Behavioral health needs and service use among those who've aged-out of foster care

• We explored behavioral health needs and service receipt among those who aged-out of foster care.
• At age 18, 68.4% had a behavioral health need. Among them, 55.7% received services.
• At age 20, those still in care were twice as likely to receive services as those who had exited.
• At age 24, 39.2% of those who aged-out of foster care indicated a behavioral health need.
• The relationship between behavioral health need and service use changes over time.

This paper is the first study to use a multi-state sample to longitudinally explore the relationship between remaining in foster care beyond age 18, behavioral health needs, and receipt of behavioral healthcare services. The study began with a sample of 732 older youth in foster care and followed them longitudinally for six years, after all had aged-out of care. Indicators of behavioral health and receipt of behavioral healthcare services were measured, as well as whether or not remaining in foster care after one's 18th birthday made a difference in receiving behavioral healthcare services. We found a high need for behavioral healthcare services in the years following their 18th birthdays and a significant drop-off in service use after exiting foster care. We also found a strong relationship between remaining in care after one's 18th birthday and receipt of behavioral healthcare services among those in need. Policy implications discussed highlight the possible role of Medicaid on young adults who have aged-out of foster care with behavioral healthcare service needs, and the potential impact of the Patient Protection and Affordable Care Act. Among the treatment implications are the need for highly effective behavioral healthcare services for older youths in foster care and the need for receipt of ongoing services upon exiting foster care.