This article is the second in a three-part series designed to bring awareness to the issue of complex PTSD among foster youth, how C-PTSD affects foster youth who are nearing the age of transition or exit from foster care, and the implications for social workers and other practitioners or adults who care for these vulnerable youth.  In the first post, we provided an overview of the issue of trauma experiences for youth in foster care.  This second article will examine in more detail the effects of complex trauma exposure for foster youth.

Complex Trauma in Foster Care

In our last post, we discussed the trauma many foster youths experience before entering the child welfare system and during their time in foster care.  Many times, youth enter the child welfare system because they had been abused or neglected and having been removed from their homes represents additional trauma.  During their time in foster care, children may move repeatedly, or they may experience continue abuse and neglect at the hands of their foster parents.

The National Coalition for Child Protection Reform (NCCPR) reported that foster care is generally unsafe for children.  In their 2015 issue paper, the NCCPR cited findings from several studies demonstrating that cases of sexual abuse in foster care were more than four times higher than the rate in the general population, and in group homes, there was more than ten times the rate of physical abuse and more than 28 times the rate of sexual abuse as in the general population.  One-third of foster children reported being abused by a foster parent, according to the NCCPR paper.

Greeson et al. (2011) reported similar results in their investigation.  Many children in the child welfare system have histories of recurrent trauma perpetrated by caregivers.  The researchers examined the trauma histories of over 2,000 youth in foster care.  Neglect, exposure to domestic violence, emotional and physical abuse, sexual assault, and community violence were the most prevalent forms of trauma exposure among youth in foster care placements (Greeson et al., 2011).

One can find numerous additional studies that reflect similar findings.  Complex trauma, a term used to describe repeated interpersonal traumas by caregivers early in life, occurs all too often in the foster care system.  It should come as no surprise that children in foster care have a high prevalence of mental health, behavioral, emotional problems, and posttraumatic stress disorder as a result of complex trauma experiences.

Consequences of Complex Trauma

The majority of children entering foster care have experienced multiple trauma, placing them at increased risk of developing emotional and behavioral problems. Community issues such as poverty, crime, mental health problems, and addiction often stem from unaddressed childhood trauma (Beyerlein & Bloch, 2014).

Common reactions among youth in response to traumatic events usually include intense emotional, psychological, and somatic complaints.  Children might show a consistent sense of fear, helplessness, sadness, inability to sleep, nightmares, bed-wetting, hypervigilance, difficulty concentrating, racing heart, dizziness, and stomach aches (Beyerlein & Bloch, 2014).  Ongoing toxic stress can result in impairments in cognition, learning and memory, behavior changes, difficulty with emotional regulation, health conditions such as obesity, cardiovascular disease, and COPD, and depression and suicidality, among other adverse outcomes (Forkey, Morgan, Schwartz, & Sagor, 2015).

Post-traumatic stress disorder (PTSD) can be seen in children exposed to complex trauma, and they can demonstrate symptoms of attention deficit hyperactivity disorder, oppositional defiant disorder, mood disorder, anxiety, substance abuse, acute stress disorder, attachment difficulties, and general behavior problems (Forkey et al., 2015).


Without emotional supports in place to help youth in foster care cope with complex trauma during the developmentally precarious period leading up to their transition to adulthood, youth who “age out” of foster care are at risk of experiencing homelessness.  At the age of 18, youth are required to exit the foster care system.  This means they have to learn to meet their own needs, which are no longer met by the state.  They must identify and maintain housing, find a job, and manage their finances – and in situations where there was abuse or neglect in their foster placement, these youth vulnerable to homelessness (Fowler, Marcal, Zhang, Day, & Landserk, 2017).

Did you know that having more than one foster care placement increases a youth’s likelihood of experiencing homelessness by 1.5 times? Or that of the approximately 400,000 youth currently in foster care in the United States, approximately 20,000 of those youth, age out each year without familial support or any family connection?  Or that within 18 months of emancipation (aging out), almost 50% become homeless?  Researchers have surveyed individuals who are homeless and have found that nearly 50% of the homeless population spent time in foster care.

Multiple experiences of trauma prior to entering the foster care system, combined with being placed in homes with complete strangers that are sometimes just as dysfunctional as the homes they were removed from, moving from home to home, foster family to foster family…  Add in resulting behavioral or mental health issues that stem from complex trauma exposure, with little training in how to cope with the trauma, and you have a recipe for disaster.  Take a youth with very few life skills needed to navigate adulthood – like, finding and maintaining a home, finding and maintaining a job – and with no supportive networks, the result is homelessness.

Change Their Stories

Youth aging out of foster care are at high risk for becoming homeless during the transition to adulthood.  Having a history of abuse and having symptoms of a mental health disorder are associated with an increased risk of becoming homeless.  Changes in policies and practices are needed to reduce the risk that youths in foster care will become homeless after aging out.

Countless research articles indicate that foster youth tend to fare poorly in a number of domains in the transition to adulthood and that the shift to independent living may be particularly challenging.  Foster youth struggle in the transition to independent living, showing higher rates of homelessness, less housing stability, poor neighborhood quality, and more reliance on public housing assistance (Berzin, Rhodes, & Curtis, 2011).

Remember Angelina from the previous post in this series?  When she turned 18, after several years in foster care, her social work caseworker picked her up, gave her the CPS file and her clothes, and dropped her off at a shelter.  Just like that, she’d aged out of foster care and had no place to call home.  Foster care left her with no life skills, no job, no high school diploma, no family connections.  She had no idea what to do in the real world, alone.

Child welfare agencies need to be doing something differently to help youth build skills while they are in foster care.  We must provide resources to prepare youth who are aging out.  We must do more to ensure that all young people who have spent time in foster care have the support necessary to find a safe place to call home.

The journey from foster care directly to homelessness should be a road our foster youth no longer have to travel.

Implications for service providers and other adults who care for youth in foster care will be discussed in the next article in this series.


Berzin, S. C., Rhodes, A. M., & Curtis, M.A.  (2011).  Housing experiences of former forester youth: How do they fare in comparison to other youth?  Children and Youth Services Review, 33(11), 2119-2126.

Beyerlein, B., & Bloch, E.  (2014).  Need for trauma-informed care within the foster care system: A policy issue.  Child Welfare, 93(3), 7-21.

Forkey, H. C., Morgan, W., Schwartz, K., Sagor, L.  (2016).  Outpatient clinic identification of trauma symptoms in children in foster care.  Journal of Child and Family Studies, 25, 1480-1487.

Fowler, P. J., Marcal, K. E., Zhang, J., Day, O., & Landsverk, J.  (2017).  Homelessness and aging out of foster care: A national comparison of child welfare-involved adolescents.  Child and Youth Services Review, 77, 27-33.

Greeson, J. K. P., Briggs, E. C., Kisiel, C. L., Layne, C. M., Ake, G. S., III, Ko, S. J., …Fairbank, J. A. (2011). Complex trauma and mental health in children and adolescents placed in foster care: findings from the National Child Traumatic Stress Network. Child Welfare90(6), 91-108.

National Coalition for Child Protection Reform.  (2015).  Foster care vs. family preservation: The track record on safety and well-being.  Issue Paper 1.  Retrieved from

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