What do the Child and Family Service Reviews (CFSR) tell us about the mental health of children in the child welfare system?

The federal CFSR rates two basic elements for mental health wellbeing; the first one concerns whether mental health needs were assessed, and the second concerns whether mental health services were adequately provided. The common concerns among the reviews indicate the scarcity of mental health services, the questionable quality of those services, and the lack of routine mental health assessments even when there seemed to be sufficient reason to conduct an assessment.

Nearly all states assess and provide some amount of mental health services for children in foster care with the belief that children entering care need services due to the trauma of removal and adjustment to a new environment. There is however, a general a lack of mental health services for children who are not in foster care and remain in their own homes with a child protection intervention.   In addition, few services exist for adolescents and youth in transition from residential to community - based placements, and for children with developmental disabilities.

There are also inconsistencies in quality and access to existing services. Inconsistencies include lack of progress reports and documentation of treatment or therapy, shortages of providers, extensive waiting lists, and geographical distances, especially in rural areas, that make access to services very difficult. Many areas lack services for children who have been sexually abused or have abused substances. Family- focused services e.g. domestic violence, substance abuse, counseling, and respite care are also in short supply Frequently the reviews show, that mental health needs were either not identified or identified with little or no follow through. This was especially true in in-home services situations.

What the CFSR process helps us do is to assess these shortcomings and begin a process of systematic change to address these challenges. One option is to offer a System of Care approach, with both formal and informal supports, that is based on the needs of the child and family, not based solely on the existing services.

Source: Best Practice/Next Practice. Winter 2004. National Child Welfare Resource Center for family Centered Practice