Foster Care Alumni's Perception of Mental Health Service Receipt While in Foster Care: A Focus on the Impact of the Mental Health Services Provider Characteristics

Background:  Older youth in the foster care system are generally heavy users of mental health services, but once youth emancipate from foster care, there’s a dramatic drop (60%) in the utilization of mental health services.  It’s unclear as to the reasons for mental health service disruption post foster.  However, studies in the general population have found that past experiences with mental health professionals influence a person’s decision to either seek or continue with mental health services.   This qualitative study sought to examine the perceptions formed by foster care alumni about the mental health services provider in the receipt of mental health services while in foster care to better understand 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 perceptions developed by 13 foster care alumni about the mental health services provider in the receipt of mental health services while in foster care.  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:  All youth received weekly individual counseling while in foster care.  Length of time in treatment ranged from 1-12 years or the duration of the youth’s time in foster care.  When examining receipt of services, client led therapy sessions allowed the youth to feel comfortable and helped motivate in the attendance of services.  Therapy sessions where the youth felt the therapist had a set agenda had the opposite effect.  Lack of confidentiality was also an issue as therapists shared information from the sessions with the social worker and group home staff.  Youth also reported a lack of empathy and genuineness by the therapist, which impacted whether the youth shared any experiences or issues.  Being left emotionally raw was also an issue in that therapists pushed the youth to revisit past trauma but were then left reeling from the emotions; this prevented the youth from opening up for fear of not being able to cope with their emotions.  Overall, youth who reported negative perceptions of the mental health services provider were also less likely to continue or seek services upon foster care exit. 

Conclusions and Implications:  Findings from this research study suggest that the mental health services provider characteristics and techniques used in therapy impact the development of the perception youth form about mental health services.  Educating mental health services providers as to the challenges and issues faced by foster care youth and developing suitable intervention techniques for this population, may significantly impact not only, the perceptions of mental health services and the long-term use of these services, but also in addressing current mental health needs.