When the System Goes Away, Does Treatment Need Follow? Behavioral Health Needs and Service Use Among Youth Aging Out of Foster Care

Purpose: The purpose of this study is to explore the continuity of behavioral health services for youth aging out of foster care, including the relationship between remaining in foster care after one’s 18^th birthday and the receipt of services. Young adults who’ve transitioned to adulthood from foster care are significantly less likely than their peers to have medical insurance and report atypically high symptomology associated with chronic mental illness and substance dependence well into their 20s (Courtney et al., 2012). Without the social capital that many access through family and other social networks, symptoms of mental illness, substance dependence, and antisocial traits are less likely to be addressed by others. Untreated symptoms often worsen and accumulate over time, negatively impacting multiple life domains. Although the Fostering Connections to Success Act (2008) gives states the option of extending foster care services until age 21, many states continue to terminate services at age 18. In this study, we explore whether or not remaining in care makes a difference in who accesses behavioral health services.         

Methods: Data for these analyses were taken from four waves of the Midwest Evaluation of the Adult Functioning of Former Foster Youth, a longitudinal survey of youths in three states who exited foster care between their 17^th and 22^st birthdays.  Participants were ages 17 or 18 at baseline (N= 732) and followed until ages 23 or 24 (response rate + 82%). At baseline, 64.8% of the sample was from a state which offered foster care until age 21.

Descriptive statistics were used to explore the change in service need and utilization over time.  Binary logistic regressions were used to estimate the relationship between remaining in foster care after age 18 and service receipt, net self-reported need for services. 

Results: Descriptive statistics showed a decline over time in receipt of substance abuse and mental health services among youth with indicated need for services; the greatest drop occurred between baseline and age 19-20.  Those remaining in care at ages 19-20 were both significantly more likely to receive services and less in need of those services than those who had exited care.  Logistic regressions controlling for service need showed that remaining in care was associated with an increase in service receipt at age 19-20, but had no effect at later waves when all youth had left care.  

Implications: Allowing foster youth to remain in care beyond age 18 is associated with receipt of services that many of these young adults have a clear need for and are otherwise not getting.  Further research is needed to explain why youth who remain in care exhibit fewer symptoms of problematic behavioral health than those who leave. Perhaps youth with greater symptoms choose to exit or are pushed out of care earlier. Alternatively, increased service receipt while in care may improve youths’ behavioral health.