P3.069: Findings From a Foster Care Specific Psychiatric Evaluation Program

Background: Up to 80% of the more than 368,000 foster care children in the United States have a mental health disorder. Only a small percentage are cared for by trauma-informed providers who specialize in treating foster youth. Foster Children Evaluation Service (FaCES) at the University of Massachusetts Children’s Medical Center provides psychiatric evaluation, diagnosis, and treatment to youth in foster care, who have significant exposure to early childhood trauma and adversity. We undertook a case review to examine the diagnosis and prescribing trends for youth served in this specialized setting.

Methods: A retrospective chart review of psychiatric visits at the FaCES clinic January to December 2024 was conducted. Demographic data, diagnosis, prescribed and de-prescribed medications, and number of visits were extracted. Patient data was collated into three groups based on patient age: 0-5 years, 6-12 years, and 13 years and older. Descriptive statistics and comparative analysis were performed using Fisher’s Exact Test, binary logistic regression and Cohen’s H test.

Results: 368 patient encounters for 112 patients were reviewed. Table 1 includes the diagnoses identified for youth prior to and after FaCES psychiatry evaluation. Diagnoses such as depressive disorder, trauma disorders, and ADHD showed statistically significant increases with both logistic regression (p < 0.001) and Fisher’s Exact Test, suggesting strong evidence of diagnostic change over time. These also had large effect sizes (Cohen’s h > 0.4), indicating meaningful clinical shifts.

In the age 6-12 cohort (n=42) ADHD was noted for 69% (n=29) patients and trauma related disorder in 71.4% (n=30) (children often had more than one diagnosis). In the 13+ Cohort (n=69), ADHD and trauma related disorder were noted in 33% (n=23) and 55.1% (n=38) respectively. In the 13+ cohort there was also a sizeable increase in comorbid disorders (26.1% (n=18) with a depressive disorder and 44.9% (n=31) with an anxiety disorder).

Medication changes over time are noted in table 2. In comparison of medications between the first and last visits (n = 89 for each group), no medication showed a statistically significant change (all p-values > 0.05). Stimulant use increased from 28 to 37 patients, resulting in a medium effect size (Cohen’s h = 0.208), suggesting a potentially meaningful trend despite the lack of statistical significance.

Conclusion: We found a high prevalence of trauma related disorders, and that trauma may be underdiagnosed or initially misdiagnosed as another psychiatric condition such as ADHD in foster youth. Diagnostic clarity in recognizing underlying trauma and its impact on a child's mood and behavior is essential in selecting the most effective treatment. Additionally, many foster youth have complex psychiatric profiles, with an increase in comorbid mood disorders as they age, further highlighting the need for comprehensive mental healthcare to support this population.