Mental Health Problems in Foster Care Children
More than 400,000 children in the United States live in foster care. Many come from unstable families or have been abused or neglected. As a result, foster children may be more likely to have a mental health problem. If you care for a foster child and think he or she may have a mental health problem, you may want to talk with your child’s doctor to see if treatment is needed.*
Treatment for mental health problems can include:
- Nonmedicine therapies (such as "psychotherapy," or talk therapy), or
- "Psychotropic" (pronounced SIE-kuh-TROE-pic) medicine, or
- A combination of the two.
Note: Psychotropic medicines (medicines for mental or emotional conditions) affect the ways in which chemicals that naturally occur in the brain interact. These medicines need to be carefully prescribed and closely watched by a doctor.
"Best Practices" for Treating Mental Health Problems in Foster Children
In September 2013, the State of Texas released a "best practices" guide for doctors who prescribe psychotropic medicines to foster children. The guide can be useful to doctors in any State who treat foster children who have mental health problems.
The use of psychotropic medicines to treat children with mental health problems is an important issue facing parents, caregivers, and doctors. Because of the emotional and mental stress that foster children often experience, it is an especially important issue for foster parents. The "best practices" guide can help doctors, foster parents, and other caregivers better understand the proper use of psychotropic medicines in foster children.
If you have a [foster] child with mental health problems, the information in this handout can help you prepare for doctor visits and make decisions about treating your child.
*In the State of Texas, only designated Medical Consenters can give a health care provider "informed consent" (written permission) to treat a foster child. This may be different in your State. This summary refers to 'foster parents' and 'caregivers,' but Medical Consenters in the State of Texas may also include case managers for child placing agencies, professional staff of emergency shelters, cottage parents, relative and kinship caregivers, and certain Department of Family and Protective Services staff and youth medical consenters. Visit your State’s department of family and protective services Web site for more information on who can give informed consent to treat a foster child.
Preparing for the First Doctor Visit
When taking your foster child to a doctor for the first time about his or her mental health problems, the doctor may want to talk to you about:
- Your child's complete health history, if you have this information
- Your child's history of trauma (physical and emotional), if you have this information
- Your child's symptoms. If you can keep a record of the symptoms, it may include:
- A list of the symptoms, when each symptom started, how often the symptoms happen, and when they flare up or get worse
- Any traumatic events that happened right before the symptoms started or got worse
If Your Doctor Wants To Treat Your Foster Child for a Mental Health Problem
The "best practices" guide recommends that your doctor do a full exam before prescribing a medicine for your child’s mental health problem. Unless it is an emergency†, the doctor may follow these steps:
- Carefully go over your child’s health history if records are available (noting any trauma your child has had)
- Do a psychosocial assessment
- Do a mental exam
- Do a physical exam
- Give a diagnosis
- Consider nonmedicine therapy as part of the treatment plan
†An emergency situation may consist of thoughts about suicide, psychosis (severe mental illness), self-injuring behavior (like cutting), aggressive behavior that is dangerous to others, or impulsive behavior that endangers your child or others; problems with mental and physical functioning (such as not eating or sleeping); or when your child has severe anxiety, isolates himself or herself from others, or withdraws from his or her usual activities.
Making a Treatment Decision
If your doctor recommends that your foster child be treated for his or her mental health problems, your doctor may explain which symptoms will be treated and what to expect from the treatment. You and your doctor can carefully weigh the possible benefits and risks of taking a psychotropic medicine. Both you and your foster child can help make all treatment decisions if he or she is mature enough to participate.
Note: Before your doctor can give your foster child any psychotropic medicine, you, or the child's appointed Medical Consenter must give "informed consent" (written permission). Make sure your doctor discusses these things with you before you give your written permission:
- Your child's diagnosis
- The results of any lab tests
- Possible benefits and risks of treatment
- Possible side effects of the medicine, including less common but possibly severe side effects such as seizures or life-threatening allergic reactions
- The risks of no treatment
These are examples of questions you can ask your doctor so that you can be involved in the decision making process:
- What treatment do you think would be best for my child? Are there any other treatment options?
- What are the results that you expect from treatment?
- What are the possible benefits and risks of treatment? What are the risks of no treatment?
- If you think my child needs a medicine, which one?
- Are there any nonmedicine treatments we could try before or along with the medicine?
- What are the possible side effects of the psychotropic medicine? Are there any possible serious side effects to watch for? What should I do if a serious side effect appears?
- How long will it take for the treatment to start working?
- How will we know if the treatment is working?
- What will we do if my child’s symptoms do not get better or if they get worse?
- How often should we come see you to monitor progress?
- What else can I do to help my foster child?
Note: Your doctor should be giving as few psychotropic medicines as possible to treat your child’s mental health problem.
If the doctor prescribes a psychotropic medicine, usually the doctor should:
- Start with only one medicine before adding any more
- Start with a low dose (amount of medicine) and carefully raise the dose if needed
- Only change one medicine at a time
- Stop a medicine that is not working before trying a different medicine
Followup Care for Your Foster Child
If your doctor started your child on a mental health treatment, the "best practices" guide recommends that your child go to the doctor at least once every 3 months. At each visit, the doctor may:
- Review your child's symptoms
- Check to see how well the treatment is working
- Make sure the treatment is having the desired effects
- Make note of any side effects from the medicines
- Especially watch for signs that your child is having suicidal thoughts
- Check your child’s weight, height, and blood pressure
- If your child is taking antipsychotic medicines, check his or her blood sugar and cholesterol (a type of fat in the blood)
These trusted Web sites provide resources about treating children with mental health problems. You can also read the "best practices" guide on the Texas Department of Family and Protective Services Web site. Available at http://www.dfps.state.tx.us/Child_Protection/Medical_Services/guide-psychotropic.asp
Resources Specifically for Foster Parents and Children:
- Mental and behavioral health of children in foster care, a Web page from Healthy Foster Care America (an initiative of the American Academy of Pediatrics and its partners). Available at http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Pages/Mental-and-Behavioral-Health.aspx.
Resources on Treating Mental Health Problems in Children
- Treatment of Children with Mental Illnesses, a fact sheet from the National Institute of Mental Health. Available at http://www.nimh.nih.gov/health/publications/treatment-of-children-with-mental-illness-fact-sheet/index.shtml.
- NAMI Basics: Ask the Doctor, a set of 28 video clips from the National Alliance on Mental Illness. Available at http://www.nami.org/Template.cfm?Section=NAMI_Basics1&Template=/ContentManagement/ContentDisplay.cfm&ContentID=59169.
- Choosing the Right Treatment: What Families Need to Know About Evidence-Based Practices, a booklet from the National Alliance on Mental Illness. Available at http://www.nami.org/Template.cfm?Section=Child_and_Teen_Support&template=/ContentManagement/ContentDisplay.cfm&ContentID=47656.
- Disorders and Treatments, a Web page from the New York University Child Study Center that has links to additional information on mental health problems in children. Available at http://www.aboutourkids.org/families/disorders_treatments.
- Publications About Children and Adolescents, a Web page from the National Institute of Mental Health that has links to booklets and fact sheets on mental health problems in children and teens. Available at http://www.nimh.nih.gov/health/publications/children-and-adolescents-listing.shtml.
- Resource Centers for Mental and Behavioral Disorders, a Web page from the American Academy of Child and Adolescent Psychiatry that has links to resource centers for different mental health problems in children. Available at http://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/Home.aspx.
Resources on Psychotherapy and Medicines for Mental Health Problems
- Psychotherapies, a Web page from the National Institute of Mental Health. Available at http://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml.
- Mental Health Medications, a booklet from the National Institute of Mental Health that includes warnings from the U.S. Food and Drug Administration (FDA). Available at http://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml.