Welcome! The Now Is The Time Technical Assistance Center
is pleased to host this brief multimedia presentation, entitled
"Mental Health: A Key to Positive Futures for Youth in Foster Care."
Before we dive into today's topic,
I want to review the broader range of
technical assistance supports and resources available to you.
The NITT-TA Center provides training, resources, and supports
to grantees from SAMHSA's Now Is The Time Initiative,
including: Healthy Transitions programs that focus on
effective mental health services and systems
for youth and young adults,
and Project AWARE, which focuses on
K through 12 student mental health
in schools and communities.
The focus of today's session is best practices
for supporting the mental health needs
of youth in, and aging out, of foster care.
I am Dustianne North, a social worker and researcher,
and I will be your presenter today.
This training is primarily aimed at
professionals affiliated with Project AWARE.
What we discuss may also be helpful to other adults
who work in schools, community mental health agencies,
or other youth- and young adult-serving systems,
or who are in leadership, administration,
or official roles in systems and policies
serving youth, young adults, and their families.
Each young person in foster care
possesses unique skills, talents, and interests,
and each holds the potential to be
a thriving member and leader in society.
However, they often face extra challenges
in getting there.
Youth become involved in the foster care system
due to abuse, neglect, or abandonment
by their primary caregivers,
which by definition has caused each of them
some level of traumatization.
Separation from their families has created
another layer of trauma,
which has often been further exacerbated
by a number of problems and negative experiences
in the systems that serve them.
When unhealed, trauma creates
serious mental health problems,
shown to have negative effects
on a broad array of developmental outcomes
for foster care youth.
As we will see,
many youth in foster care
have high mental health needs.
Yet we caution school and mental health professionals
to avoid the trap of over-pathologizing
these often highly resilient and talented young people.
Note that the higher rates
of diagnosis and medication of these youth
may be as much a reflection of heightened monitoring
by public systems,
as a reflection of their higher need.
Traumatic experiences may be accompanied
by other mental health problems in the family
and in youth themselves.
Youth in foster care
are therefore more likely than other youth
to be diagnosed with mental health problems.
Perhaps especially PTSD,
due to the trauma they have often experienced,
as well as these other mental health problems.
Youth in care are therefore more likely
to have prescriptions to psychoactive medications.
Again, however, these rates may not always
reflect higher dysfunction.
For example, in one study,
foster care youth exhibited lower levels of substance use
than their non-foster peers,
and yet were diagnosed
with substance use disorders at a higher rate.
Serious concerns have also been raised
by many researchers, practitioners, and youth and their families
about over-medication of foster care youth.
So, please, be careful not to
over-pathologize our foster care youth.
In many cases,
external life challenges are as much a concern
for youth in placement as are their mental health needs.
One of the most important common problems
is a lack of permanency in living environments
and school enrollments.
A lack of permanency can lead youth
to fall behind in school,
lose or fail to make
important connections to caring adults,
and to hinder them in forming linkages
to resources, services, activities,
and social connections in the community.
These deficits can then also lead
to a lack of life skills in foster youth,
which can really catch up with them
as they prepare to transition to adulthood,
and a lack of tangible supports as they begin
to undertake the transition process.
This lack of support and skills can cause
a spiral toward extremely negative outcomes,
in terms of education, employment, early parenting,
substance abuse issues, incarceration, and homelessness.
Our goal in serving youth who have been removed
from their families, is to address the lack
of adequate support and resources
most foster care youth face,
as well as any mental and emotional challenges
that may be present.
Ultimately it is important to remember
that youth in foster care are just like other youth
in most ways,
and want to be treated as such.
So in order to avoid the negative outcomes
that might otherwise occur,
support an approach to mental health
in foster care youth
that is culturally relevant, trauma-informed,
strengths-based, and youth-driven.
Note that these strategies overlap significantly.
Let's look at them,
and how they relate to each other,
a little more deeply.
Our recommended strategy number one
is that services you provide be culturally relevant.
The first step in doing this is to recognize
the various aspects of culture that may affect
each youth you serve.
In addition to age, family background,
gender, and sexual identity,
there is also a culture unique to foster care,
and each family or foster placement
has its own set of norms and customs.
For each young person,
their identity and experience of the world is informed
not by just one of these aspects,
but the intersections of all of them,
and there are differences even within each of these groups.
In order to provide culturally relevant services, however,
it is not enough to simply recognize and respect difference.
We must also understand that
youth of different cultural backgrounds are treated
very differently in foster care and other systems.
Note that poverty is the strongest predictor
of child removal from the home,
although youth of all different class levels
may find themselves in care,
and that Black and Native youth are overrepresented
in the foster care system despite the fact
that parents of these ethnic backgrounds
are no more likely to abuse or neglect their children.
Families of color and sexual minority youth
are also shown to experience harsher and poorer treatment
in foster care systems, which may explain
the terrible reality, for example,
that 40% of homeless youth today
are estimated to be LGBTQ.
There is no easy answer to helping youth grapple
with these complexities.
A preferred approach is to exercise cultural humility,
which avoids judgment or imposition
of one's own values,
and emphasizes self-reflection and excavation
of one's own unconscious biases.
Cultural relevance is not an "end" someone achieves;
we don't simply become "culturally competent"
and thus able to work with all populations.
Instead we remain reflective, respectful,
and always in the role of a learner
as we encounter new aspects
of the cultural experiences of the youth we serve.
A key factor in ensuring culturally relevancy
is ensuring that services are trauma-informed,
which is our recommended strategy number 2.
Trauma during childhood, when unhealed
and especially when repeated over time,
is shown to affect brain development,
leading to problems in cognitive learning,
behavior and impulse management, emotional regulation,
and social attachments and relationships.
Families involved in foster care systems
may have experienced multiple generations
of ongoing trauma, and as noted
these effects are often compounded
by external life barriers.
For these reasons, a trauma-informed approach
is necessary to assist youth in and exiting foster care.
SAMHSA recommends that these six principles
comprise a trauma-informed approach to services
in your program or school.
Seek to institute a sense of safety, trust,
and transparency in school environments,
and promote peer support and collaboration
among young people and adults.
Empower people to speak for themselves
and make their own choices
about their bodies and their lives,
and give key attention to cultural needs and issues.
If you can do these things, your services will excel
and you will help to create a trauma-informed culture
in schools and communities,
all of which will help foster youth to begin to thrive.
While these concepts represent only a starting point
for trauma-informed work,
more in-depth materials are being provided
on this important topic
through SAMHSA and Now Is The Time.
Strategy number 3 is to use a strengths-based approach.
As noted, youth in foster care can often lack support
for basic needs and the opportunity
to participate as normal members of their community.
Indeed, the family and community supports
they do have are often ripped away.
To combat these problems, we recommend
providers recognize and build upon
the natural strengths, allies,
and resources available to a young person,
and that you normalize the need for wellness and self-care
as basic life skills.
Though we have pointed out ways
in which their experiences can hinder them,
the adversities youth have faced in and out of the system
have often also taught them a great deal.
It is important to be able to recognize the upside
of even their greatest challenges.
For example, as we see on the screen,
the attachment disorders many youth in foster care deal with
can also make them highly adaptable.
Difficulties in trusting people can also teach healthy caution.
Trauma and loss can lead to wisdom and compassion.
Ultimately, many youth in foster care are quite resilient
and have learned much about self-advocacy
and social aptitude.
These skills should be acknowledged and supported
in service of a young person's healthy future.
A large number of individuals and organizations
support the development of youth in foster care,
yet the culture of each these may differ greatly from another,
and these moving parts
do not always work well together.
So many of these youth may lack coherent support,
and also experience a fragmented
or disjointed sense of culture.
It is therefore especially important,
when youth are in foster care,
to make an extra effort to coordinate services
with other professionals and systems who serve them,
to help them build their natural support networks,
connect them to resources,
help them build linkages in their communities,
and ensure that their most basic needs are met.
Partnerships, coalitions and task forces,
and models such as team decision making
and family group decision making are all ways
to bring systems together to serve youth better.
A final strengths-based strategy is to espouse notions
of mental health that are proactive,
and that normalize the need for wellness and
self-care as a basic life skill.
This is preferable to reinforcing messages
that these youth need help
because there is something wrong with them.
As noted, emphasizing strengths is one good way
to support a young person's unique cultural background
and it is important to remember
that concepts of wellness and health
are themselves often culturally specific.
Even bedrock needs like nutrition
can vary from culture to culture.
Did you know that some recent studies
have begun to suggest that it is nutritionally important
to eat the same foods as one's ancestors?
A strengths-based approach
necessarily involves youth-driven programming,
which is our strategy number 4 for today.
Providers may be hard-pressed to ensure
that services are culturally relevant,
if the youth they serve don't have significant input.
The need for foster youth-driven programming
may be especially high.
Many of these youth have most often been
the recipients of services
and have not felt they had much control
over their destinies.
Opportunities to develop leadership skills,
to feel useful and empowered,
and to discover their unique gifts
may have also been scarce.
Youth-driven strategies may include engagement
of youth in program planning
and providing leadership opportunities,
building peer to peer support among foster youth,
and encouraging them to self-advocate
when accessing mental health care and other services.
In one example of a way
to engage foster care youth
in developing mental health programming for themselves,
we asked youth existing the foster care system in California
how they take care of themselves.
Here are some of their answers.
Simple suggestions like these can be far more powerful
when offered from youth themselves,
rather than from adults
who youth may not feel understand them.
It is also critical to encourage and support foster youth
to advocate for themselves with regard
to their mental health care,
and providers should become familiar with
the Foster Youth Bill of Rights, nationally,
and various versions of
a Foster Youth Mental Health Bill of Rights,
which have been adopted in several states.
To build peer-to-peer support among youth in and exiting care,
consider organizing peer support groups
and peer mentor programs,
as well as educating them in Mental Health First Aid.
Connect youth to existing networks of
foster care youth.
Some of these, like Foster Club and iFoster,
can be found online and offer a variety
of resources and ways to connect with other foster youth.
Others may be found locally,
such as support programs on college campuses,
as well as Court Appointed Special Advocates for Youth,
which has chapters nationwide
and provides mentoring and court advocacy for foster youth.
Additionally, the TIME model of trauma-informed care,
offered by SAMSHA, is designed to guide
supportive adults to engage and prepare
current or former systems-involved youth and young adults
to do advocacy work for system reform efforts,
and to minimize the negative impacts this kind of work
may have for them while helping them
develop personally and professionally.
Thank you for taking the time today to learn
more about the best ways to support mental health
in our youth who are in or exiting foster care.
In summary, these youth face a multitude of challenges
that can increase the mental health problems they face
and the likelihood of other negative outcomes,
especially as they transition to adulthood
and attempt to secure housing, education, employment,
and a place in the community for themselves.
Yet we have also discussed their strengths,
which can often go unrecognized.
And we have recommended that mental health providers
help these youth build on their strengths
and existing resources, and recognize that
the challenges they face are often outside of themselves
and are not personal deficits.
Ensuring that the services you provide are culturally relevant,
trauma informed, strengths based, and youth driven
can lay a fantastic foundation
to promote positive futures for all of our foster care youth.