Key findings

• 1 in 5 children entering foster care (20%) were identified as having high-acuity needs. Among youth ages 11–17, the rate increases to 27%.
• Mental health needs are especially prominent: about three-quarters of youth with HAN had a reported mental health diagnosis.
• Children and youth with HAN were more likely to be placed in congregate care than children without HAN.
• Children with HAN tended to remain in foster care longer and were more likely to re-enter care after leaving.
• Among the diagnostic groups examined, children with mental health diagnoses had the highest rate of re-entry into foster care.
• Youth with HAN were also more likely to emancipate or age out of foster care, rather than leave through another permanency outcome.
• The brief cautions that diagnosed conditions may be underreported in AFCARS, meaning the available data may not capture the full extent of need.

The findings make a strong case for closer coordination between child welfare and behavioral health systems. The combination of high mental health needs, greater use of congregate care, longer stays in foster care, re-entry, and aging out suggests that youth with complex needs cannot be effectively served by child welfare alone.