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Children in foster care: More medication, less therapy

A recent news report and journal article highlight the mental health needs of children in foster care aren't being met.

Editor's note: This is first of two parts.

Foster care in a safe and prosperous environment is important to raise children whose physical and emotional health thrive. Recent press coverage about the health concerns faced by children in Delaware's foster care system has spotlighted the need for a balance between prescription medication and therapy.

A report by the Wilmington News Journal last month focused on the high rate of behavior problems in correlation to the frequency of prescribed psychiatric medications for foster children. The coverage included interviews with young adults raised in the foster care system who believed that their anger was treated with medication in lieu of more effective psychotherapy techniques and highlighted the work of experienced foster parents who could identify the anger and despair in their foster children early, and thus were able to work with them and achieve success.

Although this report prompted renewed interest in the subject, these problems are not new. In 2015, the Delaware Legislature commissioned a task force, the Delaware Task Force on the Health of Children in Foster Care, to study the issue. Their report documents problems in the care system and includes suggestions to improve its policies, including:

  1. Strong leadership at each site by professional experts in their respective disciplines.

  2. Coordination of social, educational, health and mental health services

  3. Education for case workers, foster parents, and all providers.

Furthermore, the report emphasized the urgency of making sure each child's needs are addressed when he or she enters foster care. Children in this system have greater health needs and frequently suffer from higher rates of behavioral and learning problems that are often misdiagnosed as ADHD. Prior to placement in foster care, many of these children do not receive routine medical care, may have moved around regularly, and may not have attended school consistently.

The challenges in Delaware are not unique. A week after the News Journal article, Pediatrics published a large population study showing the relationship between placement in foster care and its impact on physical health, education, and mental health. The most surprising finding was the prevalent physical and mental health problems in this population. While we often think of mental health issues, we don't always associate foster care with health and dental problems. Clearly, this is a national issue, but the solution for each community must be implemented at the local level.

The Delaware Task Force on the Health of Children in Foster Care – which is co-chaired by Vicky Kelly, Psy.D., MSW, MHA, a psychologist and formerly the director of Delaware's Family Services, and Cathy Zorc, MD, a pediatrician who sees many of these children – has a clear vision of what needs to be implemented. However, its methods have yet to become standard practice. Next week, I will discuss what one hospital is doing that addressing these children's mental health care needs.

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