Erika Andersen, LPC, on Mental Health of Children in Foster Care and the Real-Life Impact of Adverse Childhood Experiences

Name: Erika Andersen  
Role: Teacher/Mentor 
Based in: Philadelphia 
Age: 28

I am a friend, teacher, and learner. I have a background in education and mental health counseling.  

Erika Andersen is a Licensed Professional Counselor and a graduate of Wheaton College and Princeton University, where she studied Clinical Mental Health Counseling and English, respectively. What follows is a conversation attending to one of the biggest areas of need and neglect when it comes to improving mental healthcare support. We briefly touch on Erika’s personal wellness, and then do a dive deep into foster care, just how much early experiences impact the development and mental healths of youth, and what foster parents can do to provide a safe and enriching environment for youth in their care. By the way: A study by the Harvard Medical School shows that 1 in 4 foster children experience Post-Traumatic Stress Disorder symptoms, and former foster children are twice as likely as U.S. war veterans to experience PTSD in adulthood. In 2019, over 672,000 children spent time in U.S. foster care. On average, children remain in state care for over 1.5 years and 5% of children in foster care stay in the system for 5 or more years before they transition to adoptive homes or age out. 

What are some mental health habits or tips you can share with us that you actively lean on during the week to take care of yourself?

Physical and mental health are incredibly intertwined, so my baseline for self care during the week includes exercise (any movement works, even ten minutes), sleep (cleans toxins that build up in the brain each day—like brushing your teeth) and nutrition. Depression and anxiety are inflammatory diseases in nature; these three wellness building blocks can reduce inflammation. The mental/emotional component includes connecting with friends and family and grounding practices like prayer, meditation and reflection.

In the Field

What initially got you into pursuing a Masters in Clinical Mental Health Counseling after getting your degree in English? For others considering following the same path as you, what would you recommend they ask themselves before pursuing further education in clinical counseling?

Mental health counseling was not on my radar as an undergraduate and in fact there was a strong culture of perfectionism, in which our humanity gets a little lost for the sake of achievement. At least, that reflects my experience at the time. I remember learning about growth and fixed mindset in a psychology class and seeing how plastic brain development truly can be. Through working with young people in an education setting, I saw how a culture of fixed mindset affects teenagers and hinders growth. I saw a lot of other issues as well, like bullying, chronic stress, anxiety, depression, emotional dysregulation, all in the microcosm of a classroom setting. I had to learn more.

I would say the greatest thing to explore before pursuing this path would be yourself.   

Can you tell me a little bit more about your experience? Did you receive training and education around culturally and racially sensitive counseling?

My program included a class specifically geared toward multiculturally competent counseling. We learned about racial identity models and processed our personal histories among other things. I was thankful to learn from an advisor, who was particularly passionate about racial and economic equity and access in the therapy space. 

You’ve worked with kids in foster care, kids mandated to receive mental health treatment, and kids in neighborhoods with high levels of poverty or crime rates, homeless and lgbtq+ youth. What have you noticed are the biggest growth areas for the mental healthcare system and how it supports children within these demographics? 

I trained in a behavioral hospital for children and adolescents. Mental health, especially crisis care, has come a long way. Pioneers like Elyn Saks fought for patient rights, including changing laws around physical restraints. Another major historical breakthrough includes the 1973 removal of the diagnosis of “homosexuality” from the Diagnostic and Statistical Manual. That change directly affects the patient populations I met with. My training hospital had a special unit for lgbtq+ youth, many of whom are experiencing homelessness and chronic stress from discrimination.

Mental health professionals, and people more generally, are beginning to understand the role of systemic racism, poverty and discrimination in causing direct and indirect trauma, and the impact on children’s brains and behavior. Policy and economic incentives for change have a long way to go.

Mental Health for Children and Youth in Foster Care

What are common mental health issues for children in foster care?

Anxiety and depression might be the most common. Foster care might involve a lot of uncertainty and rapid change without a consistent buffer from stress. There can be a lot of grief in being separated from a significant caregiver. These traumas can result in difficulty focusing and behavioral issues in school, which can long-term impact a child.

How do mental health issues-concerns differ for pre-school children, elementary school children, middle school children, and older children?

Mental health concerns will affect children differently depending on their cognitive, social, and emotional developmental stage. For instance, lack of stimulation or neglect might result in depression, but it could also impede brain development. Therapeutic intervention takes age into account. For example, play therapy might be more appropriate for a young child, whereas CBT would work for someone older.

How does being attached to numerous caregivers affect the mental health of a child?

Children thrive on reliable, emotionally available caregivers who are attuned to their needs. Research points to the importance of consistency for optimal mental health and buffers against the stress of adapting to new environments. With that said, children are resilient especially when given the proper coping tools.

Comorbidity: Kids in care are also at a higher risk of having health problems, and up to 50% have chronic physical problems ranging from asthma, to visual loss, and hearing loss. How does this correlate with their mental health?

I’m so glad you brought this up. In the 1990s, pediatrician Dr. Nadine Burke Harris and the CDC linked Adverse Childhood Experiences (physical and emotional abuse, neglect, caregiver mental illness, and household violence) to serious health issues later in life. ACEs disproportionately impact poor communities with systemic racism and income inequality as contributing factors. Therefore, ACEs are not only a public mental and physical health crisis, but an injustice issue.

How many kids in foster care have suffered from maltreatment? Have you ever treated a child that came in for mental healthcare as a result of physical abuse? What were the circumstances around this and can you share what the process of providing mental health support for a child with experiences like this is like?

One in seven children in the U.S. has experienced maltreatment. Children in low socio-economic environments are five times more likely to. I have met with many children who have experienced physical, emotional and sexual abuse. As a mandated reporter, I sometimes have had to call Child Protective Services for an investigation. One of the most important treatment elements is presence; much of therapy is sitting with someone in pain. For children, that often translates to therapeutic play or teaching nervous system regulation (like deep breathing). These seemingly simple interventions help the brain and body heal from trauma.

Where to Find & How To Give Help

How can foster parents work to cultivate the healthiest and safest environment for their foster kid to grow healthy mentally and emotionally? Are there any resources you can direct us to?

To help a child feel safe and seen, the best tool is doing your personal work. When caregivers have looked at their own childhoods and integrated that early formation with who they are now, they have more space to be present and attuned. Mindsight by Daniel Siegel is a great book for learning about neuroplasticity even as adults.

If there is a child under 18 seeking help, and he/she doesn’t feel they can turn to family or school for help, what is the next step he/she can take?

School is often an important resource for children and adolescents; however, remote learning from a pandemic year emphasized the importance of having help widely accessible. 

The National Suicide Prevention Lifeline at 800-273-TALK (8255) is available 24/7. Locate Teen Alcohol & Substance Use Treatment Centers as well as addiction information and resources.

Letters to My Younger Self: If you had any advice to give your younger self, what would it be?


Erika Andersen has a master in clinical mental health counseling and a background in teaching. She is interested in child development, social-emotional learning and access to information about mental health.

Complement this read with a study on modern mental health treatments for youth by advocate and founder Danny Tsoi here, a wellness conversation with model & activist Theresa Hayes, who came out of foster care, and learn how Adverse Childhood experiences impact Black children at a significantly higher rate than white children.

Interview By Susan Yoomin Im

For more wellness resources, check out this resource page or get help through Made of Millions Foundation’s resources directory here.

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