We’re waiting too long to help kids in crisis — and leaving foster care as the only option

Too often, children enter foster care because their behavioral health needs have escalated beyond what families can manage without specialized support. And by the time these services are introduced, families are already in crisis.

Children involved in the child welfare system experience significantly higher rates of anxiety, depression and trauma-related conditions than their peers. In fact, as many as 80% of the nearly 400,000 children and teens in foster care have a diagnosable behavioral health need. Exposure to abuse, neglect, caregiver substance use and housing instability compounds these challenges. Without early intervention, these needs can escalate into school disruption, family conflict and crisis-level behavioral episodes.

The goal: Intervene before removal from the home becomes the only safe option — especially since the trauma of removing a child from a parent may actually worsen existing mental health needs.

Beyond the clinical: addressing structural barriers

Behavioral health services for children have historically been fragmented across child welfare agencies, Medicaid managed care organizations, schools and community providers. Families often must navigate disconnected systems, repeat their stories and wait for services that can be difficult to access in times of immediate need. And many never receive care at all — the CDC estimates that only about half of children with mental health conditions receive needed treatment. The result is a persistent challenge: delayed care, increased crises and avoidable foster care placements. We simply cannot solve a crisis-driven system with reactive solutions alone.

A different approach is already within reach. Integrated, family-centered behavioral health care offers a path forward — one that aligns treatment with the goal of keeping families safely together, whenever possible.

Four things to look for when selecting a behavioral health partner

In our work at Carelon Behavioral Health, we’ve seen how engaging families in early, in-home support and coordinated care can stabilize families before crises escalate. In our Care Coordination programs in Connecticut, for example, more than 90% of families avoided child welfare involvement, demonstrating what’s possible when support reaches families before a breaking point. If you are a behavioral health partner, engaging families early is both efficient and effective. If you are a community organization looking for behavioral health partners, prioritize those that:

1. Provide a nonjudgmental listening ear. Parents are experts when it comes to their children but should not be expected to be experts in navigating the behavioral health system of care. We have a “warm line” called “Community Pathways” that families can call to talk through concerns about their children’s behaviors and get referrals if needed.
2. Create family teams. Care Coordination puts families in the driver’s seat of their care needs. Our approach focuses on keeping families together and connected to their communities. It involves bringing together a team of family, friends and providers to develop a plan of care, set feasible goals and provide a safety net of support to manage difficult situations in the future.
3. Let the teams lead. Family teams can align treatment planning with child safety and well-being goals, ensuring that interventions support both clinical needs and family stability. Most importantly, caregivers and parents are engaged as active participants in care — not as bystanders.
4. Focus on family-strengthening supports. Family-centered models that include in-home services, peer support and evidence-based parenting interventions strengthen caregiver capacity and resilience. These supports are often the critical link between a child remaining safely at home and entering foster care.

We are currently serving more than 10,000 family members a year through the Intensive Care Coordination and Integrated Family Care and Support programs, with an overall family satisfaction rate above 95%. And while every state has a different behavioral health ecosystem, we work collaboratively with their existing infrastructure, scope of services and implementation requirements to scale a solution that focuses on early intervention, care coordination and family support to improve outcomes and help reduce the need for more intensive (and costly) services over time.

[Related: In and beyond the school day — Expanding access to the behavioral supports that shape young people’s futures]

Three investments that can expand access to community-based behavioral health services

This includes rethinking eligibility criteria, investing in workforce capacity and strengthening connections between primary care, schools and behavioral health providers — before families reach a breaking point.

1. Involve primary care and education professionals. Pediatricians, schools and community youth programming partners are often the first to recognize early warning signs. Yet all face industry-wide barriers in connecting children to timely care, from limited training to fragmented referral pathways. Strengthening these front doors to the system is critical to catching concerns earlier. Carelon offers ACCESS Mental Health for Youth — a doc-to-doc program offering real-time consultation with a board-certified child and adolescent psychiatrist to a physician with patients with behavioral health needs.
2. Make therapeutic services available earlier. In many communities, intensive in-home therapy and care coordination are only available after a child’s needs have escalated to crisis levels. Find or start a coalition to advocate for earlier hand-off options when primary care and education professionals see the need for more intensive support.
3. Invest in staffing to support continuous care approaches. Ultimately, improving youth mental health within the child welfare system requires more than adding services. It requires building a family-informed, seamlessly coordinated continuum of care that spans early identification, in-home treatment, crisis response and ongoing family support.

When that continuum is in place, child welfare can shift from a system that primarily responds to crises to one that is empowered to prevent them. And fewer children will experience the trauma of unnecessary separation from their families.

***

Vanderlyn Sewell, M.D., is a board-certified psychiatrist with over 20 years of clinical experience caring for children, adolescents and adults across a range of behavioral health settings. She currently works in healthcare administration as national medical director, autism and neurodevelopmental disorders for Carelon Behavioral Health and is based in Atlanta, GA.