State Child Welfare Policy Guide: Part of the Policy Matters Series

7.4 Evidence-based mental health and trauma treatment

Evidence-based mental health treatments and emerging first response strategies for children and youth who have experienced trauma can help improve outcomes for children involved with the child welfare system.  In a study of nearly 700 foster care “alumni” living in the Northwestern United States, researchers found that nearly half had experienced a serious mental health problem such as depression, social phobia, panic disorder, post-traumatic stress disorder (PTSD), or drug dependency during the past year.  Many of the alumni struggled with more than one of these problems.  The rate of PTSD was twice that generally attributed to U.S. war veterans. [i]   A study of placement stability in Illinois found that children with “externalizing” mental health diagnoses such as conduct disorders were 12 percent more likely than their peers to experience placement moves. [ii] See Policy Area 2.6: Home and community-based services for families and children with mental illness, for a description of research-tested mental health treatments.

Research-tested mental health treatment includes:

·         Cognitive Behavioral Therapy, which works with children and youth of many ages to improve anxiety, depression, and -- if parents are involved -- disruptive behaviors, attention deficit hyperactivity disorder (ADHD), and possibly PTSD. [iii]

·         Multi-systemic Therapy , which improves oppositional behavior, conduct disorder, sexual offenses, and substance abuse.  It reduces criminal behaviors and out of home placements.  The subject of multiple studies, the therapy has been proven primarily with males and adolescents. [iv]

Evidence-based assessments and trauma-specific treatments being used by children’s mental health practitioners include:

• Parent-Child Interactive Therapy,

• Trauma-Focused Cognitive Behavioral Therapy,

• Dialectal Behavior Therapy,

• Trauma Recovery and Empowerment for Adolescent Girls and Young Women, and

• Seeking Safety for Adolescents. [v]

Illinois legislation (2005 Ill. Public Act 004-0034, Ill. State Code: Sec. 5.25) requires that trauma services must be provided for every child in the care of the child welfare agency who needs them. 

Elimination of harmful practices is necessary along with implementation of evidence-based treatment.  The use of practices such as seclusion and restraint when not absolutely necessary has resulted in trauma, and in some cases, untimely death in residential and hospital-based mental health settings.  A federally led initiative is underway in eight states to eliminate the use of seclusion and restraint in residential facilities and hospitals.  Massachusetts, Louisiana, and Hawaii are focusing specifically on eliminating the use with children.  Both Massachusetts and Louisiana have reduced seclusion and restraints in institutions for children by 80 percent.  In Hawaii, where restraints and seclusion are not widely used, the needs of children who have run away or assaulted are being addressed. [vi]

Policy Options:   States can promote evidence -based mental health and trauma treatment by adopting and funding the implementation of either or both of the following policies:

·         Evidence-based mental health and trauma services are available for every child in foster care.

·         Unnecessary use of seclusion and restraints and other practices that research demonstrates cause or heighten trauma for children are prohibited.