Thousands of Kids Enter Foster Care for Mental Health Care

Foster Care for Mental Health Treatment: Parents Surrender Thousands of Kids Each Year In Search of Help

The Imprint conducted a first-ever survey of all 50 states, inquiring about the frequency with which parents voluntarily transfer their children into the child welfare system. An upcoming report will detail the significant disparities in how various states manage these “relinquishment” cases.

Lindsey lives in a state of constant worry regarding her son. It is more than the typical anxiety parents feel; she harbors darker fears: Will he harm others? Will he harm himself? Is he on a path toward incarceration?

Then comes a thought this Georgia mother never could have anticipated when she adopted a toddler from foster care 11 years ago: How much longer will she legally be able to call him her son?

Lindsey and her husband, Kris, have dedicated themselves to their son’s care. Now 13, he has been diagnosed with reactive attachment disorder, ADHD, disruptive mood dysregulation disorder, anxiety, and autism spectrum disorder. Kris changed his career to work from home, and Lindsey utilizes extended time off to remain present and manage a demanding treatment schedule. The couple — whom The Imprint is identifying by first name only to protect their children’s privacy — has placed him in residential treatment multiple times, only for each stay to conclude with inadequate discharge plans and a rapid return to crisis. He has been rejected by dozens of therapeutic programs because his behavior is deemed too difficult to manage.

“My daughters are afraid,” she said. “That’s no way to live.”

‘Relinquishment’ by the numbers

Thousands of children experiencing mental health crises are turned over to foster care by their parents each year, according to a first-of-its-kind database of these “relinquishments” compiled by The Imprint. This issue, which has been known to lawmakers and child welfare experts for decades, has fractured biological and adoptive families, devastated children, and strained foster care systems that are ill-equipped to handle them. However, because the practice has never been comprehensively tracked, it has remained difficult to address.

To better document the scale of the problem, The Imprint sent questionnaires to child welfare agencies across all 50 states and Washington, D.C., asking for data on foster care relinquishment cases between 2014 and 2024, as well as information on how these cases were handled and their outcomes. Relinquishment was defined as parents voluntarily surrendering custody without having been accused of abuse or neglect.

Twenty-one states and Washington, D.C. provided responses and data. The remaining states either failed to answer repeated requests or stated that they do not track these cases. The resulting dataset, while certainly an undercount, revealed the following:

Thousands of parents see no other option

Since 2014, more than 28,209 children have been voluntarily placed into foster care by parents who state they are unable to manage their children’s needs at home.

In five states that provided annual tallies, relinquishments decreased over the 10-year period. Yet, even with declining figures in those areas, hundreds of children were relinquished annually in Minnesota, Georgia, Illinois, Pennsylvania, and South Dakota.

While parents may view foster care as a temporary measure to secure treatment, relinquished children were more likely than other foster youth to remain in the child welfare system into young adulthood, and they were less likely to be adopted or enter a guardianship.

Only about half of relinquished youth were reunified with their families.

Six states — Alabama, Arkansas, Hawaii, Maine, New Jersey, and Oklahoma — along with Washington, D.C., reported that they charge parents with child abandonment in family court when they attempt to transfer custody to obtain treatment.

Conversely, in at least four other states, parents sign a “voluntary placement agreement” and work alongside the child welfare system to coordinate care and treatment plans. At least six states have established specific pathways for relinquished children to enter foster care for the purpose of receiving mental health services.

Most children relinquished by biological caregivers

While previous media coverage of this issue has focused largely on adoptive families, The Imprint’s data found that adopted children account for less than 8% of relinquishment cases nationwide.

Bobby Cagle, a child welfare consultant and former head of CPS agencies in Georgia and Los Angeles, is currently advising states on foster care matters, including relinquishment. He described The Imprint’s data collection as “extremely important.”

The problem “was vexing everywhere I worked,” Cagle said in an email.

Mike Leach, who led the South Carolina Department of Social Services until last year, joined Cagle in noting the rise in mental health needs among young people since the pandemic — and the severe lack of treatment options.

“When you see more than 28,000 kids entering foster care this way, some may say, ‘Well, that’s only 1% of the total 2.5 million kids who entered in that timeframe,” Leach said. “Using one of the costliest systems we have to solve problems — that could often be addressed earlier and more effectively in the community — is backwards.”

Parents in Georgia, Minnesota, and Idaho who spoke with Imprint reporters about relinquishing their children describe it as a last-resort measure. They do so under the belief that the foster care system is the only path for their children to receive the treatment necessary to improve — and, if possible, to return home.

In a handful of states, there has been a renewed focus on this relatively obscure group of foster youth and their families — including efforts to prevent relinquishments or stop penalizing parents who feel they have no alternative but to surrender their children to the state.

Last year, after hearing from a mother who had been charged with neglect for relinquishing her child to foster care, a Michigan Supreme Court justice advocated for a “no-fault pathway” to help parents avoid such penalties. Minnesota passed legislation protecting parents from neglect charges in cases like that of Argie Manolis. Like the mother in the Michigan case, Manolis left her 15-year-old at a hospital, fearing for the safety of a younger sibling at home.

Legislatures in Texas and Lindsey’s home state of Georgia also addressed the issue, seeking ways to prevent families from reaching this point of crisis.

While solutions are being explored, children and teens across the country continue to be left in psychiatric hospitals or emergency rooms when parents refuse to pick them up. Others are committed to juvenile detention centers for behaviors stemming from mental illness, even when they have not committed a crime.

Minnesota mother Michelle Wood discussed this during an April hearing before the state Legislature. Fighting back tears, she described her daughter: funny, obsessed with ducks and cats, and deeply involved in their local 4-H program in rural Goodhue County.

However, the child, adopted at age 1, also faced significant struggles. Wood said her daughter began experiencing suicidal ideation in kindergarten, marking the start of a downward spiral. When the girl became violent, the family had to create a safety plan. It required her younger sibling to lock himself in his room for protection whenever his sister had an outburst.

The girl cycled in and out of psychiatric hospitals and crisis centers. Before one discharge, Wood pleaded for more assistance — she knew it was unsafe for her daughter to return home. Hospital staff advised her to call 911 if the child became physical, she recounted.

“One day at school, she assaulted her best friend — and that’s exactly what happened,” she told lawmakers. “My daughter deserves better care than the justice system.”

Desperately reaching out — to CPS

For Lindsey, seeking help from the child welfare system has not been any more effective. Last summer, feeling overwhelmed and desperate, she contacted CPS for assistance.

The responding social workers mentioned that relinquishment was an option, but they warned Lindsey that if she chose that route, she and Kris would have to complete a child protection case plan to attempt to regain custody of their son. The couple was also informed they could face charges for child abandonment and would risk losing their daughters to foster care as well.

Lindsey noted that based on her interactions with CPS, caseworkers are more accustomed to addressing problematic parental behavior. “But when the child is putting the family in danger — they have no idea what to do with that.”

Moon is a service dog for Lindsey and Kris’ son. Provided photo.

The couple was instructed to attend a parenting class — where they did receive some helpful information. “We’ve complied because we want to jump through all the hoops to get him the services he needs. We want to prove that we are attentive and we’re engaged,” she said. Still, she added, “I can go to parenting class every day, but that’s not going to help my kid. My kid needs intensive psychiatric care.”

In response to The Imprint’s survey, a spokesperson for Georgia’s Department of Human Services stated that “there is no difference” in how such a case is handled compared to a typical abuse or neglect case. When parents relinquish custody, the Division of Family and Children Services maintains “the same rights and duties to a child as if the parental rights had been terminated by the court,” according to agency policy.

Leach recalled that when he headed South Carolina’s Department of Social Services, two parents and their 13-year-old son approached him outside his office. The family was receiving services from the state’s Department of Developmental Disabilities but required more support. They had just come from an emergency room seeking psychiatric help for the teen; hospital staff had instructed them to “turn him over” to CPS for residential care.

“Mom and Dad said: ‘We want to relinquish our son,’” Leach recounted, adding, “They were not neglectful or walking away. They were trying to get help.”

Leach’s staff managed to implement some intensive in-home services, and the couple brought the teen home that day. Yet within weeks, he was back in a psychiatric crisis and surrendered to the foster care system.

Leach said that “without the right supports in place,” families like these must navigate multiple agencies to try to assist children with complex needs, such as autism and developmental disabilities, in addition to mental illnesses.

“When those services aren’t available, families hit a wall. It puts caregivers in an impossible position and adds more trauma for kids who are already struggling,” he said. “It also points to a breakdown in the systems that are supposed to support families before things escalate.”

“Using one of the costliest systems we have to solve problems — that could often be addressed earlier and more effectively in the community — is backwards.”

— Mike Leach, former HEAD OF SOUTH CAROLINA SOCIAL SERVICES

So far, Lindsey and Kris are not among the thousands of people in this country who have relinquished their children. Between the countless hours spent advocating for their son and applying for treatment programs on his behalf, they have been able to delay such a drastic step. The state-sponsored health insurance he receives as an adoptee has been vital.

But the last-resort option remains ever-present in their minds.

Throughout several conversations over six months with The Imprint, Lindsey described deep love and empathy for her 13-year-old son, the middle child in the family. She said he shares her thirst for adventure. They love hiking together and exploring new places. Knowing he is at his best when immersed in such activities, the two recently took a trip to Disney World, heading straight for the most intense roller coasters.

Kris and Lindsey’s son is an avid reader of graphic novels. Provided photo.

He is funny, gregarious, and makes friends everywhere he goes, his mother said. That is what he is like when he is “safe.”

But he can become violent in an instant, Lindsey added. He will throw objects, smash glass bottles, and hurl curses and threats. Repeatedly, he has ended up strapped to a stretcher in an ambulance or in the back of a police car.

Lindsey described her son — who was not interviewed for this article — as wracked with distress about behaviors he cannot control. He has called the police on himself and attempted to get sent to jail or committed to higher levels of treatment in order to feel more stable, she recounted.

This has been ongoing for the past two years, since he turned 11. But things worsened last year, Lindsey said, and she simply could not continue to subject her 10- and 16-year-old daughters to a home fraught with fear and harm. Her oldest daughter is her adopted son’s biological sister — and has her own emotional scars from foster care. Lindsey does not want their home to be another.

Twenty years of inaction; missing data

The federal Government Accountability Office first highlighted concerns regarding relinquishment in 2003. Congress had ordered an investigation after news reports in dozens of states uncovered parents “inappropriately placing” their children in foster care or youth justice custody to obtain treatment they could not find elsewhere. It described these pathways as “two systems not designed to care for children solely because of their mental health needs.”

The resulting report identified an estimated 12,700 impacted children in 2001 alone, a number described as an undercount. Fewer than half the states were able to provide data, but they confirmed the practice occurred. Similar to the current causes of relinquishments, GAO investigators concluded that a lack of access to appropriate mental health services was to blame.

“Because federal, state, and local agencies do not systematically track these children, the extent and outcomes of these placements are not fully known,” report author Cornelia Ashby wrote.

Today, the federal government has a “relinquishment” category in its Adoption and Foster Care Reporting and Analysis System. But its definition is broad, including newborns left at fire stations, for example, and it does not include the many relinquishments categorized as child abandonment.

Last year, the U.S. Department of Health and Human Services released a report drafted by a private consulting firm that estimated the number of “custody relinquishments” of children in need of behavioral health or disability services. Without data reported by states, the researchers relied on existing foster care numbers and Medicaid claims. Using those, they found that between 2017 and 2019, as many as 5% of entries into foster care were due to relinquishment.

But they described their counts as estimates based on cases “resembling” relinquishment, noting: “We cannot assess how well these approaches identify actual custody relinquishment.”

Poor tracking of relinquishment for mental health care has left the highest-needs children and their families overlooked, said Stephanie Pasternak, who monitors and advocates for state-level mental health policies at the National Alliance on Mental Illness.

“Without that information, you kind of can’t get to the solution,” she said.

“They loved and cared about their child so much that they would do anything to get them help, including relinquishing custody.”

— Gary Blau, senior fellow, Meadows Mental Health Policy Institute

Gary Blau, a senior fellow at the Meadows Mental Health Policy Institute and former chief of the child, adolescent, and family branch for the Substance Abuse and Mental Health Services Administration, said the federal government’s inability to track the issue is based in large part on differences in how states classify these foster care entries.

He said that while relinquishment cases are relatively small compared to the roughly 330,000 children in foster care, more information is needed to help these families remain intact.

While trying to address this issue within the federal government, Blau met with parents who had made this “heartwrenching decision.” Their stories drove him to keep pushing to innovate new solutions.

“They did everything they could to get their child help — this included,” he said. “They loved and cared about their child so much that they would do anything to get them help, including relinquishing custody.”

The Imprint’s findings on the scope of relinquishments

In response to The Imprint’s inquiry, 21 states and Washington, D.C. provided explanations of how they handle these cases and tallied how frequent they are.

Most reported that these cases account for less than 2% of all foster care entries in their state; in many states, it was less than 1%. Yet some states reported far higher rates. In Minnesota, more than 13% of foster care entries during the past decade have been deemed “placement for treatment,” a term unique to that state for cases like these.

Media coverage of this issue often centers on adoptive families like Lindsey’s, and as a result, policymakers often talk about reforming post-adoptive support as a solution. But The Imprint’s data showed that in the 21 states, adoptees made up roughly 8% of relinquished children.

States also reported on the outcomes for children who entered foster care this way.

Data from the states surveyed showed that 52% eventually returned home. Those who did not were less likely than other foster youth to be placed with a permanent family: One in five were either adopted or entered a legal guardianship, and roughly 16% aged out of foster care without permanency. The remainder fell into other outcome categories, such as transfer to a different agency, or they remained in foster care.

Last fall, as Lindsey and Kris were on the brink of relinquishing custody of their son, a “miracle” placement came through: a rare facility in Missouri that accepts children with diagnoses of autism and reactive attachment disorder. For the next year, their son will receive specialized treatment that includes things like canine therapy — support Lindsey said had been lacking at poorer quality, in-state options they had tried.

The annual cost of care at the facility is $300,000 and has been covered through special approval under the teen’s government-funded adoptee insurance plan.

While she is grateful for this placement, she is also furious that they had to send their son all the way to Missouri to find a treatment center equipped to handle his particular challenges — forcing her family to travel more than 800 miles to see him every few months. She feels betrayed by the social safety net — the schools, behavioral health department, and child welfare system that she begged for help, receiving little in return beyond a list of therapy referrals.

And fear remains ever-present. Lindsey said she does not see her son engaging with the new treatment yet or making progress toward healing. She wonders if he can. A therapist has warned the couple that it might take many years before his diagnoses can be safely managed.

Stuffed toys belonging to Kris and Lindsey’s son. Provided photo.

Unless he has at least six to eight months of being violence-free by the time the yearlong program ends in November, she and Kris say they may still give up custody.

“I’m terrified every day of that discharge date,” she said. “If they were to say he’s coming home tomorrow, I would say absolutely not. That is not safe for our family.”

If her son is eventually turned over to CPS, Lindsey said she desperately hopes it would be temporary. But she is not sure that dream is realistic.

“We love him very much,” she said. “We have fought so hard, and we will continue to fight. I would love for him to receive treatment in a safe facility so that he can come home and we can be a family again.”