Helping Young People in Out-of-Home Care: Basic Elements

Children and adolescents (young people) who experience maltreatment early in life and are subsequently placed in out-of-home care (OOHC) are specifically at risk for poor mental health outcomes.¹ Although rates vary by survey and location, up to half of these young people have clinical-level mental health difficulties, and another 20% to 25% have difficulties approaching clinical significance.² These difficulties are characterized by high symptom complexity and severity, and include maltreatment-related mental health symptoms.² Many young people in OOHC are difficult to engage with and retain in treatment, compounded by a lack of specialized mental health services³ and a history of problematic social interactions with supports.⁴ They are often reluctant to seek help because of stigmatization and confidentiality concerns, limited opportunities for decision making, service inaccessibility, distrust of mental health services, and their perception that professionals do not understand their circumstances.⁵ We propose 6 clinical practice modifications for mental health services working with young people in OOHC to enhance therapeutic engagement and to maximize their therapeutic outcomes.