Addressing the Mental Health Needs of Youth in Care

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As adults, we have far more developed coping skills, capable of processing difficult experiences, and yet, think of how often we struggle with transitions and crises. How much harder must that be for kids?

Youth are vulnerable—many have experienced neglect, abuse, witnessing domestic violence, parental substance abuse, and additional traumatic occurrences. They often need mental health services to help them with various emotional and behavioral concerns. The trauma, triggers, feelings of loss, and grief that youth in care experience may be extremely difficult, confusing, and overwhelming.

Building a Therapeutic Support System
Common mental health providers include psychologists, psychotherapists, psychiatrists, therapists, counselors, and social workers. They may all have different educational backgrounds, but they all provide mental health services in some capacity. You can find more information in the Wisconsin Foster Care Handbook.

Many therapists use one or more methods of therapy with children. Some methods you may encounter include:

  • Trauma-Informed Therapy acknowledges the impact that trauma has on children, and focuses on specific ways to help traumatic memories and experiences become more tolerable, like using a trauma narrative.
  • Family Therapy focuses on the relationships among family members.
  • Talk Therapy helps the child talk through difficult or upsetting memories or issues and is often used with older children and teens.
  • Play Therapy uses art, puppets, games, or play-acting instead of words and is often used with younger or more active children.
  • Cognitive-Behavioral Therapy uses rewards or successes to replace negative thoughts, feelings, and behaviors.
  • Pharmacotherapy uses medications to help the child, usually in conjunction with another method of therapy.
  • EMDR Therapy—Eye Movement Desensitization and Reprocessing therapy is a form of trauma-informed therapy that helps kids work through their past traumas and memories.

Therapy “To Do” List
Therapy is a team effort among you, your child, the child’s parent, and the therapist, with others also becoming involved as needed. The team members should check with foster and adoptive parents, birth parents, and case managers when looking for a therapist. Additionally, you should:

  • Be available to meet with the therapist when you bring in your child, or call or email regularly with updates. This helps assist the therapist in understanding the concerning issues and progress, as well as reducing any possible triangulation.
  • Have realistic expectations of therapy. Ask yourself and the therapist if those expectations are realistic. Hopefully, you, your child, and the therapist will set goals together and review them on a regular basis. Sometimes we tend to forget that therapy is just one aspect of your child’s team—and something that usually only happens about one hour per week. The real therapy happens at home, over time.
  • Share only relevant information. Think about recent developments since the last therapy session. Review your notebook or journal prior to meeting. 
  • Talk to your children in care before and after each therapy session. This will help you understand what they are thinking/feeling and how to support them.
  • Do the homework. Sometimes therapists will give you and/or your child a homework assignment, such as reviewing a book or other resource, or doing an exercise for relaxation. Your feedback and insights are valuable resources to share with the therapist. Encourage the kids in your care to share their insights, as well.

Potential Barriers
Sometimes you may run into some obstacles in finding a good provider. These can include:

  • Types of insurance accepted
  • Lengthy waiting lists and signed medical consents
  • Lack of a good fit or knowledge between your child in care and the therapist

Some families have found creative solutions to the insurance barrier by discussing the situation with the therapist and asking if a sliding fee or other options are available. Some counties are able to offer wraparound or discretionary funding to help pay for services.

If you have to wait for services, some ideas of what you can do while waiting include:
  • Document the concerns that you and team members have.
  • Learn by seeking resources from the Coalition’s lending library. 
  • Observe and document behaviors from a non-judgmental perspective.
  • Gather useful information about your child’s history.

Another barrier encountered by many foster parents is having the medical consent form signed. This form must be signed by the parent, unless a court order gives another party the ability to sign for medical services. The whole process can be lengthy and may be frustrating for you.

However, the benefits the youth may receive from therapy often outweigh the systematic challenges. It’s the social worker’s ultimate responsibility to get the signatures you need, so if you’re having trouble, make sure to contact your worker.

When to Suggest a Change in Therapist

The best predictor that mental health services will be successful is based on having a trusting, honest, and open relationship with the therapist, where all who are involved feel supported and comfortable. If at any time you don’t feel like you have a trusting, open, and honest relationship with your child’s therapist, schedule a time to have a meeting about your concerns. Also discuss concerns with team members and ask for their support if you want to change therapists. 

Changing therapists can be necessary to meet the child’s needs. If your child is too young to make the decision to change on his own, explain the reasoning to him clearly. If your child is old enough, he should get a vote in the decision on whether to keep the therapist or not. Hopefully your child and the therapist can have a closure session to help facilitate a smoother transition to a new therapist. 

You are an essential resource in assisting your children towards developing and reaching their best potential. With the use of mental health services and a nurturing
environment, youth in care will most likely blossom as they work through their past traumas and difficult life experiences. 

You, the youth, the mental health provider, and the team will work together to identify and focus on meeting the mental health needs of the youth. However, even with the best mental health therapy services in the world, remember that the real magic happens every day, at home.

Red Flags to Watch For in a Therapist

  • Isn’t knowledgeable about foster care- and adoption-related issues such as trauma, loss and grief, abuse and neglect, divided loyalties, and triggers.
  • Focuses too much on the diagnosis without assisting on ways to change behavior.
  • Difficult to understand, uses terms without providing explanations.
  • Doesn’t accept feedback or admit mistakes, or jumps to conclusions.
  • Talks too much about his or her self, or tries to be a friend.
  • Doesn’t set goals or regularly review goals.
  • Doesn’t talk, check in, or spend time with the parent.
  • Doesn’t listen or seems preoccupied.
  • Doesn’t remember names or issues discussed from appointment to appointment.
  • Isn’t a good match or not helpful according to the youth.
  • Says her or her method is the only approach and/or has the highest success rate. Or makes guarantees about the outcomes.
  • Doesn’t believe in consulting with other therapists or professionals.
  • Doesn’t respect the issues of concern for the youth, parent, or team.
  • Youth or parent feel something is just “off” or not right.

Therapists are human, too, and it’s likely that some therapists, on some days, have some of these “flags.” But this checklist might help validate that last point that something is “off.”

Resources from the Coalition’s Lending Library

  • When Your Child Needs Help: A Parent’s Guide to Therapy for Children, by Norma Doft
  • Straight Talk about Your Child’s Mental Health, by Dr. Stephen Faraone
  • Fostering and Supporting Children with Mood Disorders (VHS tape)
  • In Their Own Words: Reflections on Parenting Children with Mental Health Issues, by Linda Grillo, Dee Meaney, and Christine Rich
  • Kids in the Syndrome Mix, by Martin L. Kutscher

Additional Resources

Copyright © 2018 Coalition for Children | Youth | Families, formerly Adoption Resources of WI