For children, especially young children, life can be unpredictable day to day. In the best of circumstances, with sensitive and capable adult guidance, these experiences can be exciting, instructive. Even in less desirable situations, if such guidance is available, the child can become an adult with resilience, self-assurance and good mental health.
For children in foster care, those "predictable" aspects of day-to-day events are too often replaced with experiences of confusion, turmoil and physical or emotional scarring.
Placement into a new environment - while safe and supportive on one or more levels - nevertheless brings new mental health stressors, disruption and new expectations in daily routines. Anxiety can arise from new home or school settings, unknown medical professionals, new peer groups and separation from the previously recognized, though troubled, environments.
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The role of the CASA/GAL volunteer is particularly important in the ongoing, often complicated, process of integrating the various agencies and staff trying to help the child. The volunteer can also play an important role in assessing and optimizing the interactions among various factors that affect children's well-being. These include the child's physical and social environments, health-impacting behavior and medical care.
Good information flow among the child, the families, medical professionals and behavioral specialists is crucial to the ultimate stability of the child. When volunteer advocates develop a comfortable and collegial relationship with both the foster and biological parents, they can often obtain better insights into the need for discussions with medical/behavioral professionals. Through interaction with the child and input from the parents, volunteers can watch for the following signs to trigger a recommendation that mental health treatment be initiated or revisited:
New or increased negative behaviors such as aggression (especially if injury to self or others is involved)
Changes in patterns of daily routines: eating, sleeping, continence
Changes in speech or social interactions
Reports of strong dislike or dysfunction related to school work or social performance at school
New or worsening fears; avoidance of specific places or situations
Dramatic shifts in mood that swing from "overly bubbly" to "sad, but I'm not sure why"; shifts in restlessness or irritability
Increasing somatic complaints of physical pain, discomfort or illness without obvious medical cause
Unfortunately, a major barrier to optimal treatment for children in foster care is the lack of continuity of care among medical, behavioral and educational professionals. Information about patterns of behavior, which would give insight to new mental health professionals as they enter the child's care system, is often not maintained because foster families and case workers come and go.
The use of psychotropic (mood-altering) medications for mental health conditions has long been an area of concern relative to children in foster care. When psychotropic drugs are prescribed, selecting the best medication(s) needed for a specific condition and maintaining a process to monitor and adjust medications are constant challenges for the medical/behavioral professional. The challenge is raised exponentially by the complexities of the children and the agency systems they are navigating.
As part of the team assisting children with mental health issues, CASA volunteers are an invaluable resource. The continuity and history they provide are beneficial to those who serve children - and ultimately to children themselves.
Richard C. Adams, MD, a neurodevelopmental pediatrician, has been active for 20 years in program development, research and clinical practice related to children with disabilities and their families. This article is reprinted from the Summer 2008 issue of The Connection, a publication of the National Court Appointed Special Advocate Association.