Former Foster Youth's Perception of Mental Health Service Receipt While in Foster Care

Background:  Studies have consistently shown that older youth in the foster care system have high rates of psychopathology when compared to youth in the general population.  While older youth in foster care are generally heavy users of mental health services, once youth emancipate from foster care, there’s a dramatic drop (60%) in the utilization of mental health services.  Reasons for mental health service disruption once youth leave foster care are unclear.  However, studies in the general population have consistently found that a person’s perception, knowledge, and attitudes toward mental health and mental health services are significant in the utilization of mental health services.  As such, this qualitative study sought to examine the perceptions former foster youth have about the mental health services received while in foster care to help explain the underutilization of services upon foster care exit. 

Methods:  Using the Parental Endorsement of Barriers questionnaire (Yeh et la., 2003) as a guiding framework, the current study examined the knowledge and perceptions of mental health services of 13 former foster youth.  Data were collected through a one hour in-depth qualitative interview.  Interviews were audio-taped and transcribed, and coded for themes across different domains.

Results:  Youth reported a number of challenges in the receipt of mental health services, with youth placed in group homes identifying the most challenges.  Although mental health services were a requirement, and were often, readily available on site, youth reported these services to be the least helpful.  Reasons given included multiple therapists, which led to the youth’s unwillingness to re-tell their story multiple times.  Youth also reported therapists being untrustworthy as information shared in sessions were reported to social workers and group home staff.  There was also a lack of communication to the youth as to the reasons for service referral, which led to resistance and/or apathy towards the services provided.  Over medication was also an issue with youth reporting the use of psychotropic medications as a form to control the youth’s behavior while in care, whether medication was needed or not.  Youth placed in foster homes had a more positive perception of services, with youth reporting consistent services with few or no therapist changes.  Interestingly, youth who reported a more positive perception of mental health service receipt were more likely to continue or seek services upon foster care exit. 

Conclusions and Implications:  Past research studies have consistently documented placement instability with older foster youth, especially those placed in group homes.  Reasons for placement disruption can generally be attributed to behavioral problems.  Findings from this research study suggest that consistent mental health services, preferably with an off-site trustworthy therapist, who can continue with the youth, if there is a placement disruption, may play a significant role in addressing behavioral problems.  This in turn, may lead to fewer placement disruptions.  Additionally, consistency in service receipt may address the underutilization of mental health services upon foster care exit.