Care experienced children and young people are much more likely to experience trauma and trauma-related mental health difficulties than their peers. Yet many do not receive timely support or access to treatments that are backed by evidence.
Recent research highlights that the challenge is not simply identifying distress but ensuring that care-experienced children can access effective interventions, particularly trauma-focused cognitive behavioural therapies (TF-CBTs).
However, barriers exist at several levels, including:1
- Misunderstandings about how trauma presents in care experienced young people,
- Difficulties identifying post-traumatic stress disorder (PTSD),
- Poor coordination between social care and mental health services,
- Challenges within service funding and delivery.
In this blog, we explore these barriers, as well as what effective trauma-informed care could look like.
What is care experienced?
The term care experienced means those who are currently in care or have spent time in care in the past. This can include young people and children in foster care, kinship care, residential care, secure care or who have been looked after at home with support from social services. Those who have left care or been adopted are also considered care experienced.
Because care experiences can vary widely, the term covers a range of circumstances and backgrounds. Unfortunately, trauma in care experienced children and young people is very common, as many have faced significant challenges before entering care.
Mental health and trauma in care experienced children
Care experienced children and young people are more likely to be exposed to adverse childhood experiences (ACEs) and trauma. Many enter care after experiences such as:
- Abuse,
- Neglect,
- Domestic violence,
- Parental substance misuse, and
- Severe family instability.
As a result, rates of mental health difficulties are higher than in the general population.2,3
While emotional and behavioural difficulties in care-experienced children and young people are well recognised, trauma-related mental health problems – particularly PTSD – have historically received less attention. Emerging evidence suggests that PTSD and complex trauma symptoms may often go unnoticed in this group.1
Signs of trauma in children with care experience
Care-experienced young people may present with a range of difficulties, including:
- Emotional dysregulation,
- Hypervigilance,
- Avoidance,
- Sleep problems,
- Irritability,
- Dissociation,
- Concentration difficulties, and
- Behavioural challenges.
These are often understood through broader behavioural or attachment frameworks, without a specific focus on trauma.
This matters because PTSD is treatable. A range of trauma-informed care approaches, particularly trauma-focused CBT, have been shown to be effective for children and adolescents who have experienced trauma.4 However, many looked after children, and those who were in care in the past, either do not access these interventions or receive support that isn’t fully aligned with current evidence.1
Issues with trauma in care-experienced youth treatment
Clinicians, carers, educators and other professionals may sometimes assume that trauma is inevitable or “normal” for care experienced kids. This can reduce the likelihood that specific trauma symptoms are recognised and treated.
As a result, emotional and behavioural difficulties may be misunderstood mainly through:
- Placement instability,
- Attachment disruption,
- Conduct problems,
- Neurodevelopmental differences, and
- Wider social adversity.
While these explanations may be partly accurate, they can also mask trauma-specific symptoms that could respond well to an evidence-based PTSD treatment for children.
There is also a common belief that PTSD treatments are not suitable for young people with complex needs or unstable circumstances. This reflects the idea that trauma-informed therapy requires full stability or “readiness” before treatment can begin.
However, evidence suggests that many trauma-focused interventions can be safely and effectively adapted for young people with complex presentations when delivered flexibly and with appropriate support.1,5
Importantly, if PTSD is not identified, young people are far less likely to be offered evidenced-based trauma care.
1. Trauma is often missed in care-experienced children
Identifying mental health needs as a result of trauma in care-experienced young people can be difficult because many present with overlapping and complex difficulties. These may include:
- Anxiety,
- Depression,
- Behavioural dysregulation,
- Substance use,
- Neurodevelopmental conditions, and
- Attachment-related challenges.
Because of this overlap, trauma symptoms can be overlooked or understood through other explanations. For example, avoidance may be seen as disengagement, emotional numbing may be interpreted as oppositional behaviour, and hyperarousal may look like aggression or conduct problems.1
Identification is also affected by differences in how services assess trauma. Some routinely screen for PTSD, while others use broader mental health assessments that may miss trauma symptoms. Without consistent trauma-informed screening, these difficulties can go unrecognised for years. This is reflected in wider research showing that trauma and PTSD are often under-identified in child mental health services.6
Finally, young people may find it difficult to talk about traumatic experiences. This can be due to shame, avoidance, fear of consequences or repeated experiences of not being believed.
2. Fragmentation between care systems
Care experienced young people often interact with multiple services at the same time, including foster care, residential care, schools, CAMHS, social workers, youth justice services and primary healthcare. However, communication between these systems is often inconsistent.
As a result, referral pathways can become unclear, delayed or disrupted. Social care professionals may struggle to access specialist trauma services, while mental health services may not feel they are fully equipped to support young people with complex needs.
Placement changes can also interrupt therapeutic continuity, and referral thresholds may exclude young people whose needs do not fit neatly into service criteria. This means that young people can end up “bouncing” between services without receiving consistent, trauma-informed support. This fragmentation makes it harder to access care and stay engaged once support has begun.1
It’s important to note that these challenges aren’t due to individual clinicians or professionals. Instead, they reflect a wider system that was not designed to provide joined-up trauma care.
3. Problems with access to trauma-focused CBT
Trauma-focused cognitive behavioural therapy (TF-CBT), along with related CBT-based treatments for PTSD, is one of the most well-supported interventions for adolescent and child trauma.4,7 However, access to these treatments is not consistent in services supporting trauma in care experienced children.
Research highlights several barriers to implementation, including:1
- Limited training in PTSD interventions,
- Low confidence in working with complex trauma
- Concerns that trauma-focused work may destabilise young people,
- Workforce and time pressures,
- Limited supervision and support structures, and
- Commissioning models that do not prioritise evidence-based trauma care.
These barriers can persist even when effective treatments are technically available within services. Simply having a treatment manual does not guarantee that young people will actually receive the intervention.
Clinicians may also worry that trauma-focused work is not appropriate when a young person is still experiencing instability, such as foster kids going through placement changes or ongoing adversity. However, evidence suggests that delaying trauma treatment until conditions are “perfect” can prolong distress unnecessarily.5
Instead, the evidence points towards more flexible, trauma-informed approaches that can accommodate complexity without moving away from evidence-based care.
Improving access to trauma-informed care for children
Trauma-informed care cannot rely solely on individual clinicians. It also depends on how services are designed, funded and commissioned. Commissioning refers to how health and social care services are planned, funded and organised, including decisions about which services are available and how they are delivered.
Commissioning decisions influence:
- What treatments are offered,
- Which professionals receive training,
- Waiting times for support,
- How easy it is to access services, and
- Whether clear trauma-focused pathways exist at all.
As a result, access to trauma-related support for care-experienced young people can vary widely depending on where they live. Some areas have well-developed trauma services, while others have little or no specialist provision.1
Recent research highlights the need for more joined-up commissioning models that improve collaboration between social care and mental health services. It also points to the importance of workforce training, supervision and creating organisational cultures that support trauma-informed practice.
Importantly, being trauma-informed is not the same as being “trauma aware.” It requires systems that enable evidence-based care to be delivered consistently.
Next steps: building better systems of care
Improving outcomes for care-experienced young people requires coordinated system-wide change, not isolated improvements within individual services. Key parts of the system – Identification, referral pathways, workforce training, commissioning and intervention delivery – are all closely related
Recent research demonstrates several priorities for improving care:
- Increasing routine trauma screening,
- Improving PTSD literacy across systems,
- Strengthening pathways between social care and CAMHS,
- Expanding clinician training in trauma-focused therapies,
- Reducing placement-related disruption to therapy, and
- Embedding evidence-based trauma interventions into standard care pathways.
Alongside system improvements, it’s also important to listen directly to care experienced children and young people. They often describe wanting support that is consistent, emotionally safe, collaborative and responsive to their experiences.1
Final word on mental health and trauma in care-experienced youth
Care-experienced young people are at greater risk of experiencing trauma and trauma-related mental health difficulties. Yet, access to effective, evidence-based support remains inconsistent.
Research suggests that barriers exist at many levels, from difficulties recognising PTSD and identifying trauma symptoms to gaps between services and wider challenges in how care is funded and delivered.
Improving outcomes means ensuring that care-experienced young people can access treatments that are supported by strong evidence, including trauma-focused CBT. This requires joined-up working across social care, mental health services, commissioners and the wider workforce.
With earlier identification, better access to evidence-based interventions and more coordinated systems of care, care-experienced children can receive the support they need to recover and thrive.
To learn more about the latest evidence on childhood trauma and effective interventions that can support your practice, check out Trauma: Evidence, Practice, and Implementation Challenges.
References
- McGuire, R., Meiser-Stedman, R., Smith, P., Halligan, S. L., Lobo, S., Fearon, P., & Hiller, R. M. (2025). Access to best-evidenced mental health support for care-experienced young people: Learnings from the implementation of cognitive therapy for PTSD. British Journal of Clinical Psychology, 64(1), 63–85.
- Ford, T., Vostanis, P., Meltzer, H., & Goodman, R. (2007). Psychiatric disorder among British children looked after by local authorities: Comparison with children living in private households. British Journal of Psychiatry, 190(4), 319–325.
- Tarren-Sweeney, M. (2018). The mental health of children in out-of-home care. Current Opinion in Psychology, 15, 53–58.
- Morina, N., Koerssen, R., & Pollet, T. V. (2021). Interventions for children and adolescents with posttraumatic stress disorder: A meta-analysis of comparative outcome studies. Clinical Psychology Review, 88, 102047.
- Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents (2nd ed.). Guilford Press.
- Lewis, S. J., Arseneault, L., Caspi, A., Fisher, H. L., Matthews, T., Moffitt, T. E., Odgers, C. L., Stahl, D., Teng, J. Y., & Danese, A. (2019). The epidemiology of trauma and post-traumatic stress disorder in a representative cohort of young people in England and Wales. Lancet Psychiatry, 6(3), 247–256.
- NICE. (2018, December 5). Post-traumatic stress disorder. NICE. https://www.nice.org.uk/guidance/ng116/chapter/recommendations
