Foster Care and Mental Health Mental Health Care Utilization and Expenditures by Children in Foster Care

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Jeffrey Harman, Ph.D., George Childs, Kelly Kelleher, M.D., M.P.H.

Archives of Pediatrics and Adolescent Medicine, November 2000, Vol. 154

Free copy from Dr. Harman


It is widely acknowledged that the more than half million children in foster care in the U.S. tend to have more behavior problems than other children. The purpose of this study was to determine whether they also have more mental health problems and use more mental health services compared to other disadvantaged children.

Using data from almost 40,000 Pennsylvania children between the ages of five and 17 who were on Medicaid, the researchers compared children in foster care with those on welfare (prior to welfare reform). The results showed much higher rates of mental health problems among children in foster care.

Children in foster care were more likely to be depressed (6 percent compared to 1 percent), to be diagnosed as hyperactive (15 percent vs. 4 percent), and to have a "conduct disorder" (4 percent vs. 1 percent) or "oppositional defiant disorder" (9 percent vs. 2 percent). These differences are surprising, because one can assume that children on welfare also have their fair share of mental health problems. Even when demographic differences were statistically taken into account, the foster children were much more likely to have used mental health services, and 6 percent had used inpatient psychiatric facilities compared to less than 1 percent of the welfare children.

In looking at other children on Medicaid, the researchers found a group of children with mental health problems that were comparable to foster care children: disabled children receiving Supplemental Security Insurance benefits (SSI).

These findings provide important information for adults who work with foster children. The good news is that the majority of foster care children do not have serious mental health problems (at least not ones that have been diagnosed). But they have many more mental health problems than do other children and, in a time of managed care, these findings raise concerns about whether current public policies ensure that Medicaid will provide foster children with the mental health services that they need.