Navigating Mental Health Services in Foster Care: Insights from Foster Parents on Facilitators and Barriers in a Southeastern State

Background and Purpose: Around 4,000 children/year are in foster care in the Southeastern state under study, and a significant number of them do not have access to adequate mental health (MH) services. This lack of support can exacerbate their existing MH problems and contribute to negative placement outcomes and overall well-being. To address this critical issue, this study seeks to explore foster parents’ perspectives on facilitators and barriers in navigating MH services for foster children.

Methods: This study used a phenomenological qualitative design. Between December 2022 and March 2023, we conducted one-on-one interviews via Zoom with nine foster parents in the Southeastern state. The interviews lasted between 30 and 50 minutes and centered on foster children's utilization of MH services, as well as the facilitators and barriers that foster parents perceived to be associated with their children's use of MH services. All interviews were recorded and transcribed verbatim and analyzed thematically by the research team using NVivo.

Results: Foster children received a wide range of MH services, such as trauma therapy, behavior modification therapy, occupational therapy, speech therapy, play therapy, and individual and/or family counseling services. We identified several facilitators that contributed to the use of MH services. At the foster parent level, foster parents' professional experiences, parenting experiences with their biological children/grandchildren, and strong advocacy were key facilitators. Regarding factors on the public child welfare agency side, the agency's trust in foster parents' judgment and having communicative and supportive caseworkers and social workers were important. Furthermore, a wide network of Medicaid-accepted providers, availability of onsite MH providers and virtual visits, sufficient providers in the neighborhoods, free transportation services, easy procedures to work with MH services providers, approachable therapists, and supportive physicians were critical for foster children to access MH services.

Foster parents also shared several barriers to accessing MH services for foster children related to the public child welfare agency. These barriers include bureaucratic influence related to who receives services, what services they may receive, and when they receive these services. The shortage of caseworkers and MH providers in the community and high turnover created further challenges. Foster parents also frequently identified barriers such as long waiting times, difficulties scheduling appointments given their working schedules and foster children's school schedules, and insufficient providers accepting Medicaid. Some foster parents reported a lack of a good foster parent network to share resources, too many assessments and paperwork, and ineffective tele-MH for young children as additional barriers. Moreover, insufficient trauma-informed services were provided to these children. Lastly, some foster parents encountered resistance from biological parents due to MH-related stigma, creating additional barriers for these children to receive MH services.

Conclusions and Implications: The findings offer valuable insights into improving foster children's access to MH services in the Southeastern state. We have formulated recommendations for the public child welfare agency, foster parent associations, MH providers, and foster parents. To tackle the MH challenges faced by foster children, all stakeholders must collaborate to address both systemic and individual barriers.