The Hidden Scars of Foster Care: How the System Impacts Youth Mental Health and Development

Moving from one house to another is not an easy way to go about life as a teenager. For foster youth, problems arise during their most crucial developmental years. Although a recent report from the Adoption and Foster Care Analysis and Reporting System (AFCARS) shows a decrease of children in foster care by six percent as of 2022, there are nearly 400,000 foster youth2 where many are still admitted in the system commonly due to abuse and neglect (Sheppard, 2024). The second children step into the foster care system, they become vulnerable to long-term psychological effects that can linger into adulthood creating childhood trauma. Among the psychological effects foster youth struggle with from being a part of the system come in the form of attachment problems, challenges in resilience, and mental health problems. 

When it comes to attachment problems, studies highlight them as social problems that start as early as before being removed from home – with no evidence that they improve during foster care. According to a study by Jacobsen et al. (2019), foster youth are at risk of being less well-adjusted to the environment as a response to the possible abuse and neglect experienced in their own homes as the child experiences relocations – also known as “relocation disruption” – children and adolescents as young as 8-years old have trouble expressing and communicating their trauma through their behavior. While they have the desire to establish secure and long-lasting relationships with their foster caregivers, they are in a constant state of experiencing instability in what to call their permanent home, which strangers to trust, and if the foster parent or family assigned would accept them as they are. In the words of Ebony E. White, PhD, LPC, NCC, ACS, children in the foster care system are bound to feel distrust, doubt, fear, and confusion because they are constantly through a ‘starting over’ process of interacting with groups of strangers in unfamiliar homes. As a result, not only does this vulnerable group often struggle with trust, anxiety, and attachment, but they are also bound to develop problematic attachment disorders such as separation anxiety disorder and reactive attachment disorder (Sheppard, 2024). This makes basic human interaction in developing long-term friendships, trusting friends or groups, and communicating needs to foster parents all the more challenging for the foster youth. This impact can cost their resilience. 

Challenges in resilience are one of the most significant concerns that apply to children and adolescents in the foster care system often related to their transition in exiting the child welfare system, especially in former foster youths. Resilience is the ability to make a decision when a risk is present – a skill that can be learned and strengthened and shaped from experience with parents and other adults (Masten and Tellegen, 2012)4. Youth in foster care, however, have been found to develop low resilience due to multiple forms of trauma such as childhood maltreatment, subsequent victimization in adolescence, and low self-esteem – all of which can interfere with the youth’s resiliency (Greeno et al., 2018). As a result, they struggle greatly with the ability to prepare themselves for transitioning in the system to living independently to adulthood and are found to have high rates of “lifetime and past-year” psychiatric problems compared to the younger youth (McMillen et al. 2005; McMillen and Raghavan 2009)4. While the foster care system expects the youth in care to become resilient and independent, many of them fear further displacement or the uncertainty of their future. The complexities of the trauma that they bring with them in adulthood put them at high risk of developing mental health issues. 

Mental health problems have long been a topic discussed in the category of foster care youth as one that calls for urgent action. Numerous studies reported that up to 80% of youth in foster care exhibit a serious mental health problem that requires intervention (Pecora et al., 2009). Reportedly, children and adolescents in the foster care system are often left with post-traumatic stress symptoms, anxiety, and depression. It is the outcome of not only their adverse childhood experience before being admitted to the system, but it is worsened by the substantiated maltreatment including physical, sexual, emotional/psychological abuse and neglect experienced during their stay – an experience that contributes to the high rates of PTSD in foster youth (US Department of Health and Human Services, 2019). Specifically, an increased risk of post-traumatic symptoms is marked by exposure to certain maltreatment. Among the studied forms of maltreatment (physical, sexual, psychological abuse, neglect), foster youth who have experienced sexual abuse are at the greatest risk of being diagnosed with PTSD (McGuire et al., 2021). 

Currently, there still needs work to be done in fulfilling the needs of the foster youth. Much more research into children in the foster care system is required and more work needs to go into ensuring foster youth are benefitting from the system in overcoming the psychological effects it has left them, especially one that would prepare them for transitioning to adulthood. This article however has shown that foster youth are still vulnerable to a range of psychological effects from growing up in the system which points out the dire need to optimize the use of mental health care services in foster care.  A recent study by Steenbakkers et al., (2017) shows that 23 percent of foster parents ensure that their children have fulfilled their mental health needs and 25 to 53 percent of mental health services are used by foster children which is a number that is incomparable to the thousands of foster youth in the system.

Sources:

1. U.S Department of Health and Human Services. (2024, November 8). New data shows consistent decrease in children in foster care. Administration for Children and Families. https://www.acf.hhs.gov/media/press/2024/new-data-shows-consistent-decrease-children-foster-care 

2. United Way of the National Capital Area. (n.d.). What is foster care? https://unitedwaynca.org/what-is-foster-care

3. Sheppard, S. (2024, July 25). The mental health effects of living in foster care. Verywell Mind. https://www.verywellmind.com/the-mental-health-effects-of-living-in-foster-care-5216614 

4. Jacobsen, H., Bergsund, H. B., Wentzel-Larsen, T., Smith, L., & Moe, V. (2019). Foster children are at risk for developing problems in social-emotional functioning: A follow-up study at 8 years of age. Children and Youth Services Review, 108, 104603. https://doi.org/10.1016/j.childyouth.2019.104603

5. Greeno, E. J., Fedina, L., Lee, B. R., Farrell, J., & Harburger, D. (2018). Psychological Well-Being, Risk, and Resilience of Youth in Out-Of-Home Care and former Foster Youth. Journal of Child & Adolescent Trauma, 12(2), 175–185. https://doi.org/10.1007/s40653-018-0204-1 

6. McGuire, A., Huffhines, L., & Jackson, Y. (2021). The trajectory of PTSD among youth in foster care: A survival analysis examining maltreatment experiences prior to entry into care. Child Abuse & Neglect, 115, 105026. https://doi.org/10.1016/j.chiabu.2021.105026 

7. Steenbakkers, A., Van Der Steen, S., & Grietens, H. (2017). The needs of foster children and how to satisfy them: A systematic review of the literature. Clinical Child and Family Psychology Review, 21(1), 1–12. https://doi.org/10.1007/s10567-017-0246-1