When you think about foster care, what comes to mind?  Warm, loving families playing Monopoly by the hearth?  Creepy halfhearted inept caregivers who are in it for the money and are probably abusing the kids, who don’t buy them school supplies so they have to get them from Sleep Train donations?

I have seen a number of current and former foster kids in my clinics, and I am a foster-adoptive mom, so I have experienced the foster care system in a couple of different ways.  I can tell you firsthand that the system is broken.  My patients often disclose stories of abuse in foster care.  Many of my patients had little to no support from anyone in the system after they aged out.  As a foster parent, I experienced a number of impediments to creating a family environment including some paranoid and controlling social workers, who cycled through every 6 to 12 months.  My husband and I were referred to as “the facility” on all of the paperwork and everyone seemed more interested in the temperature of our refrigerator and whether or not our emergency exit plan was on display (“go outside if the house is on fire”) than they were in helping us create a bond with our foster kids.  But this piece is not about how to fix foster care.  This is about its relationship to homelessness.

One study from the Midwest found that 36% of foster youth experienced at least one episode of homelessness after aging out of the system –over one third!  Among those who went on to experience homelessness, researchers found the following to be risk factors predictive of homelessness:  having run away at least once, male gender, having experienced physical abuse, having symptoms of a mental health disorder, multiple placements, and delinquent behaviors.  In my own practice, I looked at the same question from the opposite angle.  In a survey of 127 of my homeless patients, twenty percent stated that they had been in the foster care system as children.  50.0% stated that they had run away from home at least once as a child.  64.6% experienced psychological abuse as a child, 53.5% experienced physical abuse, and 43.3% experienced sexual abuse.  The prevalence of childhood abuse reported by my homeless patients is more than 10 times greater than that experienced by members of the general public.

Here is how it happens.  If you are in a family, when you turn 18, you either go to college with family support, or you stay home and find a job or go to trade school or figure out your next move with family support.  Often you can stay with relatives or family friends for low or free rent while you are getting financially stable.  If you are in foster care, when you age out (usually ages 18-22, depending on when and where you are), your “facility” does not receive government money for you any longer.  There are many healthy foster homes where young adults are able to stay longer (ours, for example), but there are many who turn the kids away when the money dries up.  Alternatively, many foster youth run away from home during these transition years.  Regardless of the mechanism, the result is the same: most 18-year-olds are not ready to live independently.

Moreover, most foster kids have additional challenges on top of the already daunting, normal teenage issues.  Studies have found that kids placed in foster care score higher on validated measures of behavioral and emotional problems and they have much higher rates of mental health disorders compared to kids of the same age in the general population.  In fact, according the the National Alliance on Mental Illness (NAMI), “between half and three-fourths of children entering foster care need mental health care.”

This perfect storm of hurting youth, poorly supported and sometimes inadequate foster homes, and other factors (substance use disorders, criminal activity, barriers in access to medical and mental health care) leads to great societal consequences.  Foster youth age out every day, creating a fast-flowing stream into the pool of homelessness.  It is clear that any approach to improving homelessness in San Jose must address foster care, especially providing mental health care, preventing abuse, supporting foster families and encouraging strong bonds, discouraging multiple placements, and acting quickly to eliminate delinquent behaviors.  The New York based nonprofit organization, You Gotta Believe, is essentially a homelessness prevention program through their work, creating permanent family situations for foster youth.  Their latest campaign, Nobody Ages Out, strives to create permanent attachments for older foster youth.