Foster Care Entry Among Children with Mental Health Needs: Findings from a National Study

Background and Purpose: The journey of youth entering foster care often intertwines with heightened mental health concerns. Youth with severe mental health needs often face barriers in accessing services, which may be exacerbated among racialized youth. Subsequently, some families voluntarily relinquish custody to child protective services (CPS) to access needed services, resulting in further mental health issues. The complex intersection of youth entering foster care, potentially prompted by mental health concerns, highlights broader systemic issues where families find themselves unable to access essential mental health services until they become involved with the child welfare system. In this study, we examined the relationship between child factors (e.g., age, parental risk factors), state factors (e.g., expanded Medicaid, mental health professionals per capita), and foster care entry among children (ages 0-17) referred to CPS with mental health issues.

Method: This study utilized data from the National Child Abuse and Neglect Datasystem (NCANDS) child file FY 2019. We also merged data from the State Child Abuse and Neglect (SCAN) Policy Database and the Substance Abuse And Mental Health Services Administration report on mental health outcomes by state. Using the merged data, we conducted a series of multi-level models to examine individual and contextual factors associated with foster care entry among youth with mental health needs with a focus on race/ethnicity. The sample included 39,271 children screened into an investigation for child maltreatment in FY 2019 who were identified as having an emotional disturbance. Multiple linear regression was conducted to examine foster care entry based on mental health service utilization while controlling for other child and state factors.

Results: Approximately 28.94% of children in the sample entered foster care after a CPS referral. Black youth (AOR = 1.14, 95% CI = 1.02-1.27), youth who utilized required health or mental health services (AOR = 7.21, 95% CI = 6.13-8.47), and youth in states that did not exempt financial issues from child maltreatment (AOR = 9.09, 95% CI = 1.33-55.5) had increased odds of entering foster care.

Conclusions and Implications: This study supports prior research demonstrating the relationship between foster care entry and utilization of mental health services. Furthermore, state policies related to child maltreatment and family financial issues may impact foster care entry among vulnerable families. Implications for policies and practices related to mental health service accessibility and equity are discussed.