Wonk Data Drop: Children with Mental Health Needs in Foster Care More Likely to Receive Therapy and Medication, Though Gaps Remain
Being in foster care means more mental health access, but a quarter of children slip through with none at all.
Wonk Data Drop
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Children with Mental Health Needs in Foster Care More Likely to Receive Therapy and Medication, Though Gaps Remain
Being in foster care means more mental health access, but a quarter of children slip through with none at all.
By Robin Ghertner, MPP
BLUF
Children in foster care who accessed mental health services were more likely to have both prescription and non-pharmaceutical treatment, but almost a quarter got neither.
Nearly half (49%) of foster care children with a mental health diagnosis received both prescription medication and therapy. This is substantially higher than non-foster care children at 31%.
23% of children in foster care with a mental health diagnosis did not get any treatment– comparable to their counterparts not in the foster care system. The difference is not statistically significant.
Children in foster care were far less likely to only receive prescription medication with no therapy, compared to their counterparts out of foster care (12% to 30%).
Children in Foster Care Have More Mental Health Challenges– What About Treatment?
We recently published an analysis showing that the percentage of children in foster care with mental health disorders grew by 14 percentage points between 2018 and 2023, from 23 percent to 37 percent.
This growth was much faster than children not in foster care, which grew by only 4 percent during that same period. That’s the prevalence side of the story.
This piece turns to a natural follow-up: treatment access. Are kids with mental health disorders actually receiving care—and if so, what type?
Despite longstanding concerns about access, there's been little analysis of recent data, especially post-COVID.
Significant challenges persist in ensuring effective and consistent treatment for children in foster care (Trubey et al., 2024).
So we ran the numbers. Using the most recent, nationally-representative data from the National Survey of Children’s Health (NSCH), we combined data from 2018-2023 to get a large enough sample size. We focus on children in foster homes, not in institutional settings like congregate care, due to limitations in NSCH data.
Methodological details are at the end of this piece. Let’s get into the results.
What We Found: All Children Face Similar Treatment Gaps, Those in Foster Care Are More Likely to Receive Therapy Along with Medication
Whether in or outside of foster care, children with mental health needs face substantial barriers to accessing care. Here’s what the data show:
23 percent of children in foster care with a mental health diagnosis did not get any mental health treatment.
This is comparable to their counterparts not in the foster care system; the difference is not statistically significant.
Nearly half (49 percent) of foster care children with a mental health diagnosis received both prescription medication and therapy. This is substantially higher than non-foster care children at 31 percent.
Children not in foster care were far more likely to only receive prescription medication, with no therapy (30 percent vs 12 percent for children in foster care).
17 percent of foster care children received therapy only, higher than the 13% of non-foster care children who do so. General clinical guidance for children’s mental health prefers combining therapy with medication, overmedication alone.1
What the Data Suggest—And What They Don’t
There’s a clear structural signal here: children in foster care with mental health needs are more likely to receive both therapy and prescription medication.
This could be the foster care system performing as intended: responding to higher-need children with higher-touch services.
But it would be a mistake to confuse access with adequacy; what these data can’t tell us is if these services were high quality, tailored to children’s needs, and effective.
Treatment gaps for children in foster care remain. Close to a quarter did not receive any treatment for their mental health condition.
Our limited sample size can’t identify specific geographic areas or types of kids who face greater treatment gaps. We also couldn’t look at trends for children in congregate care, who may be more likely to have mental health issues.
We need more research to uncover such gaps and help states and providers target resources to children in greatest need.
It will be worth watching trends in children entering the child welfare system due to behavioral health issues as states face new fiscal pressures on Medicaid, given its foundational role in behavioral health financing.
Methodological Notes
We analyzed national level data from the 2018 – 2023 National Survey of Children’s Health (NSCH) funded and directed by the Health Resources and Services Administration and conducted by the US Census Bureau.
Data were pooled across years. The sample for the analysis includes children (age < 18) with mental health and/or neurodevelopmental disorder (N = 47,864, weighted N ~ 12 million).
In the survey, parents were asked whether during the past 12 months the child has received any treatment or counseling from a mental health professional (i.e. psychiatrists, psychologists, psychiatric nurses, and clinical social workers) and whether during the past 12 months the child has taken any medication for their mental health conditions.
Based on these two questions a categorical variable measuring mental health treatment with four mutually exclusive categories were created: therapy only; prescription medication only; both prescription medication and therapy; and no mental health treatment.
Being a household survey of parents and caregivers, the NSCH excludes children in institutional settings such as congregate care. As such, foster children in this analysis only includes children living in family foster homes.
All differences discussed in the analysis are statistically significant at p<0.05.
Reference
See, for example, the Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders from the American Academy of Child and Adolescent Psychiatry: https://www.jaacap.org/action/showPdf?pii=S0890-8567%2820%2930280-X