Children in Care: Reducing Needs While Improving Mental Health Outcomes

September 20, 2022

Schwartz C, Barican J, Yung D, Gray-Grant D, & Waddell C. (2022). Children in Care: Reducing Needs While Improving Mental Health Outcomes. Vancouver, BC: Children’s Health Policy Centre, Faculty of Health Sciences, Simon Fraser University.


Children in government care face extraordinary challenges. This includes many young people coming into care because they have experienced maltreatment. Then once in the care system, many continue to experience avoidable adversities, such as multiple changes of placement which can result in inconsistent caring relationships, school disruptions and cultural disconnections. These children also face higher rates of mental disorders, lower rates of high-school graduation and more conflicts with the law. Compounding these issues are the unfair burdens faced by Indigenous children who often experience overinvolvement of the child welfare system, an ongoing legacy of colonialism.

Given these challenges, a crucial goal is to reduce the need for care placements by better supporting families to prevent child maltreatment. When this is not possible, many children who come into government care need interventions to encourage their well-being, including preventing and treating mental health challenges. This research report therefore aims to identify: 1) effective programs for better supporting families so there is less need for children to come into care; 2) the prevalence of mental disorders for children in care to estimate the degree of burden facing this population; and 3) effective programs for preventing and treating mental disorders for children in care.

To meet these objectives, we conducted three systematic reviews. Our first review identified several successful programs for preventing child maltreatment. For averting problems before they occur, Nurse- Family Partnership stood out — according to two high-quality studies. For preventing further maltreatment, Parent-Child Interaction Therapy and Multisystemic Therapy stood out — each reducing at least one form of maltreatment. Our second review identified a much higher burden of mental disorders for children in care, with prevalence approximately four times higher than in the general population of children. Our third review identified successful prevention and treatment programs for addressing mental well-being for children who have come into government care. For prevention, both Fostering Healthy Futures and Middle School Success reduced mental disorder symptoms including substance use. For treatment, both Parent Management Training – Oregon and Multidimensional Treatment Foster Care led to benefits including reducing symptoms of conduct disorder, substance use, depression and psychosis.

These findings can inform efforts to improve the well-being of some of British Columbia’s most disadvantaged children. Preventing maltreatment is the first priority. Ensuring adequate supports for families and adequate investments in programs that can prevent children from needing to enter government care are therefore crucial. The programs highlighted here provide examples. Yet even after maltreatment has occurred, children and families can still benefit from programs that prevent further occurrences. Programs such as those highlighted here should therefore also be offered. Then, if children do come into care, beyond ensuring that their basic needs are met, they also need to be provided with timely and effective mental health care, such as the prevention and treatment programs outlined in this review. In turn, these investments and commitments will honour and uphold children’s rights — providing hope and supporting their flourishing.

See full report here.