Mental health needs and therapeutic service utilization of young children in foster care in Germany

Although children in foster care often need therapeutic help, the ways to initiate therapeutic services for them is not regulated in Germany. The objective of this cross-sectional study is to identify factors associated with therapeutic service utilization in young children in foster care in Germany. Additionally, it explores predictors of foster parents' perceived need for therapeutic help for the child. Foster parents of 286 children aged 3-7 years completed questionnaires about children's mental health, child and placement characteristics. Logistic regression models tested the impact of these factors on therapeutic service utilization and foster parents' perceived need for child therapy separately for children with and without potentially traumatic experiences. Approximately 62% of the sample had some mental health problems; around 37% of these children received no treatment. Placement disruptions and cases where the child welfare services had the custodial rights predicted higher therapeutic service utilization. Foster parents' stress was associated with perceived need for help. Children's symptoms - especially externalizing problems - also predicted both outcomes. The findings indicate the need for strategies to increase therapeutic service utilization in young children in foster care on caregiver, system, and legislative levels. Such strategies should target routine assessment of children's mental health as well as interventions on foster family characteristics.