Behavioral Health Interventions for Foster Children

Foster children greater health needs than children not in foster care.

A child in foster care is a minor removed from their home due to abuse or neglect and placed into state custody (American Academy of Child and Adolescent Psychiatry (AACAP) 2023). Children in foster care are four times more likely to have health problems than non-foster peers (American Academy of Pediatrics (AAP) 2021). Half of foster children have chronic physical health problems, like asthma, and 35% to 50% have mental and behavioral health conditions related to pre-removal trauma (AAP 2021, Bilaver 2020, Turney & Wildeman 2016).

Upon entering state custody, foster children in MO undergo comprehensive developmental and medical screening by a healthcare professional within thirty days (American Academy of Pediatrics (AAP) 2021). If needed, a follow-up in-depth assessment is scheduled within sixty days. Based on the screening and assessment data, a healthcare professional determines which interventions to provide and works with a case worker to coordinate care (AACAP 2023, RSMo 210.110).

Behavioral health interventions correspond to increased placement stability.

Behavioral Health Interventions (BHIs) increase the social and behavioral function of children with mental health disorders (Dubois-Comtrois K 2021). BHIs contribute to long-term placement stability for foster children by reducing high cost institutional placement and increasing positive functional outcomes in the child’s home and community (Engler et al 2020). Placement stability is associated with improved long-term educational attainment, social relationships, and mental health outcomes (Rubin et al. 2007). Children with fewer behavior problems have more stable placements (22% unstable) than those with high behavior problems (63% unstable) (Rubin et al. 2007). BHIs teach foster children coping that reduce placement instability and support the child's long-term well-being (Engler et al 2020, NCSL 2019, Casey Family Programs 2018, Seibert et al 2018).

There are various BHI program models designed to manage trauma outcomes in foster children (Engler et al 2020). When combined, these models ensure a child’s care is personalized and coordinated within a family.

States use Medicaid to provide BHI for foster children.

Funding to implement BHI programs comes from the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit under Medicaid (U.S.C. § 1396d(a)). EPSDT requires all states to cover any medically necessary service for anyone under age 21 to treat mental or physical conditions (U.S.C. § 1396d(a)). States primarily use these funds for specialized in-home or community-based care as part of their Medicaid state plan (NCSL 2019).

The EPSDT funds allow states to use a full continuum of BHI models which differ by clinical intensity, primary service location, and duration of support. This ensures foster children receive the medically necessary services at their point of greatest need in an accessible location. States offer a wide range of programs, including (Figure 1):

• Low-intensity interventions, such as Specialized Access Programs in LA, focus on prevention and early identification by delivering services in the community, primarily in schools, over a long term.
• Intensive in-home-intervention programs are a high-frequency model used by CA and KS. This model brings specialized clinical staff directly into the family home to stabilize youth and prevent out-of-home placement.
• Mid-intensity models, like UT’s High-Fidelity Wraparound program, provide intensive care coordination over a long term across all settings, supporting the family's ability to maintain care in their home.
• Crisis and Psychiatric Diversion Models, like in FL and TX, deliver high-intensity, short-term acute care in specialized homes or community facilities to immediately stabilize a youth’s mental health and prevent costly psychiatric institutionalization.
• Intensive Therapeutic Foster Care is a program used by many states including AR, FL, IA, KY, and OK. This program is a high-intensity, temporary to stabilize a youth’s mental health until the youth is ready for a permanent placement.

MO primarily uses both therapeutic foster care and intensive in-home intervention programs to address the variable BHI needs of foster children (Seibert et al 2018). Furthermore, specialized care management is available to all Medicaid-eligible MO children, not solely those in foster care (Children’s Division 2024).

Figure 1: The spectrum of state-led BHI models. Icons indicate where treatment occurs: community (several buildings), home (one building), or specialized facility (medical bag). Models listed by clinical intensity, less intense to the left, most intense to the right. Clinical intensity determined by BHI frequency or duration, BHI provider specialization, and complexity of child’s needs. Less clinically intense programs and programs in the home/community provide long-term care whereas more clinically intense programs operating in a temporary placement provide short-term care.

References

American Academy of Child and Adolescent Psychiatry (2023) Foster Care. URL Link

American Academy of Pediatrics (AAP) (2021) Physical Health Needs of Children in Foster Care. URL link

Bilaver LA, Havlicek J, Davis MM (2020) Prevalence of Special Health Care Needs Among Foster Youth in a Nationally Representative Survey. Pediatrics, 174(4): 727-729. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2765817

California Department of Health Care Services (2025) Behavioral Health Treatment. California Health and Human Services. URL Link

Casey Family Programs (2018) Strategy Brief: Strong Families. URL Link

Children’s Bureau (2025) Data and Statistics: AFCARS. Office of the Administration for Children and Families. URL Link

Children’s Division (2024) Child and Family Services Plan. Missouri Department of Social Services. URL Link

Clinical Policy: Intensive Treatment Family Care (2025) Oklahoma Complete Health. URL Link

Community Action treatment Programs (2025) Florida Department of Children and Families. URL Link

Darling SJ, Goods M, Ryan NP, et al (2021) Behavioral Intervention for Social Challenges in Children and Adolescents: A Systematic Review and Meta-analysis. JAMA Pediatrics. 175(12): e213982. URL Link

Division of Children and Family Services (2025) Part 40: Policy and Procedure Manual. Department of Social Services. URL Link

Dubois-Comtois K, Bussieres E, Cyr C, et al (2021) Are Children in Foster Care at Greater Risk of Mental Health Problems Than Their Counterparts? A Meta-Analysis. Children and Youth Services Review. URL Link

Engler AD, Sarapong KO, Keef RJ (2020) A Systematic Review of Mental Health Disorders of Children in Foster Care. Trauma, Violence, & Abuse. 23(1): 255-264. URL Link

Family Foster Home Descriptions (2022) Kansas Department for Children and Families. URL Link

Florida State Statues § 409.175 (2025) URL Link

Intensive Care Coordination (2025) Utah Department of Health & Human Services. URL Link

Kentucky Administrative Regulations § 922.001.495 (2025) URL Link

Medical Assistance Programs. Medicaid and CHIP Payment and Access Commission 42 U.S.C. §1396d(a) (2010) URL Link

Missouri Department of Social Services (MODSS) (2024) Child Welfare Manual. Section 4, Chapter 2, Subsection 4. URL Link

National Conference of State Legislatures (NCSL) (2019) Brief Mental Health and Foster Care. https://www.ncsl.org/human-services/mental-health-and-foster-care

Seibert J, Feinberg R, Ayub A et al (2018) State Practices in Treatment/Therapeutic Foster Care. U.S. Department of Health and Human Services. URL Link

RSMo 210.110 Definitions. https://revisor.mo.gov/main/OneSection.aspx?section=210.110&bid=57656&hl=

Rubin DM, O’Reilly ALR, Luan X, et al (2007) The Impact of Placement Stability on Behavioral Well-being for Children in Foster Care. Pediatrics. 119(2): 336-344. URL Link

School-Based Medical Services (2024) Louisiana Department of Education. URL Link

STAR Health (2015) Texas Department of Family and Protective Services. URL Link

Therapeutic Foster Care (2025) Iowa Health and Human Services.  URL Link

Turney K, Wildeman (2016) Mental and Physical Health of Children in Foster Care. Pediatrics. 138(5): e20161118. URL Link

Walker JS, Bruns EJ, Penn M (2008) Individualized services in systems of care: The wraparound process. The system of care handbook: Transforming mental health services for children, youth, and families. Paul H. Brookes Publishing Co URL Link