State Advisory Council Mental Health Recommendations

The following recommendations were developed and approved by the State Advisory Council for Adoption and Permanency. The Council is a convening of state adoption and permanency directors and other public agency staff from 46 states assembled by Voice for Adoption to develop consensus-based federal recommendations on adoption and permanency issues affecting children and youth in foster care.

Mental Health Supports

Children and youth adopted from foster care have frequently experienced significant trauma, the effects of which can persist long after their adoptions. Research has shown that mental health difficulties, developmental delays, and learning disabilities are disproportionately high among adopted children.

These needs can be better met by addressing the following challenges:

• Access to Care: Research has shown that adoptive families who are able to access appropriate mental and behavioral health care tailored to their needs fare better than families who cannot access these services. Unfortunately, although the need for such care is higher among children and youth adopted from foster care, there is a significant shortage of such services.

• Crisis Supports: Providers are reporting an alarming surge in children and adolescents experiencing behavioral health crises, while emergency departments are seeing a rise in cases involving suicidal thoughts and self-harm. More must be done to provide appropriate crisis supports.

• Community-based Services: Child welfare agencies cannot meet every need of adoptive or guardianship families by themselves. Families often need support from community-based or other public services, including early identification and treatment.

• Workforce: According to the American Academy of Child and Adolescent Psychiatry, 40,000 additional mental health practitioners are needed to meet the demand for treatment of depression and other child and adolescent mental illnesses. More must be done to support an adoption-competent mental health workforce.

The following consensus-based federal recommendations would help strengthen mental health services for these children and youth.

Recommendations

Access to Care

• Enhance Access to Mental Health and Behavioral Health Services: Increase funding and access to mental health and behavioral health services for children and families post-permanency.

• Expand Mental Health Block Grant Support for Prevention Services: Expand the Mental Health Block Grant (MHBG) to include a new set-aside of at least 5% in additional funds for prevention and early intervention to help states more proactively address children’s mental and behavioral health, while continuing to allow them flexibility to determine which programs and interventions are most needed in their communities.

• Pediatric Mental Health Care Access (PMHCA) Program: Support funding for the Pediatric Mental Health Care Access (PMHCA) Program to enhance early detection, assessment, treatment, and referral of young people with behavioral health conditions.

Crisis Supports

• Fund Mobile Crisis Teams: Extend the temporary enhanced federal Medicaid match for mobile crisis teams.

• Fund Respite Care: Increase flexible, optional federal funding for respite care to provide temporary relief to parents on a planned or emergency basis.

• Fund In-Home Crisis Intervention Services: Increase flexible, optional federal funding to states for in-home crisis intervention services provided by qualified clinicians who are available 24/7.

Community-Based Services

• Invest in the Behavioral Health System as a Strong Alternative to Child Welfare: Fund the expansion of the behavioral health system, especially in rural communities, including mental health and behavioral health prevention, community-based services that include early identification and treatment services, 24/7 respite and crisis intervention services, intensive in-home treatment services and the right range of residential treatment interventions.

• Support Peer and Parent Partners: Fund and incentivize expanded use of peer and parent partners in community-based mental health services.

• Increase Funding for In-home and Community-based Services: Make permanent the enhanced 10% federal medical assistance percentage (FMAP) increase for home and community-based services (HCBS).

• Behavioral Healthcare in Schools: Expand support for school-based mental health care.

• Fund the 988 Suicide and Crisis Lifeline: Set aside funding for youth crisis care needs, including consistent and sufficient funding for the 988 Suicide and Crisis Lifeline and to expand access to step-down programs.

Workforce

• Increase Medicaid Reimbursement for Adoption-Competent Providers: Recognize adoption-competent care as a specialized service that warrants higher reimbursement rates under the Medicaid federal medical assistance percentage (FMAP). Clinicians who complete intensive trainings such as the National Adoption Competency Mental Health Training Initiative (NTI) or Training for Adoption Competency (TAC) should be made eligible for enhanced Medicaid reimbursement and formally recognized within state systems.

• Medicaid Match for Workforce Training Programs: Expand federal Medicaid matching funds for workforce training programs, including programs focused on developing career paths for peers and community health workers.

• Funding for Adoption Competency Training: To increase placement stability and reduce reentry into foster care,  provide states with optional, flexible funds to provide caseworkers, contracted providers, health care and mental health providers, educational providers, and kinship navigators with specialized training and resources, such as the National Adoption Competency Mental Health Training Initiative (NTI) or Training for Adoption Competency (TAC), on issues related to adoptive, foster, and kinship families and the services and supports available to them.

• Federal Adoption-Competency Requirements: Incentivize adoption competency training for mental health professionals in rural and underserved populations.

• Expand Loan Forgiveness: Expand funding and eligibility for grants, scholarships, and federal student loan forgiveness and loan repayment programs for behavioral health providers who work with families currently or previously involved in the child welfare system, including, where eligible, paraprofessionals such as peer recovery specialists/peer support providers and community health workers.

Approved October 10, 2025