3 - (SYM 27) Understanding the Mental Health Service Utilization Experiences of Former Foster Care Youth

Background: Although children in foster care report higher needs and use of mental health services, there is a drastic drop in service utilization during young adulthood. To truly understand barriers to service utilization and suggest systematic changes, it is imperative to contextualize and elevate the voices of those with lived experiences. The current study investigated mental health service utilization experiences among former foster youth using mixed-study methods and aims to suggest improvements to clinicians.

Methods: The study included 94 young adults (Mage = 23.54) who were maltreated and placed in out-of-home care during early childhood. The sample is drawn from a larger sample of 330 participants in the Southwestern site of the Longitudinal Studies of Child Abuse and Neglect. Participants completed surveys about service utilization and a subsample of participants (n = 40) completed semi-structured interviews about their experiences with mental health services and other supports. Interviews were transcribed verbatim and analyzed using an applied thematic approach with inductive and deductive codes. Themes were identified through group discussions about salient concepts in the data.

Results: All participants reported seeing mental health professionals at least once in the past year but only on average 1.43 times (SD = .91, Median = 1.00). 21.3% reported recognizing a need for mental health services without seeking them. Qualitative analyses identified that while over half of interviewees found psychotherapy helpful, many engaged in patterns of initiating and stopping services due to concerns regarding readiness and avoidance. Several participants reported positive experiences with school counseling services that provided mental health, academic, and financial support, as well as substance use counseling services. Key themes regarding negative experiences with mental health services included feeling pressure to continue medication, and not trusting or feeling understood by service providers.

Conclusion: Given that the majority of former foster care youth reported using mental health services for a brief duration (e.g., a single session), we suggest clinicians use short-term engagement strategies such as motivational interviewing. Additionally, our findings highlight the importance of clinicians considering the clients’ past service experiences, being familiar with the foster youth sample, building trust and therapeutic alliance, and being attentive to the client’s preferences for medication management.