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If you’re a foster parent — or considering becoming one — you need to know about the mental health needs of foster children.

Most foster children have experienced some form of trauma. Foster families can provide a stable, nurturing home to help them heal. Here’s what you should know about the mental health foster child connection.

What Is Foster Care?

Foster care is a living situation for children whose families can’t take care of them for any reason. A court of law decides when a child should go into foster care. Both private and public agencies (state, county, and tribal) provide foster care.

Foster families are volunteers who provide a loving, stable home for as long as needed. They go through a vetting process and receive a stipend for the child’s living expenses. But foster care is not a paid job or a money-making venture.

Fostering, unlike adoption, is a temporary living situation. Foster parents may or may not be relatives of the child.

The end goal of foster care is reuniting the child with their birth family, if possible. About half of all children in foster care get reunited with their birth family at some point. Some get adopted, but many simply age out of the system at age 18.

According to the American Academy of Pediatrics (AAP), the average stay in foster care is nearly three years. The stay may be longer if the child has developmental or behavioral issues. It may be longer if they are part of a sibling group or are a member of an ethnic or minority group.

Why Do Children Need Foster Care?

Courts place children in foster care because their birth families can’t take care of them. The reasons vary, but they typically involve a family crisis, neglect, or even child abuse.

Other reasons for foster care placement include:

• Death of one or both parents.
• Homelessness.
• Neglect or abuse.
• Substance use disorder by the parents.

Children placed in foster care can be any age, from newborns through teens. Sometimes sibling groups get placed in foster care together. Sometimes siblings get placed with different families.

Foster Care Mental Health Statistics

Mental health issues are a major concern among children in the foster care system. The numbers tell the story, and it’s an alarming one.

There are nearly 400,000 children and youth in foster care in the U.S. A vast majority (up to 80%) have serious mental health issues. That’s about four to five times greater than the rest of population.

The rate of post-traumatic stress disorder (PTSD) is 21.5% among foster care alumni. That’s higher than the rate of PTSD among American war veterans.

Mental Health Among Children in Foster Care

Abuse, neglect, and an unstable home environment have long-term, serious consequences for children.

Mental health problems in foster children include:

• Attention deficit hyperactivity disorder (ADHD).
• Behavioral problems.
• Depression and anxiety.
• Oppositional defiant disorder (ODD).
• Post-traumatic stress disorder (PTSD).
• Reactive attachment disorder (RAD).

Some of the reasons for mental health problems among children in foster care include:

Complex, ongoing trauma

Foster children may have experienced years of trauma, loss, and unstable living conditions. Their parents may be chronically unemployed or in jail. They might have had a revolving door of adults in their lives.

Sometimes foster children have had many traumatic events in their short lives. They may have seen violence and spousal abuse. Separation, loss, chaotic parenting, and uncertainty leave deep psychological marks.

Multiple changes in life situations

Every time a child goes through a major life change, it adds to their mental health burden. Being taken from their home, however unstable, can be traumatic for a child. And adjusting to living with a brand-new foster family can be overwhelming.

Lack of stable role models

A child’s sense of security comes from the adults around them. Children who end up in foster care often grew up with few positive role models for healthy family interaction. They may not know how to communicate well, solve problems, or show respect for people or property.

Mental Health Support for Children in Foster Care

Supporting mental health in foster children requires a holistic approach. Communication among school, home, family, and community is vital. Mental health workers, foster parents, and social service organizations are part of the picture.

Support for foster children may include:

• Encouragement of healthy habits — exercise and healthy food can help reduce stress. Getting enough sleep at night on a regular schedule can help foster children feel calmer.
• Involvement in groups — it’s good for foster children to get involved with peers. Foster families can encourage them to join clubs, volunteer activities, sports teams, or faith-based groups. Through these bonds they can gain a sense of belonging and feeling needed.
• Medicine — a doctor may prescribe antidepressants or other medicine to help a child or teen function better at home or in school. But these medicines, which can have serious side effects, should only be one part of a treatment plan. The doctor should prescribe them in minimal doses.
• Regular doctor visits — the AAP recommends that all children have a health screening within 72 hours of placement into foster care. If possible, they should have a mental health evaluation by a doctor trained in pediatric mental health.
• Stability in the foster home — children and teens thrive with structure, routines, and clear expectations. Foster families can provide a warm, predictable, and nurturing atmosphere. Staying calm, being open to talk about problems, and making good on promises are prime traits in foster parents.
• Therapy — counseling can help children and teens understand their past trauma. They can learn to identify and address the root causes of their emotions. A behavioral therapist can help them manage difficult emotions and build healthy behaviors.

What Help Is Available for Foster Parents?

UPMC has on-staff trauma and crisis therapists for foster children and family.

UPMC Western Behavioral Health provides a range of support services for foster families and those who might be looking to foster in the future. For more information or to learn how you can become a foster parent, visit our website.Social service networks and support groups can also provide help for foster parents. A good place to start is the Child Welfare Information Gateway, part of the U.S. Department of Health and Human Services. There you can find more information about fostering in your area.