Social Issues In Foster Care

Explain the social problem

There are about 500,000 children and youth in the foster care system. Children are placed in foster care for a variety of reasons, including abuse, neglect, abandonment or exploitation. Life on the move for these kids, two-thirds moving seven or more times while in foster care, leaves them particularly ill-equipped for the transition to adulthood (Helping Children Aging out of Foster Care Prepare for Independence).

“Every year more than 25,000 youth age out of the foster care system” (Jansson, 2014, p.62). “As youth in foster care mature into adulthood, they face enormous challenges, including lack of family support; educational deficiencies; employment and income problems; inadequate or inappropriate living arrangements;

medical, dental, and mental health problems; and lack of health insurance” (Health Care of Youth Aging Out of Foster Care, p. 1170). When these youths age out of foster care, they lack the skills to thrive on their own (Helping Children Aging Out of Foster Care Prepare for). These youths trying to survive without the skills and support system they need create multiple social problems. Four years after aging out of foster care, 25% of the kids have been homeless, less than half have graduated from high school, 42% are now parents and more than 80% are unable to support themselves (Helping Children Aging out of Foster Care Prepare for Independence).
One has to wonder how this would effect a child’s mental health. According to Zlotnick, Tam and Soman in their 2012 article, “Disproportionately high percentages of children who have a history of foster care, compared with those who do not, exhibit mental health problems” (p. 534). In fact, “Youth in foster care face medical and mental health challenges at significantly higher rates than other children, often as a consequence of the circumstances that led to their home and sometimes exacerbated by their experiences in foster care” (Health Care of Youth Aging Out of Foster Care, 2012, p. 1170). The statistics are astonishing for showing the rate at which mental health affects youths who have aged out of the foster care system. “In the foster care population, more than 60% of youth will have mental health problems during their lifetime; 30% to 40% of adolescents are coping with mental health issues, including posttraumatic stress disorder; and more than one-third of older adolescents have a chronic illness or disability” (Health Care of Youth Aging Out of Foster Care, 2012, p. 1170).
“Unmet mental health needs for foster children can mean ongoing problems as youth in foster care enter adulthood” (Grayson, 2012). Adults who have been in foster care suffer from PTSD at twice the rate of U.S. combat veterans. More than half of adults who have been in foster care experience serious mental health problems. (Helping Children aging out of Foster Care Prepare for Independence). It seems as though the foster care system has detrimental mental health effects on the youth aging out of it. Since this is the case, one can wonder what resources are available to these youths in order for them to take care of their mental health needs.
Schilling Wolfe notes in Getz 2012 article, “Children in foster care have special healthcare needs that are not always well addressed when they’re young and don’t get better in adulthood (Aging Out of Foster Care, 2012, p.1). Youth transitioning out of foster care face significant mental health care needs, but rarely receive the services they need because lack of health insurance (Health Care of Youth Aging Out of Foster Care). This is because the majority of foster care adolescents lose the automatic Medicaid eligibility that goes with involvement in the foster care system when they age out from foster care (McMillen, Scott, Zima, Olllie, Munson & Spitznagel, 2004). The failure to provide needed mental health services to these exceptionally vulnerable youths ensures a continued disproportionately high prevalence of poor outcomes existing throughout their adulthoods (Zlotnick et al., 2012).
Access the Impact
“For youth ‘aging out’ of foster care, providing appropriate health and mental health care is a critical component of a successful transition into adulthood (Grayson, 2012). Citizens and communities are paying $300,000 in taxpayer-funded costs for every young person who ages out of foster care at 18, which adds up to about 8 billion dollars every year (Aging Out of Foster Care in America, 2013).
“Despite the high medical and mental health needs of older youth aging out of foster care, studies have found that their access to care is slightly lower compared to peers” (The Affordable Care Act).

In order to receive the care that they need, these youths who have aged out of foster care are dependent on having some time of insurance coverage. “In response to the needs and vulnerabilities of this population, regulations on the Affordable Care Act require states to provide, as of January 2014, the full Medicaid benefit to all youth who were in foster care on, or after, their 18th birthday in their state until age 26” (The Affordable Care Act). “The ACA increases the number of individuals who have access to health insurance, simplifies insurance enrollment, requires that benefits include substance abuse and mental health coverage, as well as medical services, and promotes innovations to help coordinate the fragmented delivery of care” (Emam & Golden, 2014, p. 1). This act consists of a targeted provision to require health coverage under Medicaid for youth up to ages of 26 that have been in foster care previously while simultaneity being enrolled in Medicaid (Emam & Golden, 2014). According to Emam and Golden in there 2014 article, “Youth who aged out in the past several years and are not yet age 26 are covered immediately, and youth currently in foster care are covered when they age out” (p.

1).
In Tennessee, if you aged out of foster care or are about to and are between the ages of 18 and 26 then you possibly qualify for insurance through the Affordable Care Act. If youths qualify, then they are eligible for full insurance benefits, including: “Screening, prevention and early intervention services and diagnostic services and treatment for physical and mental health conditions” (TennCare for Youth Who Aged-Out).
This act has completed a big step in offering health care that includes mental health coverage to teenagers who have aged out of foster care. However, there is still work that needs to be done. According to Emam and Golden in there 2014 article, there are 8 next steps that need to be implemented to ensure that former foster youth are taking advantage of the full benefits that health reform offers. The first step, she writes, is to ensure that the youth who are currently in foster care get enrolled through an automated system so that as they age out they will not have to take action to provide verification for themselves (Emam & Golden, 2014). The second step is, “Find and enroll youth who aged out before 2014, but are under age 26 as of January 1, 2014, and are still eligible for coverage” (Emam & Golden, 2014, p.6). The third step is to train staff with Medicaid and child welfare workers how to enroll and reenroll for these youths who have aged out (Emam & Golden, 2014). In her fourth step she notes that child welfare workers and partners also need to be trained in heling youth learn how to use their health coverage once they are enrolled (Emam & Golden, 2014). The fifth step, “Shape the benefit package to best meet the needs of youth aging out of foster care” (Emam & Golden, 2014, p.7). The sixth step, “Promote continuity of services, as well as enrollment, for these youth” (Emam & Golden, 2014, p.8). The seventh step, “Choose the policy option to cover youth who aged out in other states and develop partnerships with other states that are frequent destinations” (Emam & Golden, 2014, p.8). The final step is to, “Assess the health insurance options available to teenagers in the child welfare system who do not age out, but instead achieve a permanent home through guardianship before they turn 18; identify potential state and federal solutions” (Emam & Golden, 2014, p.8).
Achieving the objectives of the ACA, which offer great opportunities to increase the levels of health coverage for these youths, will not happen unless more policies are structured to implement, target and be efficient in reaching out to this population (Emam & Golden, 2014). Since health care policies are not easy to understand for most people, eligibility requirements and application forms may exceed the understanding of these youths. This may impact what they know about or how they understand all of their benefits and how to access them. Once they transition out, they may no longer have access to case workers, foster parents, or other guidance they once had (Health Care Coverage for Youth in Foster Care lifeand After, 2015). This is why, although the benefits this Act offers are great, there is still work that needs to be done in order to ensure easy accessibility in the youth receiving and understanding this benefit.
Another initiative that is active in states and in local communities, including Tennessee, is the Jim Casey Youth Opportunities Initiative which increases opportunities for young people who are in or transitioning from foster care.

This initiative is “A national and state-based effort that believes every young person leaving foster care should have the family connections, opportunities and support needed for a successful transition to adulthood” (Jim Casey Youth Opportunities Initiative). The organization sponsors Success Beyond 18. This campaign “Advances policies and practices to help young adults who are transitioning out of foster care get on track for successful adulthoods” (Jim Casey Youth Opportunities Initiative). It also uses Opportunity Passport which is a program that engages youth in self-advocacy and leadership opportunities while building their personal and financial assets by using the program’s matched savings and financial education tools. The initiative also “Develops practice, policy and evaluation tools to improve young people’s opportunities and assets and advances the child welfare field’s understanding of neuroscience and brain research to encourage implementation of more effective programs and policies” (Jim Casey Youth Opportunities Initiative). Some of the benefits of extending care, and enacting reforms to the foster care system are lower healthcare costs and more young people being connected to caring families, caring adults, and support networks

(Aging Out of Foster Care in America, 2013). By extending care to these youths, their mental health can be impacted by providing the support they need and by having more resources to connect them to getting the help they need.
Conclusion
In communities across the United States, thousands of young people leave foster care without the support of family or community. For the thousands of youth that age out of foster care, this can lead to poor outcomes such as lower prospects for employment, higher rates of incarceration and struggles with mental and physical health (Jim Casey Youth Opportunities Initiative). Youth aging out of foster care have mental health needs at disproportionately higher percentages than children who were not in foster care (Zlotnick, Tam & Soman, 2013). These youths who are transitioning out of foster care face significant mental health problems, but often do not receive the care they need because their lack of health insurance (Health Care of Youth Aging Out of Foster Care).
In order to help these youth receive the mental health care they need after aging out of foster care, the Affordable Care Act was passed. This act was passed to provide full Medicaid benefits to all youth who were in foster care on or after their 18th birthday until they turn 26 (The Affordable Care Act). The act increased the number of individuals who have access to health insurance, simplifies the enrollment process, includes benefits of mental health and substance abuse coverage, medical services and helps to promote innovations that coordinate the fragmented delivery of care. Although this act offers great opportunities for this vulnerable population, there is still work that needs to be done to ensure that the system is developed in order to be taken advantage of by these youths (Emam & Golden, 2014).
More policies created to help this population are much needed. However, there is movement going in the right direction to get these youths the medical coverage that they need. Helping this population get the mental health coverage they need will in turn be better for them and also for their communities.