Work

Characterizing the use of home-based behavioral health services among children in foster care

Year: 2026

Type: article

Abstract: BackgroundChildren in foster care (FC) experience disproportionately high rates of mental health (MH) needs and frequently use behavioral health services. They are overrepresented in restrictive MH settings and are more likely to be prescribed psychotropic medications. Home-based behavioral health services (HBHS) offer a less restrictive alternative for addressing the complex needs of FC children, but their use and effectiveness remain understudied.MethodsUsing Medicaid data from 28 states, we examined MH service utilization among children aged 3–18 with primary MH diagnoses across three groups: FC (n=128,180), disability (n=214,959), and low-income (n=1,054,426). We summarized utilization patterns, estimated multivariable models of HBHS take-up, and assessed associations between HBHS and other MH-related care.ResultsAbout 60% of FC children had a MH diagnosis, compared with 65% of children with disabilities and 19% of low-income children. HBHS use was highest among FC children (29%), exceeding use among children with disabilities (15%) and low-income children (10%). Among FC children, HBHS use was associated with greater MH diagnostic complexity, Black and Hispanic race/ethnicity, and certain MH diagnoses (e.g., adjustment reaction, emotional disturbance). HBHS use (vs. no use) was associated with lower odds of hospitalization (aOR=0.82), ED visits (aOR=0.75), and new psychotropic prescriptions (antipsychotics aOR=0.76; SSRIs aOR=0.80; ADHD medications aOR=0.77), and higher odds of school-based MH service use (aOR=1.47).ConclusionsHBHS are widely used by FC and serve clinically complex populations. Their use was linked to reduced reliance on restrictive and pharmaceutical care, suggesting that expanding access may enhance MH services for children.

Source: Children and Youth Services Review

DOI: 10.1016/j.childyouth.2026.108891

Authors: Anna Chorniy, Michelle A. Moffa, Shannon Barnett, Matthew M. Davis, Rebecca R. Seltzer

Institutions: Icahn School of Medicine at Mount Sinai, Johns Hopkins University, Johns Hopkins Berman Institute of Bioethics

Language: English

Topic: Child Welfare and Adoption

Subfield: Safety Research

Field: Social Sciences

Domain: Social Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: hybrid

Estimated APC paid: $4,000