With suicide being the second leading cause of death in adolescents, the American Academy of Pediatrics (AAP), American Academy of Child and Adolescent Psychiatry (AACAP), and the Children’s Hospital Association (CHA) in 2021 declared a mental health emergency for adolescents necessitating the need for action from health care professionals and community partners (Hoffman et al., 2022). Yet the risk of suicide among youth in foster care is even higher. All professionals involved in caring for youth in foster care must be trained in the importance of understanding the increased risk of suicide for youth in foster care, but also the need for promoting protective factors, adequate screening, and referral to appropriate resources. The purpose of this article is to examine current suicide screening practices in foster care and the implications for mental health and primary care providers, child welfare systems, and policymakers.
Background and Significance Over 500,000 youth were served by the foster care system in 2024 (Children’s Bureau, 2025). Evidence has clearly demonstrated that youth in foster care have high rates of mental health disorders, 38 with youth transitioning out of care being two to four times more likely to have a mental health diagnosis (Engler et al., 2022, Greiner & Beal, 2017; Havlicek et al., 2013; Lohr & Jones, 2016; McMillen et al., 2005; Tarren-Sweeney, 2008). Their mental health problems include, but are not limited to, post-traumatic stress disorder (PTSD), anxiety, depression, attention deficit hyperactivity disorder (ADHD), and behavioral disorders, such as oppositional defiant disorder, attachment disorder, non-compliance, hypervigilance, and dysregulation (Engler et al., 2022, Greiner & Beal, 2017; Havlicek et al., 2013; Lohr & Jones, 2016; McMillen et al., 2005; Tarren-Sweeney, 2008). The American Academy of Pediatrics (2021) has deemed youth in foster care as a population with special and unique needs that require comprehensive health care services.
With the current mental health crisis facing youth today, suicide ranks as the second leading cause of death in adolescents and there is a known increased suicide risk for youth in foster care (Hoffman et al., 2022). Evidence demonstrates that a history of trauma compounded with a lack of consistent social or relational support systems increases the risk of youth suicide (Engler et al., 2022; Okpych & Courtney 2018; Taussig et al., 2014). Factors that increase suicide risk include a history of child maltreatment, multiple placements, length of time in care, and frequent engagement with the child welfare system (Engler et al., 2022; Okpych & Courtney 2018; Taussig et al., 2014).