History of Foster Care Among Newly Homeless Young Adults and the Likelihood of Psychiatric Disorders and Treatment

Background and Purpose: While foster care placement is often preceded by stressful events such as maltreatment, foster care itself often exposes children to additional severe stressors. A history of foster care, as well as the childhood maltreatment that often precedes it, is common among homeless young adults. However, whether a history of foster care elevates the likelihood of psychiatric disorders and treatment among homeless young adults, after adjustment for childhood maltreatment, is unknown. We examined whether a history of foster care was associated with psychiatric disorders, prior psychiatric counseling, prescription of psychiatric medications, and prior psychiatric hospitalization among newly homeless young adults, controlling for childhood maltreatment and other covariates.

Methods: Among a consecutive sample of 424 newly homeless young adults (18 to 21 years) in a crisis shelter, logistic regression analyses determined the associations between foster care and any psychiatric disorder (affective, anxiety, personality, psychotic) and psychiatric treatment, adjusted for demographics, childhood maltreatment, substance abuse, prior arrest, unemployment, lack of high school diploma, and histories of psychiatric disorders and drug abuse among biological relatives.

Results: Homeless young adults with histories of foster care were 70% more likely to report any psychiatric disorder (AOR=1.70) and twice as likely to have received mental health counseling for a psychiatric disorder (AOR=2.17), been prescribed psychiatric medication (AOR=2.26), and been hospitalized for psychiatric problems (AOR=2.15) than those without such histories.

Conclusions and Implications: Histories of foster care should trigger screening for psychiatric disorders among homeless young adults to aid in the provision of treatment (counseling, medication, hospitalization) tailored to their psychiatric needs. Improved coordination and continuity of services between the child welfare, mental health, and young adult homelessness service systems are needed to ensure that all young adults have stable housing, employment training and opportunities, and treatment for psychiatric problems. Further research is required on the most efficient and effective psychiatric and psychopharmacological treatment to improve the long-term trajectories of housing stability and psychiatric disorders among homeless young adults who exit foster care.