerns that were present before entering foster care such as autism, an anxiety disorder, or an eating disorder. For a youth dealing with other developmental or mental health concerns, it is important to identify the research-backed treatment for their condition and then find providers who are trained in these interventions. Effective Child Therapy and Child Mind Institute are my top recommendations of resources.
My hope is that foster youth will eventually be provided the best treatment available so that they can thrive after experiencing a really challenging disruption to their lives. Spreading this information can make a big difference!
One last thought...
One time in the American Psychological Association (APA) Monitor on Psychology magazine, I read that if you really cared about children, you would specialize in substance use treatment for adults. What they meant is that freeing up caregivers from their own mental health problems can allow them to return to safely parenting their own kids, rather than them having to be part of the foster care system. I agree that another important way to help foster youth is to provide substance use and mental health support to their parents.
Other thoughts on needs for this population? Comment below!
The foster child population is truly worthy of significant investment to avoid a lifetime of pain. And the young adults who have aged out of foster care are equally deserving. Thanks for sharing an overview of some of the treatment models that have been proven to have a positive impact. I would also consider TBRI (Trust Based Relational Intervention), and I've been hearing more about Together Facing the Challenge. Any thoughts on these models?
A reader sent me the following reply: "Another way to support youth is to provide their caregivers with physical and financial support, freeing them up to care for their own mental health and their kids! (like careportal.org)"