This in transitions of families/houses, damaged family relationships, inconsistent

This research paper focuses on the prevalence of complications
that can occur in adolescents who are in or exit the foster care system.
Current studies show that adolescents involved in foster care, such as those
with a lifetime history of foster care placement, have a tendency to have a
higher incidence of psychiatric symptoms and substance abuse/addiction problems
than adolescents that have never been in the foster care system. Factors
contributing to these issues stem from history of trauma, frequent change in
transitions of families/houses, damaged family relationships, inconsistent and
inadequate access to behavioral health services, and the over-prescription of
psychotropic medications.

Such problems can lead adolescents to make
irresponsible choices and possibly suffer mental health problems and/or
substance abuse issues as an adult. According to a variety of studies, the most
frequent type of psychiatric problems among children involved in foster care
includes Post-traumatic stress disorder, depression, attachment disorders,
ADHD, oppositional defiance disorder, and conduct disorder. Suicidal ideation
and suicide attempts are very common as well. Due to these disorders, substance
abuse is often co-occurring; the use of hallucinogens, stimulants, painkillers,
and depressants is common. Due to the overwhelming amount of adolescents being
involved with these life-altering issues, intervention, treatment, and
prevention measures will also be explored.

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            Over half a
million children in the United States are currently placed in foster care.
These children have been considered a large part of the behavioral care system
due to an overwhelming amount of clinically significant behavioral problems.
According to In a study of children and youth from different areas of public
care (child welfare, juvenile justice, and mental health), “approximately 42%
of youth in the child welfare sample met criteria for a psychiatric diagnosis
in the past year” (Courtney, Keller & Salazar, 2010, pg. 626). One of the major
factors that contribute to the development of these problems would be the disruptive
placements that often occur in foster care. According to Fisher at el. (2011), “Approximately
95% of foster children experience at least one placement disruption while in
out-of-home care, and the adverse effects of these disruptions on psychosocial functioning
are well documented…recent evidence has suggested that such disruptions are
also associated with negative effects on brain development” (pg. 482). This
evidence can explain why not only are behavioral problems present, but also the
proper development of the brain can be compromised from these abrupt

In addition, statistically, older children often face
additional issues due to rocky transitions to adulthood and lack of continued
support after they exit the foster care system. The transition to adulthood as
well as prior behavioral/mental health issues these older adolescents are
experiencing; they may struggle significantly more than younger children. According
to the same study, “older adolescents in care similarly found that they scored
above norms on self-report mental health inventories, and approximately half
had received some form of mental health service in the preceding year” (Courtney,
Keller & Salazar, 2010, pg. 627). This is due to the transition adolescents
experience on their way to adulthood, which typically would guarantee freedom
and opportunities but pose some other challenges such as a test of coping
skills, the exacerbation of pre-existing conditions, and a significant
disruption in developmental growth.

Post Traumatic Stress Disorder is the most
predominantly diagnosed mental illness of vulnerable adolescents exiting foster
care. Depression is classified as the second. Many studies have also found that
conduct issues are prevalent in foster care adolescents in addition to
psychiatric symptoms. According to a research study done on foster care of adolescents
by Courtney, Keller & Salazar (2010), the sample showed the prevalence of
issues. “The highest was conduct disorder at 47%, followed by major depression
at 27%, ADHD at 20%, PTSD at 14%, and mania 6%” (Pg. 627). The research showed
that PTSD and major depressive disorder could be prevented with proper therapy
(such as cognitive behavioral therapy) and skills based treatment. This study
had also shown that if PTSD, depression, and maladaptive coping strategies
(poor social problem-solving skills) could be lessened, there might be
potential to reduce the risk of victimization (Auslander at el., 2017, pg.

In addition to mental health issues, substance abuse
is extremely prevalent in adolescents that were previously involved in the
foster care system. According to a research study done on foster care youth and
prevalence of substance abuse, “adolescents involved in foster care had a
higher prevalence of substance use disorders, and were about five times more
likely to have a past year diagnosis of drug dependence than adolescents in the
control group” (Pillowsky and Wu, 2006, pg. 356). The prevalence of substance
use/abuse may be higher due to the co-occurrence of psychiatric disorders.
Research has also found that childhood maltreatment could be a precursor to
future substance abuse in adults. Foster care often can be a stressful
experience for youth who have experienced prior stressors such as abuse,
neglect, parental addiction, and environmental conditions. These effects could
have negative consequences in the future such as psychosomatic development,
substance abuse, homelessness, delinquency, and incarceration (Pillowsky and
Wu, 2006, pg. 357).

Research on behavioral health and substance use shows
that there are often attachment problems that stem from traumatic separations
of the children from their parents or having physically and/or emotionally
unavailable parents. According to a study on psychiatric symptoms and substance
use disorders of those in foster care, “children of unavailable parents feel
unloved, disregarded…they lack conviction that someone cares for them, they
feel alone, threatened and frightened” (Pillowsky & Wu, 2006, pg. 356).
Because of this, children often become avoidant, distant, defensive,
aggressive, or defiant. These behaviors are often due to a lack of safety,
security, and love. They tend to ignore others, tear themselves down, and
believe that they have nothing to offer the world. These beliefs can then
transpire into behavioral problems, low-self worth, substance use/abuse, risky
and promiscuous behavior, and criminal behavior to name a few.

While research has been done on effective treatment
options for foster care adolescents, the options are limited. Cognitive
behavioral therapy has been touted as one of the effective evidence-based
treatments currently available to troubled foster care youth. Cognitive
behavioral intervention with a focus on trauma has become a popular
intervention that schools are using for adolescents that were in/have been in
the foster care system and had a history of neglect and/or abuse. According to
a study done by Auslander at el. (2017), reductions in the levels of PTSD
symptoms found in both the experimental and control group saw that in a 6-month
follow-up assessment, “PTSD decreased from 65% at pretest to 36% on the
follow-up…depression symptoms decreased from 47% at pretest to 21% at the
follow-up” (Auslander at el., 2017, pg. 213). Components that make cognitive
behavioral therapy so effective include exercises such as: psychoeducation,
trauma narratives, exposure therapy, relaxation skills and techniques, and
social problem-solving. In this study, it was also observed that when the adults
in the child’s care that were included in the treatment, were called the
“caregiver” or “supportive adult” instead of “parent”, which created healthier
relationship models for adolescent participants. Home therapy, outpatient
mental health/behavioral health services, and school-based counseling were
implemented into this treatment, which proved to be helpful.

            Because there is such a high occurrence
of behavioral health problems, substance use/abuse problems, criminal activity,
and suicide in adolescents living in foster care, more research, education,
prevention, intervention, and updated policies should be implemented to keep
these problems from transpiring in adolescents in the future. According to a
study on preventative practices on adolescents in foster care, there were fewer
behavioral problems, placement disruptions, improved school achievement, larger
social support system, better relationships with peers, and less interpersonal
aggression than in the control group who received typical case-work services
(Chamberlain at el., 2006, pg. 526). While this is a single instance where
intervention is effective in decreasing the prevalence of behavioral health and
substance abuse problems, more research needs to be done on this subject.

A concern in the foster care system is that there is a
lack of comprehensive mental health screenings of all children entering
out-of-home care, the need for more thorough identification of youth with
emotional and behavioral disorders, and insufficient youth access to
high-quality mental health services” (Pecora et al., 2009, pg. 6). These
services need to be updated in order to provide the necessary support for those
who are mentally/emotionally struggling. Services such as the American Academy
of Child and Adolescent Psychiatry (AACAP) and the Child Welfare League of
America (CWLA) have worked on establishing guidelines on improving the policies
and practices in the various organizations that serve foster care children. It
was found that guidelines for mental health screening, assessment, and treatment,
as well as guidelines for parent engagement and youth empowerment needed to be
the focus of prevention measures (Pecora et al., 2009, pg. 8). This is a
positive shift in the lack of policies and practices in the welfare system;
however, it needs to continually improve as time goes on.



While the foster care system is definitely a necessity and
extremely important in giving children a safe and nurturing environment, there
are definite problems that are prevalent that need to be further studied and
understood. In those who exited the foster care system, there were higher rates
of psychiatric disorders, behavioral problems, substance abuse issues, suicidal
ideation, criminal activity and risky behavior. These are due to attachment
issues, prior abuse or neglect, abrupt transitions, lack of services, and
unaccommodating policies and procedures. Treatment options are slowly becoming
more available for these foster care adolescents such as cognitive behavioral therapy
and rehabilitation services within the school system. Services such as the
American Academy of Child and Adolescent Psychiatry (AACAP) and the Child
Welfare League of America (CWLA) are working on establishing standards to
improve the policies and practices of the foster care system and child welfare.
More research will be necessary, in addition to an updated system, but the
little strides that have occurred are important in the improvement of the
foster care system in the United States.

















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(2011). Foster placement disruptions associated with problem
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T. E., Salazar, A. M., & Courtney, M. E. (2010). Prevalence and Timing of            Diagnosable Mental Health, Alcohol,
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in the Child Welfare System. Children and Youth Services Review,      32(4), 626–634.  

P. J., Jensen, P. S., Romanelli, L. H., Jackson, L. J., & Ortiz, A. (2009).

Health Services for Children Placed in
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Pilowsky, D. J., & Wu, L. (2006). Psychiatric symptoms
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