S U P P O R T I N G YO U T H I N F O S T E R C A R E I N

M A K I N G H E A LT H Y C H O I C E S

A Guide for Caregivers and Caseworkers on Trauma, Treatment, and Psychotropic Medications
TABLE OF CONTENTS

About This Guide .................................................................................................1

Highlights of This Guide........................................................................................2

A Message From Youth to Their Caregivers and Caseworkers ...................................3

A Few Words About Confidentiality .......................................................................5

1. Using Making Healthy Choices With Youth ........................................................7

2. Understanding Trauma and Behavioral/Mental Health of Youth ........................ 9

When does trauma happen, and what are its effects?....................................... 9

How can you promote healing for youth who have experienced trauma?..........10

3. Understanding Different Treatments ............................................................. 15

How is treatment different for youth who have experienced trauma? ..............15

How can therapy help? .................................................................................16

What other approaches can be helpful? ......................................................... 17

What is the possible role of psychotropic medication? ....................................19

4. Seeking Help for Youth ................................................................................. 21

How do you know youth are struggling and may need help?............................21

How do you get a professional assessment and evaluation? ............................22

How is a treatment plan made? ....................................................................24

What is informed consent? ........................................................................... 25

How can a planning team help?.....................................................................26

How do you find a treatment provider?..........................................................28

What questions should you ask providers about medication and 

 treatment plans?.......................................................................................29

5. Monitoring Treatment and Supporting Progress .............................................32

How can you support youth in taking medication safely? ................................32

How can you support youth participating in therapy or other 

 helpful approaches? ..................................................................................34

How can you watch for changes and check progress over time? .......................34

How can you help youth who are transitioning out of foster care?....................36

How can you help yourself when working with youth in care?..........................39

Acknowledgments .............................................................................................40

The contents of this guide are for informational purposes only and do not substitute for professional medical advice. This guide 

does not replace State or local agency protocols or policies that caseworkers, supervisors, and caregivers are required to follow.
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 1

ABOUT THIS GUIDE

Youth in foster care or kinship care often have experienced abuse, neglect, chaotic 

living situations, and placement(s) away from their families. Their histories can lead 

to complicated emotions and behaviors, and many experience trauma. While youth 

can heal, often it will take small steps over time with stability, supports, and services. 

To help youth in foster care understand and make decisions about their mental 

health care, in 2012 we published Making Healthy Choices: A Guide on Psychotropic 

Medications for Youth in Foster Care. (Find it, in English and Spanish, at 

https://www.childwelfare.gov/pubs/makinghealthychoices/ .) The guide for youth 

provides valuable information about recognizing the need for help, considering 

treatment options, asking questions, and taking medication safely. 

Even then, we knew that publishing a guide for youth was not enough and that 

caseworkers, foster parents, relatives, and other adults who care about youth in 

foster care needed some guidance to support youth. So, this companion guide is 

intended to help you as a caseworker, foster parent, other caregiver, or other 

caring adult to use Making Healthy Choices with youth. You are a key part of the young 

person’s team, and your role is particularly important for a young person who may 

be struggling with the effects of trauma and/or improving his or her mental health.

Many young people in foster care are prescribed psychotropic medication(s) to help 

treat their emotions and/or behaviors. We know that use of psychotropic medication 

in the foster care population is higher than use in the general population.1

 In fact, 

evidence points to some inappropriate use of psychotropic medication with youth 

in foster care.2

 While some youth may benefit from medication to treat certain 

illnesses, these drugs may be harmful if not used appropriately. Also, medications 

do not address the causes of the trauma, that is, what’s often triggering the 

emotions and behaviors. So, even those youth who benefit from medication may 

need other trauma-informed mental health services.

This guide is designed to help you learn more about treatment for youth in foster 

care who have experienced trauma and are working to improve their mental health. 

Chapters 2 and 3 can help you better understand trauma and treatments for trauma. 

Chapters 4 and 5 talk about strategies for helping youth.

1

 Stambaugh, L. F., Leslie, L. K., Ringeisen, H., Smith, K., & Hodgkin, D. (2012). Psychotropic medication use by children in child welfare. 

Retrieved from http://www.acf.hhs.gov/sites/default/files/opre/psych_med.pdf

2

 Fernandes-Alcantara, A. L., Caldwell, S., & Stoltzfus, E. (2014). Child welfare: Oversight of psychotropic medication for children in 

foster care. Washington, DC: Congressional Research Service.

3

 Information about younger children may be found through the following links: http://www.aap.org/fostercare, http://www.nctsn.

org, http://www.samhsa.gov, and http://www.zerotothree.org.

NOTE

While young children 

in foster care also have 

treatment needs, Making 

Healthy Choices and this 

companion guide are 

meant for use with 

preteens, adolescents, 

and young adults.3
2 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

HIGHLIGHTS OF THIS GUIDE

We’ve tried to make this guide a useful resource for adults working with youth in 

foster care. Here are some of the most important points:

• Consider options besides medication. While psychotropic 

medication may be helpful for some youth, it should rarely be 

the first and only treatment option. There are a number of other 

treatment options, such as therapy.

• Learn about safe medication use. If a young person is 

prescribed medication, learn how it works, including side 

effects and expected benefits. 

• Empower youth and give them a voice. Get youth involved 

in regular and ongoing discussions about how they are feeling, 

treatment options and decisions, and the importance of taking 

care of themselves.

• Learn about trauma and its effects. Many youth have suffered 

trauma as a result of their experiences in their families or 

neighborhoods (including abuse and neglect), removal from 

their homes, and placement in foster care. This trauma may 

affect their development and behavior and the way they 

interact with others. You will need to work in partnership with 

trauma-informed treatment providers to help youth heal and 

learn healthy coping skills.

• Honor youth’s specific ethnic, racial, cultural, and sexual identities. This 

includes their native languages as well as their beliefs, values, and attitudes 

about care and treatment. We need to welcome cultural and religious practices 

and the use of spiritual traditions, some of which may be considered “nontraditional” but are important to youth’s identities. We also need to support youth in 

building a deeper understanding of their identities, including sexual orientation 

and gender identity.

• Don’t be afraid to ask lots of questions of the doctors and specialists who 

provide services to youth in your care. The more you understand, the better 

you are able to advocate for the needs of young people.

• Have realistic expectations of yourself, the young person, and your 

relationship. When needed, seek support for yourself.
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 3

A M E S S AG E F R O M YO U T H TO T H E I R 

CAREGIVERS AND CASEWORKERS

A message from youth around the country who participated in the Young 

Adults Training and Technical Assistance Network under the National 

Resource Center for Youth Development:

It is important for us to know that the adults in our lives care about us and are 

working together with us to act in our best interests. We need support and 

encouragement to understand the issues we are facing and to seek the help we 

need. But we also want to be heard and want to have a say in decisions being 

made. This guide will provide you with a lot of information, but here is what is 

most important to us:

• Ask us what we think and want. If there is something we are not happy about, 

or we are doing something you might not advise (like dropping out of 

counseling), take time to understand why, rather than fighting against us.

• We don’t always know what is best for us, but when our opinion is paired with 

those who have expertise in certain areas, the outcome will be better.

• Engage with us about our needs, but use language we can understand. Take 

time to explain things to us, like what certain medications do, what our 

diagnosis means, etc. Do it in a way that is not intimidating or stigmatizing. 
4 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

• Ask us if we want you to go with us to any of our appointments or need 

support, and then make the time to do so. Ask questions like: 

– “Do you want me to come with you?”

– “Do you know how appointments like this work?”

– “Do you know how to fill out the forms?” 

• We want to feel safe in uncomfortable situations. If you can’t take us to an 

appointment, and the agency is going to arrange for a driver, make sure 

we’re comfortable with this. Work with us to come up with a better solution 

if we’re not feeling okay about it.

• If we aren’t following the treatment plan, talk with us about how we’re 

feeling. Maybe we don’t feel we’re benefiting from therapy or medication. 

Or maybe we’re afraid of medications. Or maybe we don’t want to attend 

“traditional” therapy and prefer another way for working through our issues. 

• Please don’t make us feel like we are the problem. 

• Even after we turn 18, we may want your support, advice, and guidance. We 

may still want you to go with us to some appointments. Stay connected with 

us, and help us understand how important it is to keep on top of our medical 

and mental health needs.

• We might fight against something if we are not informed and are struggling 

with trust. Do everything you can to see things from our perspective and 

personal background. We just want to be cared for, cared about, and heard.
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 5

A FEW WORDS ABOUT CONFIDENTIALITY

The issues of privacy and confidentiality for young adults are very important. 

Research has shown that concerns about confidentiality can affect youth’s openness 

in discussing their health histories and willingness to accept treatment services.4

Confidentiality can be a complicated issue. It is guided by both Federal and State 

laws and varies depending on the age and circumstances of the young adult. 

• For youth under the age of majority. The child welfare agency is responsible for

making sure that youth in foster care receive needed health and mental health

care. Even so, it is important for youth to feel that they can talk privately with a

doctor, therapist, or other treatment provider. There are several ways to support

youth’s treatment and respect confidentiality:

– Talk with health- and mental health-care providers to understand

confidentiality laws in your State.

– Ask providers if they have general guidelines about which types of

information (for example, safety concerns) will be shared with parents,

foster parents, guardians, or caseworkers.

– Partner with providers and youth to establish clear rules for when

information will be shared with parents, foster parents, or caseworkers.

– Let youth know when information is about to be shared and with whom

so that youth are comfortable with such sharing and the reasons for it.

KEY TERMS

CONFIDENTIALITY: 

The right to discuss 

private information with 

doctors, therapists, or 

other health- and mental 

health-care providers 

and to trust that such 

information will not be 

shared without 

permission. 

CONSENT: To give 

permission for 

something to happen, 

such as treatment or 

information sharing.

AGE OF MAJORITY: 

The age at which a 

young person is 

considered an adult 

by law. In most States, 

the legal age of majority 

is 18, but in some States 

it is 19 or 21. 

4 National Institute for Health Care Management Foundation. (2011). Protecting confidential health services for adolescents and young 

adults: Strategies and considerations for health plans. Issue brief. Retrieved from http://www.nihcm.org/images/stories/NIHCM-Confidentiality-Final.pdf
6 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

• For young adults who are over the age of majority or meet special 

circumstances outlined in State law.5 These youth can consent to treatment 

and must agree in writing before health- or mental health-care information can 

be shared. Even then, certain information will have to be shared, such as when a 

young person expresses plans to harm him or herself or others. There are several 

ways to support these youth: 

– Assure youth that their treatment is confidential. 

– Let youth know you are there if they want to share concerns or need your 

support in talking with a provider. 

– Encourage youth to talk with their providers about when information will 

have to be shared.

5 Special circumstances may include youth under the age of majority who are emancipated (for example, youth who are serving in the 

military or are married). Also, in many States, laws allow youth under the age of majority to consent to certain types of services (such 

as services for substance abuse treatment, birth control, sexually transmitted diseases, or certain emergency care).

KEEP IN MIND

It is important to explain 

to youth what consent and 

confidentiality mean in 

ways they can understand. 

In addition, youth should 

not be forced to sign 

consent forms to share 

confidential information. 

If a young person opposes 

sharing information that 

a service provider, 

caseworker, foster parent, 

or relative feels should be 

shared with others, talk 

with the young person 

about the reasons why.
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 7

1 USING MAKING HEALTHY CHOICES WITH YOUTH

Making Healthy Choices is a tool to engage youth 

in decisions about their physical and mental 

health. You can present the booklet to youth as 

part of a larger discussion about their goals for 

their own well-being, including their physical 

health and emotional wellness. Do this in a supportive way that encourages youth to think 

and talk about their strengths, concerns, needs, 

and preferences.

To help youth recognize when they might need 

help, Making Healthy Choices contains “symptom 

checklists.” (See Section #1.) These checklists and 

other worksheets can help youth identify 

troubling symptoms and talk about their 

concerns with trusted adults. Completion of 

checklists and worksheets should be optional; never require youth to give completed 

worksheets to caseworkers, service providers, caregivers, or others. 

GET COPIES OF MAKING HEALTHY CHOICES FOR YOUTH 

IN YOUR CARE OR SUPERVISION:

Online in English 

https://www.childwelfare.gov/pubs/makinghealthychoices/

Online in Spanish 

https://www.childwelfare.gov/pubs/makinghealthychoices-sp/

In print from Child Welfare Information Gateway 

Email info@childwelfare.gov or call 800.394.3366

http://www.nrcyd.ou.edu/psych-med-youth-guide a Learn more to decide what’s best for you.

Mak ing 

Healthy 

Choices

A	GUIDE ON PSYCHOTROPIC MEDICATIONS

FOR YOUTH IN FOSTER CARE

we have 

Options.

KEEP IN MIND

Youth must feel safe 

in sharing honest 

information about their 

experiences. This 

information should not 

be used against them 

in any way. 
8 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

TIPS FOR USING MAKING HEALTHY CHOICES WITH YOUTH

 Set aside time on a regular basis to talk about youth‘s health, feelings, and goals. Focus first on strengths 

and progress, and then move to any areas where youth may need assistance.

 Introduce Making Healthy Choices as a tool that can help youth with thinking about experiences, needs, 

strengths, and helpful treatment options.

 Provide an overview of what’s in the booklet and how it can help youth make decisions about their 

health. Point out the checklists and worksheets. Some youth may feel comfortable reading through the 

booklet and completing the checklists and worksheets on their own. Others may wish to go through each 

section with a trusted adult.

 Inform youth that using the booklet is their choice. There should be no requirement to complete the 

checklists or worksheets. Some youth may want to talk about the checklists and worksheets with a 

doctor or therapist, while others may not. Some may not want to use the booklet at all. Allow youth to be 

in control of their health information.

 Assure youth that the information they share with you will not be used against them. Supporting them 

to find appropriate help requires open, honest conversations.

 Encourage youth to talk through what they learn in the booklet with you, their health-care providers, 

and/or other trusted adults. Listen carefully when youth share their wishes (such as “I want to be off 

medication”). Work together with youth and their health-care professionals to develop short-term and 

long-term strategies for achieving goals.

 Talk about plans for next steps.

As you go through the rest of this guide, look for the following 

icon to alert you to related sections in the Making Healthy Choices

booklet for youth: 
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 9

U N D E R S TA N D I N G T R A U M A A N D 2 B E H AV I O R A L/M E N TA L H E A LT H O F YOUTH

This chapter provides background information on trauma. This information may help 

you understand why youth behave in certain ways and how you can respond most 

effectively. When adults don’t understand what’s happening with youth who have 

experienced trauma, trauma symptoms may just seem like difficult behavior (“he 

refuses to behave in school” or “she shuts down when I’m talking”). These symptoms 

and behaviors are sometimes managed with psychotropic medications, which do not 

address the underlying issues of trauma. 

When does trauma happen, and what are its effects?

Trauma is an emotional response that happens after a person experiences one or 

more stressful or scary events. Traumatic stress occurs when that trauma leads to 

harmful effects on physical and emotional health and well-being. The stressful or 

scary events can be real or perceived (felt to be real). Trauma may affect the person 

who experienced the event or someone else who cares about that person.

Trauma in the lives of children and youth involved with child 

welfare often results from the following:

• Physical, sexual, or emotional abuse

• Neglect

• Chaotic and unpredictable parenting

• Parents with mental health, physical health, or substance 

abuse challenges

• Seeing or being around violence in the home or community

• Separation from or loss of a parent, caregiver, and/or other 

important relationships

• Placement in foster care and multiple changes in foster homes

• Historical or intergenerational trauma6

These experiences can have negative effects on how children 

and youth develop physically, how they feel, how they learn, 

and how they relate to others. Sometimes, the symptoms of 

trauma may not appear right away but show up later, such as 

during adolescence.

6 Historical and intergenerational trauma refers to the long-lasting impact of violent events 

that continue to affect later generations of certain ethnic/racial groups, such as American 

Indians and African-Americans. 
10 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

The effects of trauma may make it harder for youth to do the following: 

• Trust others

• Control physical and emotional responses to stress

• Manage emotions

• Form positive relationships

• Learn and function in school or other group situations 

• Deal with life’s changes and stresses7

Early childhood trauma can have a lasting effect on the brain. Those changes in the 

brain can affect how youth cope with what they view as an unsafe world. Certain 

behaviors―such as acting aggressively, not sleeping, or “tuning out”—may be their 

body’s way of protecting against potential threats.8

 These responses may have been 

protective in the youth’s earlier environment yet may no longer be appropriate. 

The brain and body need to learn new responses once the young person is in a safer 

setting. The good news is that research shows that the teen brain can be “rewired” 

and, over time, youth can learn new responses that fit their new situations.9

Learn more about the impact of trauma on the brain:

• Child Welfare Information Gateway, Supporting Brain Development in Traumatized 

Children and Youth, at 

https://www.childwelfare.gov/pubs/braindevtrauma/

• Harvard University Center on the Developing Child, Toxic Stress Derails Healthy 

Development [video], at 

http://developingchild.harvard.edu/resources/multimedia/videos/three_core_

concepts/toxic_stress/

• Jim Casey Youth Opportunities Initiative, The Adolescent Brain: New Research and 

Its Implications for Young People Transitioning From Foster Care, at

http://www.jimcaseyyouth.org/understanding-adolescent-brain-and-its-implications-young-people-transitioning-foster-care

How can you promote healing for youth who have 

experienced trauma?

You may find it challenging to help youth manage the emotions and behaviors that 

result from past trauma and current uncertainties in foster care. But the way you 

interact with youth, along with more formal treatment, can support healing. In 

particular, it is important to remember that young people’s behaviors and emotions 

7

 National Child Traumatic Stress Network. Effects of complex trauma. Retrieved from http://www.nctsn.org/trauma-types/complex-trauma/effects-of-complex-trauma

8

 American Academy of Pediatrics, & Dave Thomas Foundation for Adoption. (2013). Helping foster and adoptive families cope with 

trauma: A guide for pediatricians. Retrieved from http://www.aap.org/traumaguide

9

 Jim Casey Youth Opportunities Initiative. (2011). The adolescent brain: New research and its implications for young people transitioning 

from foster care. Retrieved from http://www.jimcaseyyouth.org/adolescent-brain—new-research-and-its-implications-young-people-transitioning-foster-care

KEEP IN MIND

Trauma takes many 

forms and may have 

lasting effects. Yet, youth 

in foster care show great 

strengths. By focusing 

on youth strengths and 

supporting them through 

their challenges, you can 

help youth heal and learn 

to manage the effects of 

trauma.
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 1 1

may be a response to their experiences with traumatic events. Viewing youth 

behavior through a “trauma lens” can help you keep perspective, reduce frustration, 

and avoid self-criticism (such as “I’m a terrible parent.”)

Youth who have experienced trauma need to feel safe and cared for. With help, youth 

can develop resilience—the ability to cope with and recover from challenges.10 A key 

to resilience is strong relationships with supportive adults. 

You can support youth in developing a positive sense of who they are and what 

they’re capable of achieving. Focus more on what youth can do rather than what 

they cannot do. Here are some suggestions:

• Help youth gradually take on responsibilities and develop new skills. 

• Promote healthy social interaction, peer support, and a sense of belonging.

• Let youth participate in “normal” activities that other youth participate in (such as 

afterschool activities, sleepovers, and social media).

• Listen closely to what youth tell you.

• Have fun together.

Another important way you can help youth who have experienced trauma in their 

healing process is to help them get trauma-focused treatment. Find out whether 

youth have received trauma screening and assessment by a professional trained 

to recognize trauma. (Assessment and treatment are discussed further in Chapters 

3 and 4.)

10 Jim Casey Youth Opportunities Initiative. (2012). Promoting development of resilience among young people in foster care. Retrieved 

from http://jimcaseyyouth.org/sites/default/files/documents/Issue%20Brief%20-%20Resilience.pdf

KEEP IN MIND

Youth in foster care 

often feel abnormal, 

“damaged,” and alone. 

Remind youth that 

what they’re feeling and 

experiencing is a normal 

response to trauma. Let 

them know they can take 

time to heal and that they 

have your support.
12 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

TIPS FOR HELPING YOUTH WITH TRAUMA HISTORIES*

Here are ways you can help youth manage overwhelming emotions and behaviors that result from trauma:

 Tune into youth’s emotions. Let youth share feelings without being judged. Remind them that their 

feelings and reactions are normal given past experiences. Be sensitive to youth’s needs, particularly when 

moving to a new home environment. You can help youth who may not know how to put their feelings into 

words with statements like “It sounds like you are feeling really frustrated...” or “Some young people might 

feel angry in that situation, how about you?” 

 Identify “triggers.” Triggers are reminders of traumatic events (people, places, sounds, smells, words, 

etc.). While youth may not be aware of specific triggers, they may feel nervous or stressed around them. 

Notice and try to lessen the things that make youth anxious. Talk with a therapist about helping youth 

learn positive ways to identify and deal with triggers.

 Remain calm. When youth become overwhelmed and upset, don’t yell or match their tone. Lower your 

voice and acknowledge the seriousness of the situation and feelings.

 Be available. Stay emotionally and physically available, even if youth keep you at a distance. Be ready to 

listen and don’t avoid difficult topics or uncomfortable conversations.

 Be consistent and predictable. Do what you say you’re going to do. This can help build trust. With youth 

input, set routines and schedules that let them know what to expect.

 Promote peer support. Encourage youth participation in group activities, such as clubs, teams, cultural 

groups, or church or other faith community groups. Help youth find support networks of youth with similar 

backgrounds. (See, for example, https://www.fosterclub.com/.)

 Speak of youth’s families in positive yet realistic terms. You can say, for example, “I hear you’re 

disappointed in your mother because she didn't show up for the visit. I know this is hard. She loves you 

but has a tough time making good choices sometimes.”

 Be a role model. Model positive behavior in how you express your emotions, deal with frustration, and 

show respect for youth and others. 

 Be patient. Learning to trust will not happen overnight!

* Adapted from American Academy of Pediatrics, & Dave Thomas Foundation for Adoption. (2013) Parenting after trauma: Understanding your child’s needs. A guide for foster 

and adoptive parents. Retrieved from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Documents/FamilyHandout.pdf; 

National Child Traumatic Stress Network. (2010). Caring for children who have experienced trauma: A workshop for resource parents. Retrieved from http://learn.nctsn.org/

course/view.php?id=67
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 1 3

Learn more about supporting youth who have experienced trauma:

Resources for foster parents and other caregivers:

• American Academy of Pediatrics, Parenting After Trauma: Understanding Your 

Child’s Needs, at 

https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/

healthy-foster-care-america/Documents/FamilyHandout.pdf

• Child Welfare Information Gateway, Parenting A Child Who Has 

Experienced Trauma, at 

https://www.childwelfare.gov/pubs/factsheets/child-trauma/

• National Child Traumatic Stress Network, Resources for Parents and 

Caregivers [website], at 

http://www.nctsn.org/resources/audiences/parents-caregivers#q7

• National Child Traumatic Stress Network, Complex Trauma: Facts 

for Caregivers, at 

http://www.nctsn.org/sites/default/files/assets/pdfs/complex_trauma_caregivers_final.pdf

• National Child Traumatic Stress Network, Caring for Children Who 

Have Experienced Trauma: A Workshop for Resource Parents, at 

http://www.nctsn.org/products/caring-for-children-who-have-experienced-trauma

Resources for child welfare workers and supervisors:

• Chadwick Center for Children and Families, Desk Guide on Trauma-Informed Mental 

Health for Child Welfare, at http://www.chadwickcenter.org/CTISP/images/TICWPracticeToolkit.pdf

• Child Welfare Information Gateway, Trauma [website], at 

https://www.childwelfare.gov/topics/systemwide/mentalhealth/common/trauma/

• National Child Traumatic Stress Network, Child Welfare Trauma Training Toolkit, at 

http://www.nctsn.org/products/child-welfare-trauma-training-toolkit-2008

• National Technical Assistance Center for Children’s Mental Health, Trauma 

Informed Care: Perspectives and Resources [website], at 

http://gucchdtacenter.georgetown.edu/TraumaInformedCare/index.html

Learn more about building resilience:

• American Psychological Association, Resilience Guide for Parents and Teachers, at 

http://www.apa.org/helpcenter/resilience.aspx#

• Jim Casey Youth Opportunities Initiative, Promoting Development of Resilience 

Among Young People in Foster Care, at 

http://jimcaseyyouth.org/promoting-development-resilience-among-youngpeople-foster-care
14 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

Learn more about youth's behavioral/mental health needs: 

• American Academy of Child and Adolescent Psychiatry, Family Resources 

[website], at 

http://www.aacap.org/AACAP/Families_and_Youth/Family_Resources/Home.aspx

• Find Youth Info, Youth Mental Health [website], at 

http://findyouthinfo.gov/youth-topics/youth-mental-health/mental-healthdisorders

• National Institute of Mental Health, Publications About Children and Adolescents 

[website], at 

http://www.nimh.nih.gov/health/publications/children-and-adolescents-listing.

shtml
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 1 5

3 UNDERSTANDING DIFFERENT TREATMENTS

This chapter describes different treatments that can be used to help youth heal from 

trauma. Effective treatments can improve youth’s well-being, placement stability, 

and transition to healthy adulthood. Youth may benefit from different treatments, 

including therapy and other alternatives to medication. (Chapters 4 and 5 provide 

more guidance on steps you can take to help youth and find the right treatment for 

each young person.) 

How is treatment different for youth who have 

experienced trauma?

A trauma-informed approach recognizes trauma symptoms and the impact of 

trauma on youth’s thoughts, feelings, and behaviors.11 A trauma-informed approach 

asks “What happened to you?” instead of “What’s wrong with you?”12 Such an 

approach also helps foster parents, caseworkers, and service providers interact with 

youth in a way that prevents additional trauma.

Trauma-focused (or trauma-specific) treatments look for root causes and not just 

the resulting symptoms (depression, an inability to concentrate, an eating disorder, 

etc.). Trauma-focused treatment can help youth understand how trauma affects their 

emotions and how to cope with related feelings.

Trauma-focused treatment generally supports youth with the following:

• Identifying their feelings and managing anxiety, sadness, anger, and other difficult 

emotions

• Understanding the connection between thoughts, feelings, and behaviors 

• Learning to replace hurtful thoughts with more helpful ones

• Reframing traumatic experiences so that they are viewed as only one part of 

many life experiences

• Learning about personal safety and how to develop healthy boundaries

• Identifying strengths that help them cope with ongoing grief, loss, and uncertainty 

in foster care13

11 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s 

concept of trauma and guidance for a trauma-informed approach. Retrieved from http://store.samhsa.gov/shin/content//SMA14-4884/

SMA14-4884.pdf

12 National Technical Assistance Center for Children’s Mental Health, & JBS International. (2014). Trauma informed care: Perspectives 

and resources. Retrieved from http://gucchdtacenter.georgetown.edu/TraumaInformedCare.html

13 Chadwick Trauma-Informed Systems Project. (2012). Creating trauma-informed child welfare systems: A guide for administrators. 

Retrieved from http://www.chadwickcenter.org/CTISP/images/CTISPTICWAdminGuide2ndEd2013.pdf
16 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

You can speak with health- and mental health-care providers to find out more about 

what trauma-focused options are appropriate for youth in your care. When programs 

or providers trained in research-based, trauma-focused treatment are not available 

in youth’s communities, you can look for other services by professionals who may 

not be trained in specific research-based treatments yet have an understanding of 

trauma and its effects. 

Learn more about evidence-based, trauma-focused treatment:

• California Evidence-Based Clearinghouse for Child Welfare, Trauma 

Treatment [website], at

http://www.cebc4cw.org/topic/trauma-treatment-for-children/

• National Child Traumatic Stress Network, Empirically Supported 

Treatments and Promising Practices [website], at 

http://www.nctsnet.org/resources/topics/treatments-that-work/

promising-practices

• National Technical Assistance Center for Children’s Mental Health, 

Evidence-Based Treatments Addressing Trauma [website], at 

http://gucchdtacenter.georgetown.edu/TraumaInformedCare/

Module4.html

• Substance Abuse and Mental Health Services Administration, 

National Registry of Evidence-based Programs and Practices 

[website], at 

http://www.nrepp.samhsa.gov

How can therapy help?

Approaches other than medication, particularly therapy or counseling, can help 

youth cope with their thoughts, feelings, and behaviors and contribute to healing. 

Health- and mental-health experts advise that, ideally, therapy should be considered 

before or at the same time as psychotropic medication.14

Therapy can help identify and address the root causes of youth’s emotions and 

behaviors. As previously discussed, trauma-informed therapists can help youth 

better understand their traumatic experiences and identify ways to manage resulting 

stress, difficult emotions, and behaviors. Through therapy, youth receive emotional 

support and encouragement in trying new strategies to build healthy behaviors. 

Talk with the mental health professional and the young person to find the approach 

(or combination of approaches) that best fit each young person’s needs. Also, it will 

be important for you and the young person to work with treatment providers to 

14 American Academy of Child and Adolescent Psychiatry. (2012). A guide for community child serving agencies on psychotropic 

medications for children and adolescents. Retrieved from http://www.aacap.org/App_Themes/AACAP/docs/press/guide_for_community_child_serving_agencies_on_psychotropic_medications_for_children_and_adolescents_2012.pdf; American Academy of 

Pediatrics. (n.d.). Mental and behavioral health. Retrieved from http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/

healthy-foster-care-america/Pages/Mental-and-Behavioral-Health.aspx
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 1 7

ensure the young person receives help that is sensitive to his or her cultural and 

sexual identities. (See also the section in Chapter 5, "How can you support youth 

participating in therapy or other helpful approaches?")

Learn more about counseling and therapy: 

• American Academy of Child and Adolescent Psychiatry, Facts for Families: 

Psychotherapies for Children and Adolescents, at 

http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_

Families_Pages/Psychotherapies_For_Children_And_Adolescents_86.aspx

• National Child Traumatic Stress Network, Resources for Parents and Caregivers 

[website], at 

http://www.nctsn.org/resources/audiences/parents-caregivers

• National Institute of Mental Health, Psychotherapies [website], at 

http://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml

What other approaches can be helpful?

In addition to therapy, other helpful approaches may be considered instead of or in 

addition to medication. Work with youth and health- or mental health-care providers 

to explore appropriate options:

• Meditation, exercise, and changes in diet. Exercise for the mind and body can 

help youth reduce stress and feel calmer. Changes in food and getting enough 

sleep also may boost mood and energy levels.

• Self-expression. Keeping a journal, doing art work, participating in social media, 

and similar activities can help youth explore their emotions and identities.

• Family routines. Spending time together, creating new traditions, and having fun 

with other foster family members can build ties and offer an emotional lift.

• Clubs or volunteer activities. Group activities and “giving back” can help youth 

experience a valuable sense of belonging to a community, group, or cause.

• Faith and cultural activities. Cultural practices and being part of a faith community (church, synagogue, mosque, etc.) can help strengthen youth’s sense of identity, 

serve as protective factors, and contribute to healing. 

• Traditional healing approaches. Youth and their families may have preferences 

for practices that fit with their cultural beliefs and traditions.

Refer youth to Section #3 of Making Healthy Choices (Considering 

Your Options) and talk about which approaches they may want 

to explore.

KEEP IN MIND

Some youth may not 

be ready right away to 

discuss the trauma that 

they have experienced. 

A good, trauma-informed 

counselor or therapist 

will know when and how 

to help youth talk about 

their pasts.
18 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

Learn more about healthy approaches to youth wellness:

• Mental Health America, Living Well [website], at

http://www.mentalhealthamerica.net/live-your-life-well

• National Center for Complementary and Integrative Health, Mind and Body 

Practices [website], at

http://nccam.nih.gov/health/mindbody

• National Clearinghouse on Families and Youth, Creative Coping: Using the Arts 

to Foster Youth Engagement and Resilience, at

http://ncfy.acf.hhs.gov/features/thinking-creatively-family-and-youth-work/

creative-coping
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 1 9

What is the possible role of psychotropic medication?

Psychotropic medications are drugs that target the brain and affect a person’s mind, 

emotions, moods, and behaviors. Studies have found them to be effective for 

specific conditions. Psychotropic medications include antianxiety medications, 

antipsychotics, antidepressants, mood stabilizers, sleep medications, stimulants 

and other medications for attention deficit/hyperactivity disorder, and others. 

Doctors may prescribe such medications to help youth control symptoms and 

function better at home, in school, and in the community. Sometimes, long-term use 

of medications is needed to treat specific mental health disorders, like schizophrenia. 

Other times, medications may be used for a short time to lessen symptoms while a 

healing process begins. Medication should be only one part of a comprehensive 

treatment plan. 

Psychotropic medications may have serious, mild, or no side effects. Side effects can 

be very different for different people and may include the following:

• Stomach upset or headaches

• Appetite loss or weight gain

• Sleepiness or sleep problems 

• Nervousness, tearfulness, or irritability

• Disturbing thoughts 

• Medical problems, such as a racing heart or dizziness

• Long-term illness

In recent years, many people have become concerned about the inappropriate use 

of psychotropic medications among youth in foster care for a number of reasons: 

• Many youth in foster care who may need counseling and other trauma-focused 

mental health services do not receive them.

• There are potential serious side effects to many psychotropic medications.

• The medications have not been tested widely with children and youth.

• Dosages are often higher than might be normally used.

• Monitoring of medications is not always well coordinated across all individuals 

involved in youth’s treatment. 

• When prescribers are not aware of all medications youth are taking, some youth 

may be prescribed several different drugs that have unintended interactions.

The decision to use psychotropic medication should never be made lightly.

If a doctor or specialist recommends the use of psychotropic medications for youth 

in your care or supervision, there are important things to consider in making an 

informed decision. Considerations include benefits, risks, side effects, and youth 

and family preferences. (See questions on page 30.)

KEEP IN MIND

While medications may 

have benefits for some 

youth, they should not be 

seen as the only solution 

or as a quick fix.
20 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

Learn more about psychotropic medication:

Resources for foster parents and other caregivers:

• American Academy of Child and Adolescent Psychiatry, Psychiatric Medication for 

Children and Adolescents Part 1—How Medications Are Used, at 

http://www.aacap.org/aacap/Families_and_Youth/Facts_for_Families/Facts_for_

Families_Pages/Psychiatric_Medication_For_Children_And_Adolescents_Part_I_

How_Medications_Are_Used_21.aspx

• American Academy of Child and Adolescent Psychiatry, Psychiatric Medication for 

Children and Adolescents: Part II—Types of Medications, at 

http://www.aacap.org/aacap/Families_and_Youth/Facts_for_Families/Facts_for_

Families_Pages/Psychiatric_Medication_For_Children_And_Adolescents_Part_II_

Types_Of_Medications_29.aspx

• National Institute of Mental Health, Mental Health Medications [website], at 

http://www.nimh.nih.gov/health/publications/mental-health-medications/index.

shtml

Resources for child welfare workers and supervisors:

• Children’s Bureau, Information Memorandum on Promoting the Safe, Appropriate, 

and Effective Use of Psychotropic Medication for Children in Foster Care (IM-12-03), at 

http://www.acf.hhs.gov/programs/cb/resource/im1203

• Child Welfare Information Gateway, Use of Psychotropic 

Medications [website], at 

https://www.childwelfare.gov/systemwide/mentalhealth/ 

effectiveness/psychotropic.cfm
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 2 1

4 S E E K I N G H E L P F O R YO U T H

You are one of the adults who can assist youth in recognizing that they may need 

help. This chapter will help you recognize warning signs that youth are struggling and 

suggest steps you can take to get help.

TIPS FOR RECOGNIZING AND ADDRESSING YOUTH NEEDS

Taking time to build connections with youth and nurture their trust is a critical first step in understanding their 

needs and strengths. Here are some other important things you can do:

 Be aware of signs and symptoms that youth may be struggling with emotions, thoughts, or behaviors.

 Reassure youth that symptoms may be a normal reaction to what has happened to them.

 Focus on youth strengths and resources as well as needs.

 Let youth know there are adults in their lives who are there to support them.

 Listen carefully and calmly to what youth have to say.

 Remain in contact with others who are involved in youth’s lives, such as caseworkers, caregivers, teachers, 

coaches, health- and mental health-care providers, and family members.

 Raise your concerns and ask for help from specialists. 

How do you know youth are struggling and may need help?

These are some warning signs that youth may be struggling:

• Physical symptoms, such as illness, headaches, weight loss or gain, or sleep 

problems

• Concerning behaviors or changes in behavior at home, school, or work

• Relationship problems, such as trouble with friends or a lack of friends 

• Troubling thoughts and feelings, such as feeling very sad or lost, having emotions 

that change quickly, overreactions, or unexplained fears

• Risky or dangerous behaviors, such as setting fires, cruelty to animals, drug or 

alcohol abuse, or inappropriate sexual behavior

KEEP IN MIND

Making the decision to 

seek help for a young 

person is not easy. There 

is not always one right or 

wrong answer.
22 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

Not all young people who have experienced trauma or who need help will show 

these signs. Also, not all youth who experience an occasional symptom will need 

treatment. You need to consider how frequent and how serious the symptoms are. 

If you have questions or concerns, talk with a doctor.

Section #1 of Making Healthy Choices, Recognizing You Need 

Help, provides symptom checklists for youth to record the ways 

they are feeling and behaving. You may go through the symptom 

checklists with youth or suggest other adults with whom they 

might feel more comfortable talking about concerns. Talk with 

youth about what you or others have noticed during your time 

together. It’s important for youth to have honest feedback so 

that they can better understand their strengths and needs. 

If you have concerns and a young person is unwilling to talk about his or her 

symptoms, try to quickly coordinate a team meeting with the caseworker, 

caregiver, and family members who are involved with the young person. The team 

should brainstorm options that are available to engage the young person and help 

him or her access needed services. Let the young person know up front that you 

are concerned about him or her and need to ask for help. 

How do you get a professional assessment and evaluation?

Based on the symptoms a young person exhibits, you may want to talk with him or 

her about requesting a professional assessment. This may take place in a two-step 

process:

1.The young person may complete an assessment with his or her primary care 

doctor. By consulting first with a primary care doctor, the young person can create 

a “medical home” that helps coordinate services over time.

2. If the primary care doctor determines that a more comprehensive mental health 

evaluation is needed, the doctor may refer the young person to a behavioral/

mental health specialist, such as a psychiatrist or psychologist.

Caregivers and caseworkers are encouraged to work together with youth to 

identify an appropriate mental health specialist. Some child welfare agencies have 

designated service providers (through Medicaid or a special contract) that will be 

contacted for an evaluation.

When looking for a mental health specialist, consider providers who:

• Specialize in working with teens

• Have experiences with youth in foster care or high-risk youth

SEEK IMMEDIATE 

HELP from a doctor 

or mental health 

professional if you 

suspect a young person 

is experiencing any of 

the following:

• Thoughts of hurting 

him or herself or 

attempting suicide

• Thoughts about 

hurting someone else

• Feeling depressed, 

hopeless, or worthless 

for several days and 

being unable to take 

care of himself or 

herself

• Hearing or seeing 

things that others do 

not hear or see
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 2 3

• Are familiar with the signs and symptoms of trauma and trauma-focused 

treatment 

• Have experience working with youth from the youth’s culture, ethnicity, and/or 

sexual identity (if this is not possible, make efforts to provide relevant cultural 

information to the provider)

• Conduct interviews with youth and their families (foster parents and/or birth family 

members) as part of the evaluation

• Work with the school to find out if the child has a learning disability, communication 

delay, or other issue that may affect their learning or emotions

For questions to ask providers, see the "How do you find a treatment provider?" 

section of this chapter.

KEEP IN MIND

The first weeks in foster 

care are a major adjustment period. Youth may 

need time to process the 

big changes in their lives. 

They need additional 

support as well as time to 

have some fun. 

INFORMATION TO PROVIDE DOCTORS OR SPECIALISTS BEFORE AN 

ASSESSMENT OR EVALUATION

Make sure that health- and mental health-care providers have as much information as possible to develop a 

full understanding of youth during assessments or evaluations. Caregivers, caseworkers, and youth can 

partner to provide information, as available and appropriate, about a variety of topics:

 Current symptoms and concerns 

 Developmental, medical, mental health, and trauma history 

 Strengths and interests, including hobbies

 Family information, including supports and stressors, reason for the youth’s out-of-home placement, and 

current involvement with birth family members

 Child welfare involvement, placement history (length of time in care and number of placements), and 

permanency goals

 Education status (including copies of past and current educational testing and individualized education 

programs [IEPs] or other school intervention plans) and any concerns about behavior or learning raised by 

teachers

 Social or community factors that affect youth and their families 

 Records of previous medication and nonmedication treatment (e.g., counseling)

 Input from other professionals involved with youth and their families (e.g., teachers, coaches, juvenile 

justice professionals)
24 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

Learn more about the screening, assessment, and evaluation of 

mental health issues:

• California Evidence-Based Clearinghouse for Child Welfare, Child Welfare 

Measurement Tools [website], at

http://www.cebc4cw.org/assessment-tools/

• Center for Health Care Strategies, Clinical and Functional Well-being Assessments: 

Technical Assistance Tool, at

http://www.chcs.org/media/Clinical-and-Functional-Well-Being-Assessments_

FINAL.pdf

• National Child Traumatic Stress Network, Assessment of Complex Trauma 

[website], at

http://www.nctsn.org/trauma-types/complex-trauma/assessment

• U.S. Substance Abuse and Mental Health Services Administration, Identifying 

Mental Health and Substance Use Problems of Children and Adolescents: A Guide for 

Child-Serving Organizations, at

http://store.samhsa.gov/shin/content/SMA12-4700/SMA12-4700.pdf

How is a treatment plan made? 

The assessment or evaluation should support the development of an individualized 

treatment recommendation. Some evaluations may result in a diagnosis, while 

others may rule out diagnoses (that is, they may determine that the youth does not

have a certain condition that was thought possible). Depending on a young person’s 

specific diagnosis (if any), needs, and circumstances, recommendations may include 

KEEP IN MIND

A written diagnosis can 

be very scary for youth. 

It can feel like they are 

being negatively labeled. 

They may have concerns 

based on other people 

they know with similar 

diagnoses. It’s essential 

that adults provide a lot 

of reassurance that a 

diagnosis does not set 

the path of the young 

person’s life.
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 2 5

therapy and other types of nonmedication treatment. Medication, if considered, 

should be a last resort and should be used in combination with therapy and other 

nonmedication treatments. 

It’s very important to talk about assessment and evaluation findings with youth. 

The specialist who conducted the evaluation should go over the results with the 

young person. It’s helpful for the specialist to explain any diagnoses and treatment 

recommendations in a positive way using words the young person understands. For 

example, the specialist might emphasize that seeking treatment is a positive step 

in dealing with past trauma and is not a sign that something is wrong with the 

young person. Also, the young person may disagree with a diagnosis. As such, it 

is important for the specialist to take time to explain what led to the diagnosis and 

openly discuss any concerns.

The doctor, caseworker, caregivers, and young person should talk about a plan for 

treatment that includes approaches other than medication. Medication also may be 

recommended if appropriate for the diagnosis. The young person’s biological family 

should be involved in this discussion as long as they are still involved in the young 

person’s life and there are no safety concerns. As always, talk with the young person 

before sharing information. (See “A few words about confidentiality” on page 5.)

When talking about treatment plans, consider the following:

• Expected treatment results and benefits

• Negative side effects and possible risks of treatment

• How long treatment will take

• What research says about “what works” for youth

• The young person’s and his or her family’s preferences and concerns 

Refer youth to Sections #3 (Considering Your Options) and #4 

(Making Your Decision) of Making Healthy Choices. Point out 

questions youth can ask and worksheets that explore pros 

and cons.

What is informed consent?

Informed consent is a process in which doctors or specialists provide information 

about possible treatment options to youth and the people responsible for making 

health decisions for those youth (parents, guardians, child welfare administrators/

supervisors, courts, or others). This information should include treatment benefits 

and risks and factors that might support or interfere with treatment effectiveness. 

KEEP IN MIND

When helping youth 

make decisions about 

treatment and medication, it’s important 

to take a look at your 

own biases. Be aware of 

how your own trauma 

history, attitudes about 

medication or therapy, 

and beliefs may affect 

the guidance that you 

provide to youth.
26 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

Each State has different laws and policies about informed consent for psychotropic 

medication and youth in foster care. These laws and policies guide the following:

• Who is allowed to make the final treatment decision (child welfare agency staff, 

health administrators, courts, parents, guardians, or others)

• Which procedures must be followed in obtaining consent

• Requirements for youth assent (agreement)

Know the laws and policies in your State, as well as your responsibility in 

decision-making. If you are a foster parent and have questions about legal rights, 

ask your caseworker. If you need additional information, contact a State or district 

child welfare attorney, a guardian ad litem (GAL), or a court-appointed special 

advocate (CASA).

Refer youth to Section #2 of Making Healthy Choices (Knowing 

Your Rights and Who Can Help) so they understand informed 

consent and their rights related to health care and medication.

QUESTIONS TO ASK ABOUT INFORMED CONSENT

Here are questions to ask to learn more about informed consent policies in 

your State:

 How is informed consent defined in my State?

 Who has the right to make decisions about youth’s health treatment?

 What steps or protocols are required before decisions can be made?

 If psychotropic medications are going to be prescribed, who must be 

notified?

 What is the role of the birth parents/guardians in health decision-making?

 What is the role of youth in making decisions regarding treatment options? 

How can a planning team help?

Making decisions about assessment and treatment should not be the 

responsibility of just one person. If a planning team is not already in place, you 

and the young person may consider asking to have one established to provide 

input and guidance about health-care decisions. 
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 2 7

Planning teams should include youth. While some young people may not want to 

participate at first, always encourage their involvement in decision-making and ask 

who else they would like to have involved. If the youth are over the age of consent in 

your State, they must agree before information is shared with others.

The planning team may include:

• Youth

• Individuals selected by youth (peers, mentors, teachers, coaches, etc.)

• Caseworkers and supervisors

• Birth parents, siblings, or other family members (if they are involved with youth’s 

health care)

• Foster parents or guardians

• Attorneys, guardians ad litem (GAL), or court-appointed special advocates (CASA) 

(people assigned by a judge to look out for the youth’s best interests while in care) 

• Doctors, nurses, or other medical professionals who help with youth’s health care

• Behavioral/mental health specialists

• Independent living or other service providers 

When forming a planning team, youth can complete the 

Worksheet on Who Can Help Make Decisions in Section #2 of 

Making Healthy Choices (Knowing Your Rights and Who Can Help). 

Ask youth if there are trusted people that they would like to 

include on the team.

KEEP IN MIND

Youth should be actively 

involved in planning and 

decision-making 

activities. When youth 

are involved in making 

decisions, they are more 

likely to participate in 

treatment, and they 

build their decisionmaking skills for when 

they leave care.
28 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

How do you find a treatment provider?

Foster parents, caseworkers, youth, and others on youth’s planning teams can work 

together to identify appropriate treatment providers. Ask questions of potential 

providers to find a good fit with youth’s needs (see box).

QUESTIONS TO ASK POTENTIAL TREATMENT PROVIDERS WHEN 

SEEKING HELP*

Experience and approach

 What is your approach or philosophy in working with youth?

 What is your experience in working with youth with issues like the ones this young person has?

 Are you aware of effective treatments for this young person’s issues?

 In what ways will treatment be sensitive to the young person’s cultural and sexual identity? 

 Are you open to incorporating cultural, religious, or spiritual beliefs and practices into treatment?

Trauma-informed treatment

 Are you familiar with the research on the effects of trauma on children and youth? 

 What is your experience working with youth who have experienced trauma?

 How do you determine whether youth’s emotional and behavioral symptoms may be caused by trauma?

 How do trauma symptoms influence the way you provide treatment?

School partnership

 How will you work with youth’s schools to make sure that there aren’t learning issues that are negatively 

affecting the youth?

 How will you work with the school to find out if a medication (if any is taken) is working or is leading to side 

effects that could impact school performance? 

Caseworker/caregiver involvement

 How involved will I be in setting goals and participating in treatment? 

 How will I know if the young person is getting better?

 How will you keep me informed of progress?

*Adapted from Find Youth Info. (2013). Treatment options for youth with mental health disorders. Retrieved from http://www.findyouthinfo.gov/youth-topics/youthmental-health/treatment-options-youth-mental-health-disorders
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 2 9

For information on finding treatment providers 

and services:

• American Psychological Association, Psychologist 

Locator [website], at

http://locator.apa.org/

• National Child Traumatic Stress Network, Finding 

Help [website], at

http://www.nctsnet.org/resources/audiences/parents-caregivers/finding-help

• Substance Abuse and Mental Health Services 

Administration, Behavioral Health Treatment 

Services Facility Locator [website], at 

https://www.findtreatment.samhsa.gov/

What questions should you ask providers about medication 

and treatment plans?

When a treatment plan has been recommended, there is a lot of information to 

consider. Some questions to ask when making decisions about medication and other 

treatment options are on page 30 of this guide. 

Doctors should let youth know when information is being shared with caregivers or 

caseworkers. If youth are over the age of majority in your State, they must consent 

before information is shared with anyone.

KEEP IN MIND

If you or the young 

person are worried about 

the type or number of 

medications prescribed, 

or how medication is 

being monitored, you 

may want to request a 

second opinion from 

another behavioral/

mental health 

professional. Ask youth to look at Section #4 of Making Healthy Choices 

(Making Your Decision) for additional questions they may 

want to ask doctors or specialists about treatment plans or 

medications.
30 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

QUESTIONS TO ASK PROVIDERS ABOUT MEDICATION 

RECOMMENDATIONS*

Diagnosis

 What is the young person’s diagnosis (or diagnoses)?

 What symptoms led you to this conclusion?

General information about medication

 What diagnosis or symptoms is medication being prescribed for?

 What is the name of the medication? Is it known by other names? Is a generic version available? 

 How, when, and for how long should this medication be taken? Is a refill needed? If so, when and how can 

we get the refill (e.g., is an appointment needed first)? 

 Is there written information available about how to use the prescribed medication?

 Should the medication be taken with or without food?

 What foods, drinks, other medicines, or activities should the youth avoid while taking this medicine?

 Are there any laboratory tests (blood tests, heart tests, etc.) that need to be done before the youth begins 

taking the medication?

 How should the medicine be stored?

 When and how should the young person stop taking the medication?

Benefits of the medication

 How will this medication help this young person? 

 What is known about this medication’s helpfulness with other youth who have similar conditions? 

 How long will it take before we see improvements in emotions or symptoms?

Potential side effects of the medication and safe-use measures

 Is there written information available about potential side effects?

 What side effects should I keep in mind? Can they be prevented?

 What should I do if the young person experiences these side effects?

 Will the medication interact with other medications (prescription or over-the-counter medication) the 

young person currently takes? 

continued on next page
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 3 1

QUESTIONS TO ASK PROVIDERS ABOUT MEDICATION 

RECOMMENDATIONS* CONTINUED FROM PREVIOUS PAGE

 What should the young person do if a dose is missed?

 Is this medication addictive? Can it be abused?

 What should I do if I become aware that the medication is being used for recreational purposes?

 What should I do if the young person attempts to commit suicide using this medication?

Monitoring medication

 How will we know if the medication is working?

 What should I watch for while the young person is taking the medication?

 How often should the young person see the doctor (or specialist) who prescribed the medication?

 What follow-up tests need to be conducted? How often? Who will order such tests?

 If prescribed to be a temporary treatment, when will we know it is safe to discontinue use?

Alternatives and options

 Are there alternative treatment options available that do not include a prescribed medication?

 Are there other types of treatment that should be used in combination with medication (counseling, 

exercise, changes in diet, physical therapy, or faith or cultural activities)?

*Adapted from the American Academy of Child and Adolescent Psychiatry. (2012). Psychiatric medications for children and adolescents part III: Questions to ask. 

Retrieved from http://www.aacap.org/App_Themes/AACAP/docs/facts_for_families/51_psychiatric_medication_for_children_and_adolscents_part_three.pdf. 

Reprinted with permission from the American Academy of Child and Adolescent Psychiatry ©2014. All rights reserved.
32 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

M O N I TO R I N G T R E AT M E N T A N D 5 SUPPORTING PROGRESS

Addressing the behavioral/mental health needs of youth in care is an ongoing 

process. This chapter talks about how you can support youth in whatever treatment 

they need.

INFORMATION NEEDED BY NEWLY ASSIGNED CASEWORKERS 

AND CAREGIVERS

For newly assigned caseworkers and new caregivers of youth who are already on medication, make sure you 

obtain the following information as soon as possible:

 Names of medication(s) the young person is currently taking or recently was prescribed

 Date the young person started taking the medication and the reason for the prescription

 Young person’s experience with medication, including any side effects

 Date when the young person was last evaluated and date scheduled for follow-up, if any

 Most recent formal assessment or evaluation (such as psychological assessment) to understand the 

current diagnosis and treatment recommendations

 Date of the young person’s last physical examination (check-ups should occur at least once a year and 

perhaps more frequently) 

 Date when any current prescriptions will run out and need renewal

How can you support youth in taking medication safely?

You can play an important role in helping make sure that medicine is taken safely and 

that any concerns are addressed.

• Talk with the prescribing doctors/specialists about medication use and 

monitoring. See the questions on page 30. Engage youth in discussions with 

the doctors about expected results and when you and the youth should expect 

to see changes.
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 3 3

• Ask questions of the pharmacists filling the prescriptions. The pharmacist can 

provide information about how to use the medication, side effects, potential 

interactions with other medicines, etc.

• Keep medications secure. All medication in foster homes should be kept in locked 

areas and given out by foster parents. 

• Make sure that youth are taking the medication as instructed and following 

other treatment recommendations. 

• Encourage youth to talk openly to you, their providers, or other trusted adults 

about progress, concerns, and how they feel treatment is, or is not, helping. 

Ask youth if they are experiencing side effects.

• Assist youth in understanding their rights in using (or declining to use) 

medications and understanding other options. (Refer to Section #2 of 

Making Healthy Choices.) 

• Assist youth in obtaining a copy of their medical records for future use.

Write the name of each medication taken, for how long, and its effects. 

KEEP IN MIND

When youth begin to feel 

better, they may want to 

stop medication or other 

treatment. Suddenly 

stopping certain 

medications can have 

harmful side effects. 

Instead, youth should 

talk with their doctors or 

mental health specialists 

about when and how 

to safely stop taking 

medications.

Section # 5 of Making Healthy Choices (Maintaining Treatment) 

talks about continuing and stopping treatment. Take some 

time to review this information with youth in your care or 

supervision. 
34 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

How can you support youth participating in therapy or 

other helpful approaches?

Support systems are an important part of the treatment process. As with medication, 

it is helpful to check in routinely with youth and their treatment providers to see how 

youth are doing in therapy or other approaches. Observe youth’s emotions and 

behaviors, and talk with therapists or other providers about signs of progress. 

Support youth in practicing new strategies for managing emotions and behaviors.

QUESTIONS TO ASK YOUTH ABOUT THERAPY 

You may want to have conversations with youth about their treatment as a way of showing support and 

checking in to see if therapy is helpful to them. 

 Do you feel as if you can be honest and open with this therapist about what you are feeling and 

experiencing? 

 Are you able to understand what the therapist says to you? Does he/she offer helpful advice and 

suggestions to you?

 Since you’ve been in therapy, in what ways do you think you’ve changed? Do you feel more hopeful that 

you will achieve your goals?

 Do you feel like you’re starting to understand yourself better?

 Are you learning skills from your therapist about how to handle emotions and/or change behaviors?

 How can I best support you while you are in therapy? What is most and least helpful?

How can you watch for changes and check progress 

over time?

Assessing youth’s progress in treatment is important to ongoing care. Youth and 

their service providers should talk about their expectations and goals for treatment 

outcomes and regularly assess progress toward those goals. Having clear, realistic 

goals and expectations at the beginning of treatment will help guide later 

assessments of whether treatments are “working.”

After a period of time in treatment, ask youth to go back 

through the symptom checklists in Section #1 of Making Healthy 

Choices (together with caseworkers or caregivers, if youth so 

choose). Look for changes in symptoms, feelings, or behaviors 

that had previously been a concern. 
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 3 5

Caregivers and/or caseworkers who can provide feedback about youth’s behaviors, 

moods, etc., are encouraged to go with youth to their appointments. First, let youth 

know that you would like to provide feedback to their doctors or therapists and what 

kind of information you’d like to share. Consider the following areas:

• Compliance with prescribed medications (do youth take the required dosages 

regularly?) 

• Any changes in behavior, mood, appetite, sleep habits, weight

• How youth are functioning in school, work, and personal relationships

• Any physical health reactions (stomachaches, nausea, headaches, rashes)

• Any significant events since the last appointment (placement changes, legal status 

changes, separation from siblings, issues related to visits with family members)

• Any suspected or confirmed drug or alcohol use

• Whether desired changes in emotional well-being or behaviors specific to youth’s 

goals for treatment are being achieved and how youth are reacting to such changes

KEEP IN MIND

Therapy may bring up 

memories and trigger 

emotions that don’t 

always feel pleasant. This 

doesn’t mean that the 

therapy is not effective. 

Making peace with the 

past is an important part 

of a young person’s 

journey of healing.

Involve youth in assessing progress. Talk with youth about what you have noticed, 

such as changes in physical reactions (for example, fewer stomachaches), moods 

(calmer), or behaviors (fewer angry outbursts and paying more attention in school). 

Youth may have unrealistic expectations about how medication and therapy will 

or will not help them and how quickly they should be seeing changes. You can help 

youth understand that many things influence changes in their minds and bodies.
36 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

In some cases, you and the young person may find that the current treatment plan is 

not working as well as you and the young person had hoped. A team meeting could 

be held to talk about any concerns with the quality of the providers, the quality of 

treatment, or the need for a second opinion on prescriptions or therapies used. 

How can you help youth who are transitioning out of 

foster care?

When youth are getting ready to transition out of foster care, you can prepare them 

to take care of their ongoing health and mental health needs. This may include 

helping youth with understanding how to accomplish the following: 

• Maintain connections to caring and supportive adults

• Get health insurance, including Medicaid (see text later in this section for more 

information)

• Find affordable, quality health and mental health services

• Continue or discontinue medication safely

• Make doctor’s appointments and go to the pharmacy for medication refills 

(have them practice with your guidance)

• Gather medical records (including information on health-care providers, major 

illnesses and conditions, and treatments and responses)

KEEP IN MIND

Youth are much more 

likely to stay engaged in 

treatment when they 

see that things are 

changing and they are 

feeling better. Take time 

to celebrate progress 

with youth and 

acknowledge their 

commitment to the 

treatment plans. 
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 3 7

A transition plan is a valuable tool for youth leaving care. Federal law requires the 

development of a transition plan during the 90-day period before youth turn 18 

(or older if the State has extended the age at which youth can leave care). This plan 

must be developed in partnership with youth. The plan talks about ways to address 

specific needs after youth leave care, including health and mental health services, 

health insurance, housing, education, employment, and community support.

As part of transition planning, it is important to prevent any gaps in health insurance 

coverage for youth. Medicaid is an important source of health insurance to pay for 

treatment services and supports. Youth leaving foster care at age 18 or older who 

were enrolled in Medicaid while in care are automatically eligible for continued 

Medicaid health insurance coverage up to their 26th birthdays.

Youth who previously aged out of care but are under the age of 26 are also eligible 

for Medicaid coverage until their 26th birthdays. The enrollment process at 

www.healthcare.gov will identify former foster care status and provide information 

on coverage options for youth formerly in foster care. This is also true for youth who 

were enrolled in Medicaid when they left foster care and had a lapse in coverage for 

any reason. Options for health insurance coverage for those 26 and older also can be 

found on www.healthcare.gov.

After you explain to youth that they are eligible for health-care coverage, work with 

them to understand what they need to do to get and stay insured. For example, talk 

about what forms they might need to fill out. 

Learn more about transition planning:

• American Academy of Pediatrics, Moving to Adulthood: A Handout for Youth Aging 

Out of Foster Care, at 

https://www.healthychildren.org/English/family-life/family-dynamics/adoptionand-foster-care/Documents/AAP%20Fostercare_AgingOut_FINAL.pdf

• Child Welfare Information Gateway, Working With Youth to Develop a Transition 

Plan, at 

https://www.childwelfare.gov/pubs/transitional-plan/ 

• Child Welfare Information Gateway, Helping Youth Transition to Adulthood: 

Guidance for Foster Parents, at 

https://www.childwelfare.gov/pubs/youth-transition/ 

• Foster Club, Transition ToolKit, at 

https://www.fosterclub.com/_transition/article/transition-toolkit

KEEP IN MIND

Preparing for adulthood 

should occur over time. 

Young people need 

gradually changing levels 

of responsibility balanced 

with continued support. 

Start early by including 

young teens in 

decision-making and 

planning processes to 

prepare them to make 

decisions on their own. 
38 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

Sit down with youth and talk about “What Should I Do About 

Medication When I’m Leaving Foster Care” in Section #5 of 

Making Healthy Choices. This section addresses some important 

things for youth to know about future medication and 

treatment, health insurance, and medical records.

Learn more about health insurance for youth transitioning out of 

foster care:

• American Academy of Pediatrics, Health Insurance for Youth Who Used to Be in

Foster Care [website], at

https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/

healthy-foster-care-america/Pages/Health-Insurance-Foster-Care.aspx

• Child Welfare Information Gateway, Health-Care Coverage for Youth in Foster Care—

and After, at

https://www.childwelfare.gov/pubs/issue-briefs/health-care-foster

• Healthcare.gov [website], at

https://www.healthcare.gov/

• Young Invincibles [website], at

http://health.younginvincibles.org/
A GUIDE FOR CAREGIVERS AND CASEWORKERS ON TRAUMA, TREATMENT, AND PSYCHOTROPIC MEDICATIONS 3 9

How can you help yourself when working with youth 

in care?

Caseworkers and caregivers may experience stress or secondary trauma symptoms 

when working with youth who have experienced trauma. As you help youth 

address their trauma symptoms and deal with difficult emotions and behaviors, 

it’s important that you have realistic expectations for you, the youth, and your 

relationship. If you have a trauma history of your own, be particularly aware of 

how your feelings and experiences may affect how you react to youth’s trauma. 

Be sure to take care of yourself and find ways to seek support from friends, family, 

and professionals. 

KEEP IN MIND

When you take care of 

yourself, you will be 

better able to help youth 

in your care. 

TIPS FOR SELF-CARE* 

Some things you can do to take care of yourself when working with youth in foster care:

 Live a healthy, balanced life. Eat right, exercise, and get enough rest. Spend time with friends and 

family and do things that bring you joy and relaxation. 

 Know your limits. Set realistic expectations and clear boundaries. Learn to say “no.” 

 Spend some quiet time alone. Make time for yourself. Take breaks from caring for others or add 

meditation to your daily routine. 

 Be aware of things to avoid when you’re stressed. Don’t make big decisions when you feel worn out. 

 Ask for and accept help from others. Find support through family, friends, and peers. Ask for assistance 

in getting things done. If needed, seek professional guidance.

*Adapted from National Child Welfare Resource Center for Adoption. (2013). Compassion fatigue: Secondary traumatic stress disorder, burnout, vicarious trauma. 

Adoption Competency Curriculum, Trainer’s guide. Retrieved from http://spaulding.org/wp-content/uploads/2014/10/TG-Compassion-Fatigue-7-131.pdf.

To learn more on taking care of yourself when working with youth who 

have experienced trauma:

• Child Welfare Information Gateway, Secondary Trauma [website], at

https://www.childwelfare.gov/topics/responding/trauma/secondary/

• National Child Traumatic Stress Network, Secondary Traumatic Stress [website], at

http://www.nctsnet.org/resources/topics/secondary-traumatic-stress
40 S U P P O R T I N G Y O U T H I N F O S T E R C A R E I N M A K I N G H E A LT H Y C H O I C E S 

ACKNOWLEDGMENTS

This guide was developed through a collaborative committee of many young 

people and professionals, including individuals from the following agencies 

and organizations:

Children’s Bureau, U.S. Department of Health and Human Services

American Academy of Pediatrics 

Division of Adult, Children and Family Services, Iowa Department of Human Services 

Division of Child and Family Services, Utah Department of Human Services 

Food and Drug Administration, U.S. Department of Health and Human Services 

Jim Casey Youth Opportunities Initiative 

National Resource Center for Youth Development

Office of Child Welfare Programs, Oregon Department of Human Services

PATH (Fargo, North Dakota)

Substance Abuse and Mental Health Services Administration, U.S. Department 

of Health and Human Services

Tufts Medical Center

The contents of this publication do not necessarily reflect the views, opinions, 

or policies of these agencies.

The committee acknowledges the work of Child Welfare Information Gateway, a 

service of the Children’s Bureau, for the design and editing of the guide. The 

committee also thanks the many young adults, child welfare caseworkers and 

supervisors, and foster and adoptive parents who completed a field test and 

provided feedback. Your assistance has been invaluable.

This material may be freely reproduced and distributed. However, when doing 

so, please credit:

Children’s Bureau et al. (2015). Supporting youth in foster care in making healthy 

choices: A guide for caregivers and caseworkers on trauma, treatment, and psychotropic 

medications. Washington, DC: Author. 

The guide is available online at https://www.childwelfare.gov/pubs/mhc-caregivers.
This page is intentionally left blank.
U.S. Department of Health and Human Services

Administration for Children and Families

Administration on Children, Youth and Families

Children’s Bureau

http://www.acf.hhs.gov/programs/cb