Why psychiatric counseling should be part of foster care

children at play

Children in foster care are at higher risk of several life-long issues, including mental illness and substance abuse.

In an article published in the Archives of Psychiatric Nursing, lead author Julie Bertram, MSN at the Saint Louis University School of Nursing, says that "adding a mental health nurse to the treatment team [for foster children] would be ideal."

Screening for Mental Illness

Child welfare and social workers are not usually trained to diagnose or treat mental illnesses (or most other health problems), but mental health experts – specifically specializing doctors and nurses – are trained for that. Adding these experts to the team caring for foster children would enhance the child's chances of being mentally healthy, the article says.

With three-quarters of all children in foster care suffering from serious traumas (often sexual abuse or mistreatment) and with many having parents who have a history of mental illness and substance abuse, the odds are against the child emerging into adulthood without mental health issues.

Bertram notes:

High rates of psychotropic medication use, polypharmacy and problems in continuity of care have raised alarms about whether youth in the foster care system may be receiving inappropriate treatments for the symptoms they present. The strikingly high rate of medication use may be just the tip of the iceberg when it comes to concerns about quality of care within the child welfare system.

Impact on Mental Health

Several issues, such as quality of housing, stability and mistreatment can all affect a child in foster care. In a qualitative research study as part of the article, Bertram and her team cared for eight adolescents in foster care who had a history of psychiatric hospitalization. All were in residential care facilities (group homes). During the study, the children were transitioned to foster families who had received training specific to the child's mental health needs. Training was conducted by Bertram's team.

On average, the teens were taking 13 psychotropic drugs each, often due to conflicting diagnosis from a history with multiple physicians. Her team was able to vet those various diagnosis to two or three per child instead.

A New System

The study resulted in a newly-reorganized reporting process for the child health system in the foster care system in Missouri. Case workers were shown how to more readily manage and simplify health records for the children in their care.

The foster children themselves were empowered with more information about their illnesses and what was being done or could be done to treat them.

"Psychiatric nurses don't replace the role of social workers or case managers, but complement the treatment team by contributing knowledge of mental health nursing," Bertram said in her study. "The needs for the knowledge, skills and understanding of a psychiatric nurse were substantial, and our findings suggest employing psychiatric and mental health nurses is one way to improve fragmented care within the foster care system."


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