Assisting Foster Care Youth with PTSD

YOUNG ADULTS AGING OUT OF FOSTER CARE WITH PTSD

Young Adults Aging Out of Foster Care With PTSD

One in four youth in foster care will have posttraumatic stress disorder (PTSD) symptoms. There are about 26,000 youths who age out of foster care each year. Out of this number, a majority of the youth will suffer from PTSD (Pecora, 2010; Sakai et al., 2014). The youth who age out of foster care are faced with the difficulty of transitioning to adulthood without social and emotional supports, which could complicate their mental health issues (Ai et al., 2013). While laws are mandating the youth should be allowed to continue receiving mental health services, less than half of former foster care youth are engaged in mental health services. The discontinuation of these services is due to costs and lack of insurance after they age out of foster care. The youth might also be dissatisfied with the services or feel the services they receive do not improve their well-being. Samuels and Pryce (2008) indicates youth aged 19-30 years have PTSD rates up twice as high as United States War Veterans. PTSD is often triggered by traumas the youth face when they were young especially if they faced emotional and physical abuse. Children who face these traumas will be placed in foster care by Child Protection Services (CPS), and some of the children might remain in foster care till they are 21 years old (Salazar, Keller, Gowen, & Courtney, 2013). Youth in foster care have high rates of trauma exposure approaching 90%. While a majority of youth in the general population will also have experienced some form of a traumatic event in their lives, those in foster care seem to have experienced far higher rates than normal youth. The childhood maltreatment and adverse experiences the youth faced took place during a key developmental phase of their life, which could have compromised the youth\\\\\\\'s emotional functioning and placed them at risk of adverse mental health consequences. Even after leaving foster care, Valdez, Bailey, Santuzzi, and Lilly (2014) notes one in four youth will still be coping with symptoms of PTSD. Youth in foster care will have a lifetime prevalence of PTSD. Therefore, there is a need to assess their access to mental health services and make recommendations towards ensuring they still receive the support they need to deal with their mental health issues.

Literature Review

Ai et al. (2013) posits child abuse will lead to a chronic inability of the brain to regulate emotions in adolescence and later in life. The National Comorbidity Survey (NCS) indicates children who were repeatedly molested are likely to have drug abuse, dysthymia, and childhood conduct disorder when they become adults. For foster youth aging out of foster care, they are still attempting to process the highly traumatic experiences they faced during childhood, and they lack the necessary emotional, financial, and social support that a typical youth would have when transitioning into adulthood (Pecora, 2010). Foster youth will experience negative outcomes and face considerable challenges as they attempt to secure opportunities and resources, they need to lead independent lives (Ai et al., 2013; Samuels & Pryce, 2008). Foster youth struggling with symptoms of PTSD will have increased depressive symptoms as they transition out of foster care. If the youth do not receive the mental health support, they need they will end up suffering in silence as they do not have the coping mechanism to manage their transition. As the youth transition, they are leaving a system that required their dependence into an abrupt expectation of independence (Pecora, 2010). Upon leaving foster care the youth have to fend for themselves and they might have to seek mental health assistance elsewhere, which proves challenging as most of the youth do not have medical insurance (CARE, 2012). Having to pay for their own medical care results in most of the youth abandoning their mental health leading to further deterioration of their PTSD symptoms (Megan Hayes 2017).

According to Megan Hayes (2017), the idea of letting the youth decide for themselves what is best when it comes to their mental health does not work. With 60% of the youth discontinuing mental health services within a year of leaving foster care. Therefore, there should be a consideration on follow-up services where a social worker is assigned youth with PTSD to ensure they do keep up with their appointments. While in foster care the youth are not involved in making decisions regarding their care (Ai et al., 2013). Therefore, when they eventually have the right to make the decisions, they prefer to suspend mental health services even though the youth know they need the services. Their past experiences with mental health professionals could have an impact on their decision. As of January 2014, the Affordable Care Act added a provision that all youth in foster care who attain the age of 18 years are eligible for Medicaid until they reach 26 years of age (Sakai et al., 2014). Even with this provision, which is meant to ensure the youth have insurance coverage when they leave foster care, most of the youths are not aware of the coverage. There is a huge knowledge gap hindering the use of health insurance and most youths have indicated they face challenges when they attempt to use Medicaid (Valdez et al., 2014). Some of the youth have stated they were advised at the health facility their costs would be covered and they still received a bill in their mail for the services they accessed (Sakai et al., 2014). With these knowledge gaps, it becomes hard for the youth to make use of the available services. Access to medication is a struggle for most of the youth as they have to get a prescription to get the medication. Getting a prescription requires they make an appointment with a mental health professional and in most cases, the appointments have to be made a month in advance. Therefore, the youth will be out of medications for a month, which can negatively affect their mental health.

The proposed solution is that the youth need to be engaged in their mental health treatment options when they are still in foster care. With this engagement, the youth will understand what they need to do when they are out of foster care, and they can seek the assistance they need (Pecora, 2010). Without the necessary transition planning, the youth are forced to fend for themselves once they are out of foster care, and this can be challenging for most of them. Moving from pediatric to adult health care systems has been noted by Christina (2014) to be a huge challenge, and the youth need the requisite skills to navigate the transition. The negative side effects of medications have been noted as a deterrent to seeking mental health services when they leave foster care. Therefore, actively monitoring the side effects of medication and addressing the side effects will allow the youth to continue seeing a professional and taking their medications after they leave foster care.

Application to Group Practice

Engagement with Group Members

Strengths-based strategies would work well for the group since the focus would be on the strengths that the individuals, group, and families possess instead of focusing on their weaknesses (Lougheed, 2019). Of note is that the strengths-based group work will not ignore the issues or problems a person faces, rather, it seeks out the strengths that will assist the individual to overcome the challenges. For the youth, the focus would be on identifying the strengths in areas of physical and academic competencies, goal setting, past coping, and hidden talents (Piel & Lacasse, 2017). Using the strengths-based approach, the youth can remain engaged throughout the group process, and they will have the opportunity to interact with other youths. The interaction will benefit the youth as it will allow them to bond with other youths who are experiencing similar situations. According to Piel and Lacasse (2017) with the interaction, the youths can share experiences and solutions that could be implemented where the focus would be on individual strengths. Being allowed to make decisions and mistakes is what the youth need during the transition phase (Lougheed, 2019). Here, the youth can learn how to use their strengths in decision-making and learn from the decisions they make. The strengths-based approach builds on the youth\\\\\\\'s strengths and sees them as resourceful and resilient individuals when they are faced with adversity. The strengths-based approach focuses on the outcomes of the youth, which will be beneficial to the youth when they are setting their future goals. The youth will feel they are in charge of making their decisions, which is something they did not have in the past when they were in foster care (Lougheed, 2019; Piel & Lacasse, 2017). In a group setting, there will be open communication and thought processing for the youth to identify their value and determine their strengths in the course of change (Sakai et al., 2014).

Assessing the Needs of The Group

Youth aging out of foster care will face a myriad of issues, and for some of them, this would be a challenging time (Sakai et al., 2014). To determine their needs, one must engage them in a focus group. The focus group will offer vital insights into the perceptions of the youth regarding their mental health needs and support during the transition. In the focus group, the youth will feel like they are interacting with their peers, and they can genuinely air their concerns and fears (Salazar et al., 2013). This would be an opportune time to note their needs and offer vital knowledge or strategies for them to mitigate or use when they exit from foster care. The focus group will generate questions, and the youth will have to answer the questions individually. The strategy will elucidate information that one would normally not receive if they were to interact on a one-on-one with the youth (Salazar et al., 2013). The presence of other youth with a similar issue allows the youth to openly share information with each other in the group (Sakai et al., 2014).

Intervention Considerations

Educating the youth on the differences they will have to undergo during the transition period will be key to the youth continuing with their mental health services (Valdez et al., 2014). The youth needs to be linked up with key people who will assist them to transition out of foster care, and these individuals can assist the youth to get professional assistance without having to undergo the hassle of searching for one. Having noted there is a huge knowledge gap regarding Medicaid access and use, the youth should be taken through what they should expect in regards to their health insurance and what is required of them when using their health insurance. Filling the knowledge gap gives the youth ample information and understanding of what is covered and how they can access the services. The information will assist the youth to transition into adulthood seamlessly, and they can continue to access mental health services and PTSD drugs ensuring they can continue to function even after leaving foster care.

Evaluation Considerations

Engaging, partnering, and empowering the transition-age youth will increase their likelihood of them accessing mental health services when they are out of foster care. Determining the effectiveness of an intervention could be done by interviewing the group members and asking them questions regarding the use of the intervention. Using this strategy, we can determine if the members grasped the requirements and how they could use the services. Surveys could be used to establish how well the intervention is working or assisting the youth. Three months after the youth have exited foster care, one could send them a survey to determine how they are coping and the challenges they are facing as they are outside of foster care. The issues could then be compared to what had been discussed with the youth during their transition phase, to determine if they have implemented what they were taught.

Relationship to HBSE

What we need to understand is that the youth aging out of foster care will be in the young adulthood stage of life. The young adulthood phase is concerned with the young adult\\\\\\\'s role confusion and identity crisis. The youth will get their first chance of independence, and they will have to leave foster care. Young adulthood is a transitional stage as it symbolizes the end of adolescence and the start of adulthood as noted by Levinson\\\\\\\'s Theory of Life Structure (Hutchison, 2014). The youth needs to get a good base if they are to succeed in adulthood after they leave foster care. Considering this will be a challenging stage for the youth the social worker should ensure they have good access to the group and inform them of some of the challenges they are likely to face when they leave foster care. Preparing the youth for this stage is vital as they will have a dream and also a mentor. The vision the youth has for his or her future will be the driver for the youth as they will be pursuing this dream once they leave foster care. Having someone to guide them during the transition face will allow the youth to maintain focus on their dream and purpose. The group will receive the necessary guidance on how to navigate outside foster care, and they will be given information on services they can access when they leave foster care. All this will benefit the youth as they will have to seek mental health services outside of foster care, which would ensure the youth can maintain their mental health. Evaluating the success of the group would be based on how the youth have fared since they left foster care.

Personal Experiences and Affective Reactions

My feelings would be mixed up as some of the group members might be prepared for a life outside of foster care, and others will not be ready to leave foster care. While one would be happy to see the youth taking a vital step in their lives, it can be anxious to see if they will implement what they have been taught. Believing in the youth will be the best strategy. The youth should feel you believe in them and that you do trust they will make the right judgment once they leave foster care. A social worker can be overwhelmed with emotions when they have to see their group of youth exiting foster care. Having spent a considerable amount of time with the youth and bonding with them during this time, the social worker will feel some attachment. Curiosity can develop to determine how the youth are faring in the outside world, which could create anxiety in the social worker. To regulate these feelings, one should learn detachment by striking a balance between professional and emotional engagement. A social worker should have enough periods of rest between sessions with the group for them to handle other personal things. Social workers should learn coping strategies that will assist them to build resilience in their work and not allow emotional attachment to progress.