Mental Health Service Use of Children Adopted From Foster Care: Findings From the National Survey of Adoptive Parents

BACKGROUND & PURPOSE: Annually an estimated 120,000 adoptions are completed of which roughly 50,000 involve children from foster care. Although studies have found children and adolescents in foster care use mental health services at exceptionally high rates, little is known about the mental health service patterns once children are adopted out of care. Therefore this study provides one of the first examinations of mental health service use among children who have been adopted out of foster care. The explicit purpose of this study was to 1) identify the extent of mental health service use among a nationally representative sample of adopted children, and 2) identify predictors of mental health service use for children adopted out of foster care.

METHODS: The National Survey of Adoptive Parents (NSAP) is a nationally representative dataset of all adopted children ages 0-17 in 2007. The NSAP sample consists of 2,089 parents drawn from the 2007 National Survey of Children's Health (NSCH). Mental health services use was measured by parent reports of whether the adopted child had ever received mental health care or counseling since the time of his/her adoption (yes/no). Adoption characteristics included type of adoption, child's age at adoption, and whether the placement was transracial. Need was assessed with three indicators: clinical need (based on parent knowledge of a diagnosis of PTSD or Attachment Disorder, IEP, or Drug/Alcohol problem), delinquent behavior (trouble at school or with police), and history of prior maltreatment. Predictors of service use since adoption for children adopted from foster care was modeled using logistic regression.

RESULTS: Out of the entire sample (N=1,722) mental health services were utilized by 38.2% of respondents' adopted children with statistically significant differences by adoption type. Those families who adopted from foster care used mental health services the most (49.7%) compared to private (32.7%) and international adoptions (17.6%). For children adopted from foster care, statistically significant differences were found with those most likely to receive services being male, adolescent, with special needs, adopted at an older age and those who experienced prior maltreatment. The overall model predicting mental health service use was statistically significant (χ2=91.4, p<.001). Children adopted from foster care with clinical need were 5.8 times more likely to receive mental health services. Those with special health needs were 3.9 times more likely to receive mental health services. Parents who reported that their child experienced multiple types of maltreatment were twice as likely to receive mental health services.

CONCLUSIONS & IMPLICATIONS: Children adopted from foster care utilize mental health services at higher rates than children adopted privately or internationally or in the general population. This study provides evidence that the mental health needs of children in foster care do not go away once a child is adopted out of care. Therefore, policies and practitioners must focus on helping adoptive parents in meeting the ongoing mental health needs of their adopted children.