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Methods: This symposium uses data from two studies on the long-term mental health, placement, and relationship experiences of foster youth. First, data from a mixed-methods study in North Carolina provided qualitative insights into the challenges that high-needs foster youth face as they navigate the child welfare system via reflexive thematic analysis. For two studies in this symposium, in-depth interviews with over 20 caseworkers, foster youth, parents, and advocates were examined. For the third study, a subsample of 288 parents from the National Survey of Child and Adolescent Well-Being Adoption Study (NSCAW) provided survey data, linked to prior waves of the NSCAW, to create a longitudinal file on youth and family demographics, placement changes, adoptive parent perceptions, and family relationship dynamics.
Results: The first study identified three themes related to CWS service providers' perspectives on the challenges of serving high-needs youth in rural regions: (1) Training gaps, (2) Service resource shortage, and (3) Crisis-driven placement instability. The second study focused on providers' perspectives on strategies to improve supports and outcomes for high-needs foster youth in rural regions. Three themes were developed: (1) mental health provider accountability, (2) dedicated care coordination, and (3) rural-specific investment. In the final study, bivariable and multivariable logistic regression analyses showed that adopted youth with a history of mental health challenges and those adopted over the age of 5 had more adoption breakdown and their parents reported more negative parental perceptions about adoption. Those youth with a history of mental health difficulties had an adoption breakdown rate of about 37% as compared to 14% for those without (Х²(1) = 15.09, p<.000). Further, less pre-adoption parent preparation and a youth history of substance abuse were also associated with negative findings related to adoption breakdown and parental perceptions of adoption.
Conclusion/Implications: These studies illuminate the challenges of high-needs foster youth and their families, such as elevated risks of placement disruptions and poor wellbeing. This symposium suggests avenues for future research, including the need to investigate the long-term effectiveness of specialized residential mental health care across multiple mental, physical, and relational domains. The symposium also suggests changes in practice, including the need to provide more preventive services at the front end of foster care cases (e.g., intensive in-home services) to reduce the need for more expensive and perhaps less effective specialized mental health placements later in the case.