Mental illness and substance abuse in the child welfare system


Most statistics or studies dealing with children in the child welfare system (CWS) deal with placement, whether it be in a congregate setting (such as a group home), placement with a relative, or adoption.

A study published in the American Journal of Orthopsychiatry took a different tack. This study tracked the behavioral health patterns of young people who aged out of the system. Researchers identified over 1,300 youth who aged out of the CWS in Allegheny County, Pennsylvania, between 2002 and 2008. The study found young people post-CWS with criminal records, mental health issues and substance abuse disorders (SUDs) experienced significant placement difficulties and spent more time in congregate care settings.

This article will explore the repercussions these findings have on the youth and on society.

CWS snapshot

The situation is not all grim. The Adoption and Foster Care Analysis Reporting System (AFCARS) gathers data from all state agencies involved in placing children and for all children adopted with the aid of a public child welfare agency. According to a 2014 report generated from the data:

  • As of September 2014, there were over 400,000 children in foster care
  • Nearly half were placed in nonrelative foster family homes
  • Over 50 percent of children who left foster care that year were united with parents or primary caretakers
  • Nearly half of the children were in foster care for less than one year

Unfortunately, the news is not so bright for African-American children. Compared to Caucasian children, African-America children are 44 percent more likely to end up in foster placement.

Ageing out

Ageing out refers to youth who reach maturity (18) and leave CWS without any goal of reunification with family or a primary caretaker. The Journal study notes that “these young people … are more likely to face hardships across a number of domains, such as employment, housing instability and homelessness, mental health and substance abuse issues …” Researchers point to a similar study conducted in the Midwest, which found that by the age 24, 28 percent of women and 59 percent of men who aged out of CWS reported having been convicted of a crime, compared to 2 percent and 10 percent, respectively, for the community sample group.

The science of cluster analysis

Researchers developed five clusters based on subjects’ involvement post-CWS in the following four systems: mental health, drug and alcohol treatment, juvenile justice and criminal justice. Cluster one included subjects with low involvement in any of the four systems. Cluster two included subjects with mental health only. Cluster three included subjects with mental health and drug and alcohol involvement. Cluster four included individuals with mental health and involvement with the juvenile justice system. Cluster five included individuals with mental health and involvement with the criminal justice system.

Of the five clusters, mental health only was the largest, with over 30 percent of the aged-out population. Cluster one, low involvement, was the smallest, with 16 percent of the population. Members of the two, three and five clusters had the highest levels of involvement with mental health services, substance abuse treatment and law enforcement. These individuals also had more total placements while in CWS. Which means there is a direct correlation between placement instability and later-life behavioral health issues among aged-out individuals.

Mental health and more system entanglements

Significant from a behavioral health point of view are the corollaries between mental health services and post-CWS legal difficulties. The study authors note 27 percent of the aged-out population who received mental health services were caught up in the juvenile justice system, and 20 percent spent time in jail. Of those who did not seek or require mental health services, 13 percent were involved in the juvenile justice system and 14 percent in the criminal justice system.

The African-American odyssey

The study found African-American youth fell primarily into cluster one – low involvement – and cluster five – mental health and criminal justice system. In other words, they constituted both ends of the system-involvement spectrum. The authors note African-American children are placed in foster care at earlier ages, spend more time in foster care, and spend less time than in congregate care than Caucasian children. Researchers believe this accounts for the inclusion in cluster one. As for why these young people leapfrog the other clusters before landing in cluster five? Researchers say this mirrors the fact Caucasian youth – CWS and non-CWS – with behavioral health issues are funneled into treatment; African-American youth are packed off to jail.

Conclusion and recommendations

Compared to the regular youth population, aged-out youth face significant societal challenges. Study authors point to the need for more resources devoted to monitoring and assessing the experiences of these young people. They also believe cross-system coordination/communication before and after children age out of CWS will reduce the numbers of aged-out youth who require mental health services or who end up in the juvenile or criminal justice systems.

White River Academy is a therapeutic boarding school for boys aged 12 to 17 who have behavioral health issues. Contact our 24/7 helpline for more information.

About the author

Darren Fraser, worked two and half years as reporter and researcher for The Yomiuri Shimbun until they realized he did not read, speak or write Japanese and fired him. Undeterred, he channels his love of research into unearthing stories that provide hope to those dealing with addiction and mental illness. Darren loves the Montreal Canadiens hockey club and horror films and would prefer to enjoy these from the comforts of his family’s farm in Quebec. 

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