Require foster care mental health screenings

Prevention, Early Intervention, & Youth
Parity, Coverage, & Equitable Access
social determinants of health
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Coverage & Standards
Federal department
Health and Human Services
house committees
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senate committees
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The Department of Health and Human Services (HHS) should require mental health screenings when a child enters foster care and comprehensive assessments when a mental health challenge is identified; improve and invest in the availability and provision of mental health and substance use disorder (MH/SUD) services for youth in foster care; and provide technical assistance for states to cover certain specialized services for foster youth enrolled in Medicaid who have intensive MH/SUD needs with guidance from the Centers for Medicare and Medicaid Services (CMS).[1][2][3]


More than 391,000 children are in foster care, and more than 600,000 children are served by the foster care system annually.[4] Mental health and substance use needs are the largest unmet health need for these children.[5] Nearly 80 percent of children in foster care have significant challenges [6] and are much more likely to have worse mental health than their peers.[7] The long-term effects are substantial - compared to the general adult population, adults previously involved in the foster care system are five times more likely to experience post-traumatic stress disorder and seven times more likely to have a SUD.[6][8]

Annual screenings are critical components of prevention and early intervention of MH/SUDs.[9] Early identification and treatment lead to better outcomes in overall health and may lessen long-term disability.[10] HHS and CMS should guide states in meeting the critical need for children to receive MH/SUD screenings and necessary treatment immediately when entering the foster care system - before, during and after placements - and when emancipating from foster care.[1][3][11] There is also a lack of data about MH/SUD interventions specific to youth in foster care.[12] HHS and CMS should provide technical assistance to states in collecting and reporting data about the children in foster care screened and treated for MH/SUDs.[1][2]


1. Timely Mental Health for Foster Youth Act. H.R. 2033 (Lawrence) and S. 836 (Blunt), 117th Congress (2021-2022). Last Accessed July 25, 2023.

2. U.S. Senate Committee on Finance. SFC Bipartisan Mental Health Care Provisions. Last Accessed July 25, 2023.

3. U.S. Department of Health and Human Services, Office of the Surgeon General. Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory. Last Updated December 2021.

4. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. The Adoption and Foster Care Analysis and Reporting System (AFCARS) Report No.29. Last Updated June 28, 2022.

5. American Academy of Pediatrics. Mental and Behavioral Health Needs of Children in Foster Care. Last Updated July 21, 2021.

6. National Conference of State Legislatures. Mental Health and Foster Care. Last Updated November 2, 2019.

7. Greiner, Mary V. and Sarah J. Beal. Foster care is associated with poor mental health in children. The Journal of Pediatrics. 182: 401-404. Last Updated March 2017.

8. Casey Family Programs - The Foster Care Alumni Studies. Assessing the Effects of Foster Care: Mental Health Outcomes from the Casey National Alumni Study (Summary). Last Updated December 2003.

9. The Kennedy Forum. Navigating The New Frontier of Mental Health and Addiction: A Guide for the 115th Congress. Last Updated January 2017.

10. National Alliance on Mental Illness (NAMI). Mental Health Screening. Last Accessed July 23, 2023.

11. U.S. Department of Health and Human Services, Administration for Children and Families. This National Foster Care Month, be the Champion; Support Mental Health. Last Updated April 28, 2023.

12. Hambrick, Erin P., Shani Oppenheim-Weller, Amanda M. N’Zi, and Heather N. Taussig. Mental Health Interventions in Children in Foster Care: A Systematic Review. Children and Youth Services Review. 70: 65-77. Last Updated November 2016.