A study of the mental health and relationship problems in a sample of children in family foster care compared with a matched control of school peers and concordance in mental health need and service use
Mental health problems are common and complex in children in care and most have mental health needs that resemble clinic referred groups. Deficits in relationships and poorer educational outcomes are identified in the population yet services are often poorly matched to levels of need. The mental health and relationship problems of 39 children in family foster care, aged 6 to 13 (mean age 8.4 years) was assessed on Teacher and carer report as well as concordance in service use and mental health need. 1 in 10 children in care had significant mental health problems compared with 1 in 20 peers. Social problems occurred more frequently than any other mental health problem, identified in two thirds of boys and over half of girls in foster placement and one third of boys and less than one in ten girls in school. More externalizing problems were detected than internalizing problems suggesting emotional distress can be missed in the population. Relationship problems were a significant concern for one in four children in care in school and one in five in foster placement and associations were found between relationship problems and mental health indicating the potential buffering role of relationships for emotional wellbeing. The low to moderate concordance in mental health need and service use and the few contacts with mental health agencies suggests that problems are not being sufficiently targeted in the population while the high rate of contact with GP raises questions about the health of the sample. Almost a quarter of children had no contact with their caseworker suggesting unmet social service need and the unavailability of an important gateway for children to access supports. 36.6% of children in care needed extra educational supports yet only 2.4% received educational psychology provision confirming high educational risk and unmet educational needs. Findings confirm the importance of including school systems in mental health assessment and intervention in the population. Other research implications include the need for systematic studies with representative samples to capture the mental health of the looked after population in general, the need for multi agency supports and tiered entry to services to address the critical gaps identified in existing service provision for children in the looked after system.
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