Weekly Wonk: The Other Pediatric Mental Health Crisis
New Data Drop and analysis of policymaking process
Welcome, Wonks. We’re almost all the way to Congressional recess, with the House now back home and the Senate soon to follow.
Last week, the U.S. Senate Finance Committee held a confirmation hearing for Alex Adams to lead the Administration for Children and Families (ACF). See more here.
This week, we’ve got a thematic focus for you on mental health.
While headlines have focused on a national youth mental health emergency, our analysis of new federal data reveals something deeper: children in foster care are facing their own distinct—and worsening—mental health crisis.
We unpack the data, connect it to policy, and break down the structural reasons for federal inertia on the issue.
Let’s get into it.
Wonk Data Drop
Data drives Child Welfare Wonk. From the beginning we’ve brought you original data analyses that cut through the noise to surface what matters.
Now we’re scaling that effort; inviting sharp researchers to drop new data-driven insights you won’t find anywhere else.
These fast, focused analyses are made for decision makers; rigorous, fluff-free, and aimed at the underlying structural tensions that actually matter in policy decisions.
The Other Pediatric Mental Health Crisis: Children in Foster Care Face an Alarming Burden
Robin Ghertner, MPP
You’ve probably seen the headlines. Since the COVID-19 pandemic, children’s mental health needs have surged into the national spotlight.
But our exclusive analysis of the most recent national data shows something else: for children in foster care, the crisis is severe enough to be its own crisis.
Here’s what we found, in brief. You can read the full analysis here.
The percentage of children in foster care with mental health disorders grew by 14 percentage points between 2018 and 2023 – much faster than children not in foster care.
By 2023, children in foster care were nearly 20 percentage points more likely to have a mental health condition than children not in foster care.
These findings confirm a long-understood reality: children in foster care face a significantly higher risk for complex mental health needs—shaped both by what brings them into care, and what happens to them once there.
The policy implications here are profound.
Cuts to Medicaid or other parts of the health system—even if not explicitly aimed at children—risk eroding access to the services these children urgently need.
This is especially true given the deep Medicaid cuts in the One Big Beautiful Bill Act (OBBBA), which includes new work reporting requirements, cost-sharing, and state financing changes that would affect access to specialty services like mental health.
Fewer mental health services mean more untreated conditions. More untreated conditions mean more family crises. And more family crises mean more entries into foster care, often with more acute needs.
This is where cross-system leaders face tough choices.
Financing, monitoring, and delivering appropriate care for this population is never simple. But the stakes have never been higher.
Trends in Mental Health and/or Neurodevelopmental Disorder Among US Children, 2018-2023
Notes: Weighted estimates shown. Unweighted total N=262,097. Mental health and/or neurodevelopmental disorder defined as having one or more of the following: anxiety problems, depression, behavior or conduct problems, attention-deficit/hyperactivity disorder, or autism spectrum disorder.
Robin Ghertner is Child Welfare Wonk’s Founding Director of Strategic Policy Intelligence.
Mental Health on the Hill: Structural Barriers and Emerging Opportunities
By Doug Steiger, Child Welfare Wonk Senior Contributor
The findings above underscore what those in child welfare already know intuitively: children in foster care face a growing mental health crisis.
Despite bipartisan expressions of concern and frequent hearings over the past five years, no comprehensive federal strategy has emerged.
The explanation is structural, not cynical.
Why the Structure of Government Matters
Congressional outsiders focus on leadership and personalities. Insiders know that Congress’ circulatory system rests on committee jurisdictions; who “owns” what issues.
Readers will know that these committees tend to focus on what they oversee, rather than viewing the needs of foster youth holistically.
Understanding this dynamic unlocks deeper insight into why policy moves or stagnates, and how to navigate this terrain effectively.
The House
Key levers for addressing children’s mental health are spread across multiple committees, which often have different incentives, expertise, and goals:
Ways & Means
The Power: Congress’ oldest committee has jurisdiction over foster care funding, including Title IV-E.
The Imbalance: Members seeking spots here are more likely to want to flex tax, trade, and tariff chops than safety net expertise.
Energy & Commerce
The Power: E&C oversees Medicaid and most public health and mental health programs.
The Imbalance: Major health resources flow through E&C, but there’s no required connection to child welfare financing.
Education & the Workforce
The Power: Ed & Workforce has jurisdiction over the Child Abuse Prevention and Treatment Act (CAPTA).
The Imbalance: CAPTA’s requirements on states make it a driver of policy, but its lack of relevant open-ended funding constrains its leverage.
The Senate
Senators’ representation of states provides disproportionate rural influence, shaping how the Senate sees issues.
Jurisdiction is more consolidated, driving broader perspectives and coordination, while simultaneously making it challenging to map policy and process to what the House does.
Finance Committee
The Power: Finance oversees most health financing, including Medicaid, and most foster care and safety net programs.
The Imbalance: Health financing policy alone is so large that it takes significant bandwidth and focus.
Health, Education, Labor, and Pensions (HELP)
The Power: HELP oversees public health and mental health programs, as well as CAPTA.
The Imbalance: HELP has authority over the agency infrastructure of most of HHS, but not the core resource flows that Finance controls.
The Administration
In the absence of legislation, the executive branch, particularly the Department of Health and Human Services (HHS), tends to act at the margins: through guidance, grants, and regulatory tweaks.
One angle to watch is Secretary Kennedy’s interest in reducing the use of psychotropic medicine for children, which could lead to a coordinated effort.
However—with proposed budget cuts, a shift toward block grants, and increased fiscal pressure on states—the Administration’s tools may be shrinking just as the need grows.
What Lies on the Horizon for Mental Health on The Hill
Budget reconciliation will reduce Medicaid spending by nearly $1 trillion over the next decade.
As a result, state Medicaid programs will face serious fiscal pressures just to keep the status quo, making expanding their mental health supports or improving their quality a serious challenge.
But there are federal resources for mental health in public health programs.
The House has passed the SUPPORT for Patients and Communities Reauthorization Act which renews a host of public health programs with modest changes, including for children’s mental health programs.
The bill passed the House on a bipartisan vote of 366-57, but faces headwinds from Democrats uncomfortable with the Administration’s changes to the agency implementing the law.
Conclusion: What Could Change the Game
In Washington, legislation passes when it is either politically important to the majority party or is bipartisan.
Foster care issues are never that important politically, so a bill addressing the mental health needs of foster youth needs to be bipartisan – and if it’s comprehensive, it will need to be bipartisan across multiple committees.
It’s hard to negotiate meaningful bipartisan policy in one committee, let alone more than one.
That’s why structural leadership matters, and often requires White House pressure.
This is rare but not unheard of – 1997’s Adoption and Safe Families Act became law in part because Hillary Clinton and House Majority Whip Tom DeLay collaborated on its policies to promote adoption.
First Lady Melania Trump has repeatedly expressed interest in older youth in foster care, which could be a structural pressure for progress.
Substantive progress is possible despite these architectural barriers, but anyone who wants to advance it needs to be aware enough to navigate them effectively.
Doug Steiger is a Child Welfare Wonk Senior Contributor and public policy consultant.
He served as a Counselor to the HHS Secretary during the Obama Administration and was a Senate staffer for 12 years.