Mental Health: A Key to Positive Futures for Youth in Foster Care

Mental Health: A Key to Positive Futures for Youth in Foster Care


Welcome! The Now Is The Time
Technical Assistance Center is pleased to host this brief
multimedia presentation, entitled “Mental Health: A Key to Positive
Futures for Youth in Foster Care.” Before we dive
into today’s topic, I want to review
the broader range of technical assistance supports
and resources available to you. The NITT-TA Center provides
training, resources, and supports to grantees from SAMHSA’s
Now Is The Time Initiative, including: Healthy Transitions
programs that focus on effective mental health
services and systems for youth
and young adults, and Project AWARE,
which focuses on K through 12
student mental health in schools and communities. The focus of today’s session
is best practices for supporting the
mental health needs of youth in, and
aging out, of foster care. I am Dustianne North,
a social worker and researcher, and I will be
your presenter today. This training is
primarily aimed at professionals affiliated
with Project AWARE. What we discuss may also
be helpful to other adults who work in schools, community
mental health agencies, or other youth- and
young adult-serving systems, or who are in leadership,
administration, or official roles
in systems and policies serving youth, young adults,
and their families. Each young person
in foster care possesses unique skills,
talents, and interests, and each holds
the potential to be a thriving member
and leader in society. However, they often face
extra challenges in getting there. Youth become involved
in the foster care system due to abuse, neglect,
or abandonment by their primary caregivers, which by definition
has caused each of them some level of traumatization. Separation from their families
has created another layer of trauma, which has often been
further exacerbated by a number of problems
and negative experiences in the systems
that serve them. When unhealed,
trauma creates serious mental
health problems, shown to have
negative effects on a broad array
of developmental outcomes for foster care youth. As we will see, many youth
in foster care have high
mental health needs. Yet we caution school and
mental health professionals to avoid the trap of
over-pathologizing these often highly resilient
and talented young people. Note that the
higher rates of diagnosis and
medication of these youth may be as much a reflection
of heightened monitoring by public systems, as a reflection
of their higher need. Traumatic experiences
may be accompanied by other mental health
problems in the family and in youth themselves. Youth in foster care are therefore more likely
than other youth to be diagnosed with
mental health problems. Perhaps especially PTSD, due to the trauma
they have often experienced, as well as these
other mental health problems. Youth in care
are therefore more likely to have prescriptions
to psychoactive medications. Again, however,
these rates may not always reflect higher dysfunction. For example,
in one study, foster care youth exhibited
lower levels of substance use than their
non-foster peers, and yet were diagnosed with substance use
disorders at a higher rate. Serious concerns
have also been raised by many researchers, practitioners,
and youth and their families about over-medication
of foster care youth. So, please,
be careful not to over-pathologize
our foster care youth. In many cases, external life challenges
are as much a concern for youth in placement
as are their mental health needs. One of the most important
common problems is a lack of permanency
in living environments and school enrollments. A lack of permanency
can lead youth to fall behind
in school, lose or fail to make important connections
to caring adults, and to hinder them
in forming linkages to resources,
services, activities, and social connections
in the community. These deficits
can then also lead to a lack of life skills
in foster youth, which can really
catch up with them as they prepare
to transition to adulthood, and a lack of tangible
supports as they begin to undertake
the transition process. This lack of support
and skills can cause a spiral toward
extremely negative outcomes, in terms of education,
employment, early parenting, substance abuse issues,
incarceration, and homelessness. Our goal in serving youth
who have been removed from their families,
is to address the lack of adequate support
and resources most foster care
youth face, as well as any mental and
emotional challenges that may be present. Ultimately it is
important to remember that youth in foster care
are just like other youth in most ways, and want to be
treated as such. So in order to avoid
the negative outcomes that might
otherwise occur, support an approach
to mental health in foster care youth that is culturally relevant,
trauma-informed, strengths-based,
and youth-driven. Note that these strategies
overlap significantly. Let’s look at them, and how they relate
to each other, a little more deeply. Our recommended
strategy number one is that services you provide
be culturally relevant. The first step in doing this
is to recognize the various aspects
of culture that may affect each youth you serve. In addition to age,
family background, gender, and
sexual identity, there is also a culture
unique to foster care, and each family
or foster placement has its own set of
norms and customs. For each young person, their identity and experience
of the world is informed not by just one
of these aspects, but the intersections
of all of them, and there are differences even
within each of these groups. In order to provide culturally
relevant services, however, it is not enough to simply
recognize and respect difference. We must also
understand that youth of different cultural
backgrounds are treated very differently in foster care
and other systems. Note that poverty is the
strongest predictor of child removal
from the home, although youth of
all different class levels may find themselves in care, and that Black and Native youth
are overrepresented in the foster care system
despite the fact that parents of these
ethnic backgrounds are no more likely to abuse
or neglect their children. Families of color and
sexual minority youth are also shown to experience
harsher and poorer treatment in foster care systems,
which may explain the terrible reality,
for example, that 40% of
homeless youth today are estimated
to be LGBTQ. There is no easy answer
to helping youth grapple with these complexities. A preferred approach is to
exercise cultural humility, which avoids judgment
or imposition of one’s own values, and emphasizes
self-reflection and excavation of one’s own unconscious biases. Cultural relevance is not
an “end” someone achieves; we don’t simply become
“culturally competent” and thus able to work
with all populations. Instead we remain
reflective, respectful, and always in
the role of a learner as we encounter
new aspects of the cultural experiences
of the youth we serve. A key factor in ensuring
culturally relevancy is ensuring that services
are trauma-informed, which is our recommended
strategy number 2. Trauma during childhood,
when unhealed and especially when
repeated over time, is shown to affect
brain development, leading to problems
in cognitive learning, behavior and impulse management,
emotional regulation, and social attachments
and relationships. Families involved in
foster care systems may have experienced
multiple generations of ongoing trauma,
and as noted these effects are
often compounded by external life barriers. For these reasons,
a trauma-informed approach is necessary to assist youth
in and exiting foster care. SAMHSA recommends
that these six principles comprise a trauma-informed
approach to services in your program
or school. Seek to institute
a sense of safety, trust, and transparency
in school environments, and promote peer support
and collaboration among young people
and adults. Empower people to
speak for themselves and make
their own choices about their bodies
and their lives, and give key attention
to cultural needs and issues. If you can do these things,
your services will excel and you will help to create
a trauma-informed culture in schools and communities, all of which will help foster
youth to begin to thrive. While these concepts represent
only a starting point for trauma-informed work, more in-depth materials
are being provided on this important topic through SAMHSA
and Now Is The Time. Strategy number 3 is to use
a strengths-based approach. As noted, youth in foster care
can often lack support for basic needs
and the opportunity to participate as normal
members of their community. Indeed, the family
and community supports they do have
are often ripped away. To combat these problems,
we recommend providers recognize
and build upon the natural strengths, allies, and resources available
to a young person, and that you normalize the need
for wellness and self-care as basic life skills. Though we have
pointed out ways in which their experiences
can hinder them, the adversities youth have faced
in and out of the system have often also taught
them a great deal. It is important to be able
to recognize the upside of even their
greatest challenges. For example, as we
see on the screen, the attachment disorders many
youth in foster care deal with can also make them
highly adaptable. Difficulties in trusting people
can also teach healthy caution. Trauma and loss can lead
to wisdom and compassion. Ultimately, many youth
in foster care are quite resilient and have learned much
about self-advocacy and social aptitude. These skills should be
acknowledged and supported in service of a young
person’s healthy future. A large number of
individuals and organizations support the development
of youth in foster care, yet the culture of each these
may differ greatly from another, and these moving parts do not always
work well together. So many of these youth
may lack coherent support, and also experience
a fragmented or disjointed
sense of culture. It is therefore
especially important, when youth
are in foster care, to make an extra effort
to coordinate services with other professionals
and systems who serve them, to help them build their
natural support networks, connect them to resources, help them build linkages
in their communities, and ensure that their
most basic needs are met. Partnerships, coalitions
and task forces, and models such as
team decision making and family group decision
making are all ways to bring systems together
to serve youth better. A final strengths-based strategy
is to espouse notions of mental health
that are proactive, and that normalize the need
for wellness and self-care as a basic life skill. This is preferable
to reinforcing messages that these youth need help because there is
something wrong with them. As noted, emphasizing
strengths is one good way to support a young person’s
unique cultural background and it is important
to remember that concepts of
wellness and health are themselves often
culturally specific. Even bedrock needs
like nutrition can vary from
culture to culture. Did you know that
some recent studies have begun to suggest that
it is nutritionally important to eat the same foods
as one’s ancestors? A strengths-based approach necessarily involves
youth-driven programming, which is our strategy
number 4 for today. Providers may be
hard-pressed to ensure that services are
culturally relevant, if the youth they serve
don’t have significant input. The need for foster
youth-driven programming may be especially high. Many of these youth
have most often been the recipients of services and have not felt
they had much control over their destinies. Opportunities to develop
leadership skills, to feel useful
and empowered, and to discover
their unique gifts may have also
been scarce. Youth-driven strategies
may include engagement of youth in
program planning and providing
leadership opportunities, building peer to peer support
among foster youth, and encouraging them
to self-advocate when accessing mental health
care and other services. In one example of a way to engage foster care youth in developing mental health
programming for themselves, we asked youth existing the
foster care system in California how they take care
of themselves. Here are some
of their answers. Simple suggestions like these
can be far more powerful when offered from
youth themselves, rather than from adults who youth may not feel
understand them. It is also critical to encourage
and support foster youth to advocate for
themselves with regard to their mental health care, and providers should
become familiar with the Foster Youth
Bill of Rights, nationally, and various versions of a Foster Youth
Mental Health Bill of Rights, which have been
adopted in several states. To build peer-to-peer support
among youth in and exiting care, consider organizing
peer support groups and peer mentor programs, as well as educating them in
Mental Health First Aid. Connect youth to
existing networks of foster care youth. Some of these, like Foster
Club and iFoster, can be found online
and offer a variety of resources and ways to
connect with other foster youth. Others may be found locally, such as support programs
on college campuses, as well as Court Appointed
Special Advocates for Youth, which has chapters nationwide and provides mentoring and
court advocacy for foster youth. Additionally, the TIME model
of trauma-informed care, offered by SAMSHA,
is designed to guide supportive adults to
engage and prepare current or former systems-involved
youth and young adults to do advocacy work
for system reform efforts, and to minimize the negative
impacts this kind of work may have for them
while helping them develop personally
and professionally. Thank you for taking
the time today to learn more about the best ways
to support mental health in our youth who are in
or exiting foster care. In summary, these youth
face a multitude of challenges that can increase the mental
health problems they face and the likelihood of
other negative outcomes, especially as they
transition to adulthood and attempt to secure housing,
education, employment, and a place in the
community for themselves. Yet we have also
discussed their strengths, which can often
go unrecognized. And we have recommended
that mental health providers help these youth build
on their strengths and existing resources,
and recognize that the challenges they face are
often outside of themselves and are not personal deficits. Ensuring that the services
you provide are culturally relevant, trauma informed, strengths
based, and youth driven can lay a fantastic foundation to promote positive futures for
all of our foster care youth.

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