When Loren Rae Grace fostered her first child nine years ago, she didn’t know what to expect. But Grace had space to fill and love to give, so she decided to open up her home to kids in need.
Since then, Grace has fostered more than 20 children, and she and her husband have adopted four biological siblings.
Fostering children isn’t easy, she said.
“Signing up for foster care means you’re exchanging their grief for yours,” Grace said. “You’re saying a kid who’s hurting can come into my home, and my goal is for them to leave their hurts here and to move on in joy and peace.”
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Grace knows she has no control of the children’s lives once they leave her home, though. And she can’t save them from what may lie ahead.
The number of American children in foster care has been rising for years, and Georgia is no exception. More than 19,000 Georgia youth have already spent time in state custody this year, up from just under 13,000 children in 2010. That’s an increase of almost 60 percent in less than a decade.
As the number of children in foster care continues to grow, more and more youth will feel the effects of a system that can drastically change the course of their lives. Research shows that children who spend time in foster custody suffer from mental health issues at higher rates, and the consequences can be long-lasting.
“This is a very vulnerable group of kids,” said Kristin Turney, a sociologist who has studied the health of children placed in foster care.
Displaced children are more likely to have ADHD, anxiety, depression and multiple other mental illnesses, Turney and sociologist Christopher Wildeman reported in 2016.
The sociologists couldn’t pinpoint one particular explanation for the disparities, but Turney noted that experiences both before and after children’s placement in foster care could play a role in their mental health. The family separation, itself, can be extremely traumatic, she said. One thing Turney knows for sure, though, is the harm that uncertainty brings.
“Any kind of instability is really detrimental for children and their mental health,” she said.
Many kids who are placed in foster care have experienced instability before entering the foster system, said Andrew Benesh, an assistant professor at Mercer Medicine who often counsels children in foster custody.
“When kids are in states where they’re really unsure about the safety of their home environment, about whether or not they’re going to be able to eat today, things like that, that creates a lot of anxiety that tends to make them very vulnerable to developing anxiety disorders that can lead to depression, things of that nature,” Benesh said. “So it can just kind of reinforce any sort of pre-existing vulnerability to psychiatric issues there.”
Children who spend time in state custody are also more likely to experience what the CDC calls Adverse Childhood Experiences, or ACEs, which are often linked to higher rates of mental illness, Grace said.
“They have experienced extreme loss, extreme violence,” she said. “So, you can’t just give ‘em platitudes of, ‘You’re safe,’ or, ‘No one’s gonna hurt you. Everything’s gonna be ok.’ Because they’ve seen it not be OK. They’ve seen the very people that are supposed to keep them safe hurt them.”
Kids in foster custody might struggle to trust others, she said, because they’ve been burned before. Onlookers might rush to label unusual behaviors, without understanding the underlying causes.
“If we look at children through a trauma lens, if we know that there’s trauma’s there or wonder if a behavior is showing trauma, and give them the space to earn our trust, and for them to trust us, then we may get a totally different kid,” Grace said.
But counselors, case workers and foster parents are often on such high alert that they jump to characterize unusual behaviors as mental illness, which could also account for the higher rates of diagnoses, Benesh said.
“When we train professionals to work with kids in foster care, when we train foster parents, we put a lot of emphasis on potential hazardous behaviors — things like that — symptoms to look out for,” he said. “And so, things that in kids outside of foster care we might just kind of say, ‘Oh, he’s having a really rough day,’ get logged in and turned into potential symptoms for psychiatric disorders.”
Adults focus so much on clinical disorders they often overlook kids’ overall mental well-being, Benesh said.
“It’s so easy to get caught up in, ‘This kid has PTSD, this kid has bipolar, this kid has autism, and they all need specialized care and services.’ And lose track of, kind of, a more basic reality, that these are kids and teenagers who need warm, caring, supportive, consistent, stable relationships in their lives,” he said.
Children in foster care are often misdiagnosed, said Jill Stapleton, vice president of clinical services at The Methodist Home. She oversees the foster organization’s mental health care resources, including its community counseling center, Lighthouse for Families.
“That’s one of the important things during counseling is to get an accurate diagnosis for that child, because, when they’ve been in foster care for a while, a lot of times there is some misinformation over the years,” Stapleton said.
Lighthouse for Families Clinical Director Dottie Chambers said children placed in foster care are also frequently over-medicated with psychotropic drugs, especially if they’ve recently been hospitalized. Other times, they’re prescribed the wrong medication.
“If you’re medicating the wrong diagnosis, then you’re often pouring oil on a fire and not helping with mood management,” Grace said.
It can be difficult for children who pass through the foster system to get the mental health care that they need. Shortages of psychiatrists, school psychologists, and youth therapists limit access to treatment, especially for those who can’t afford private care.
The Division of Family and Children’s Services connects foster children and their parents with local mental health resources, like Lighthouse for Families and River Edge Behavioral Health, said Shannon Fields, director of the Bibb County DFCS office.
Fields was hoping to hire more caseworkers who could help families get the mental health care that they need, but the Bibb County division just lost 25 percent of its county funding for fiscal 2019, and she said they’d have to put those plans on hold.
DFCS offers early intervention resources whenever possible, which Benesh said can make all the difference.
“If we provide the services to these youth and to their family and their caregivers, then we see improved outcomes for them,” Benesh said. “So, we know kids who are able to get the support and services they need are more likely to do things like graduate high school. They’re less likely to run away from a foster home or a group home. They’re less likely to have a teenage pregnancy. They’re less likely to become homeless.”
He said they’re even less likely to suffer from chronic health conditions.
But if children’s mental health is not addressed, Grace said, they’re more likely to perpetuate a generations-old cycle.
“If we squander their time in foster care and don’t help them heal, then we’re missing out on a window of time where we can help them become the productive members of society that they can be,” she said.
Grace has dedicated her life — both professionally and personally — to displaced children. In addition to being a foster and adoptive parent, the mental health counselor also works with children who have spent time in the foster system.
She helps kids to rebuild trust and to let them know that’s it’s OK to open up and share their stories.
“So much of these hurts are healed in the context of relationships, not just on an island,” Grace said. “And it is imperative, too, with clients to help them look up from their immediate circumstances and hold hope for them until they can hold it for themselves. That the future can be different. That their story is not completely over.”
Samantha Max is a Report for America corps member and reports for The Telegraph with support from the News/CoLab at Arizona State University. Follow her on Facebook at https://www.facebook.com/smax1996 and on Twitter @samanthaellimax. Learn more about Report for America at www.reportforamerica.org.