The U.S. Child Welfare System: A De Facto Public Behavioral Health Care System

Abstract

At a recent child protection hearing, a presiding judge was heard to query “What is a child with emotional problems doing in foster care?” The implication of this question was the judge's underlying belief that if a child who was a ward of the state had an emotional or behavioral disorder, then surely he or she should be in specialized foster care, residential treatment, or a psychiatric hospital. Although for many who have worked in child welfare setting, this question reveals a startling level of naiveté on the part of the judge, this quote eloquently illustrates the importance of the work published by Barbara Burns and her colleagues in this issue of the Journal. If, in fact, half of the children in the child welfare system have clinically significant emotional or behavioral problems, then the child welfare system is a de facto behavioral health care system. Recognition of this reality by all child welfare system partners is the first step to addressing the complex needs of involved youths. Considering current system funding levels, there is absolutely no way any state could afford to address these needs by placing half of their children in specialty treatment settings. Unfortunately, as Burns et al. demonstrate and the judge's comments might suggest, most child welfare systems do not have sufficient community-based services in place. The result is that many children's behavioral health needs do not get addressed until they are serious enough to warrant residential or hospital treatment. We know the solution. The system of care philosophy with child-serving systems is the consensus approach ( Stroul and Friedman, 1996 Stroul B Friedman R The System of Care Concept and Philosophy in Children's Mental Health: Creating Systems of Care in a Changing Society. Brookes, Baltimore1996 Google Scholar ). Only by carefully building an integrated system in which behavioral health needs are identified and addressed throughout the child welfare system can these frequent and complex needs be met with any consistency ( Lyons, 2004 Lyons JS Redressing the Emperor: Improving the Children's Public Mental Health System of Care. Praeger., Westport, CT2004 Google Scholar ).