Relationship Between Entry Into Child Welfare and Mental Health Service Use

Loma Linda University, لوما ليندا، كاليفورنيا, California, United States
Psychiatric Services (Impact Factor: 2.41). 09/2005; 56(8):981-7. DOI: 10.1176/
Source: PubMed


This study examined the relationship between initiation of outpatient mental health service use and level of child welfare involvement.
Three levels of child welfare involvement were examined: in-home care and no child welfare services beyond an initial investigation, in-home care and additional child welfare services, and placement in out-of-home care (foster care). Longitudinal data were collected for a subsample of children (N=3,592) aged two through 14 years who were enrolled in the National Survey of Child and Adolescent Well-Being, a nationally representative sample of children undergoing investigation for abuse or neglect. Event history analysis was used to model relative risk of initiation of mental health service use over time.
Hazard functions revealed a large increase in onset of mental health services immediately after the time of the initial contact with child welfare, varying by level of child welfare involvement and leveling off by three months after the initial contact. The multivariate Cox proportional-hazards model indicated that compared with children who were placed in out-of-home care, those in in-home care who did not receive any further child welfare services were about one-third as likely to use mental health services and those in in-home care who received additional child welfare services were one-half as likely to use mental health services. Other covariates in the model predicted mental health service use, including being older, being Caucasian, having a history of maltreatment (specifically, physical abuse, physical neglect, or abandonment), being uninsured, and need for mental health services, as measured by the Child Behavior Checklist.
Contact with child welfare functions as a gateway into mental health services for children in child welfare, even when need for such services is controlled for.

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    • "Additionally, presenting problems and psychiatric diagnoses will differ between the two groups; a significantly greater proportion of the foster care group will have experienced abuse and traumatic stress, and the severity of illness may be greater in the foster care group as well. It is also possible that because child welfare involvement is often a gateway to mental health services (Leslie et al. 2005), more of the youth in foster care will have had prior mental health service experiences. Second, multivariate regression analyses are conducted to examine the association between foster care and medication use controlling for other clinical and demographic correlates. "
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    ABSTRACT: Using data from the Client/Patient Sample Survey, a nationally representative study of outpatient mental health service utilization, the prevalence and correlates of psychotropic medication receipt for youth who live with families and in foster care are compared. The medication rate is similar for both groups, with slightly more than one-third of youth treated with medication. Additionally, when medication is prescribed, it is the sole intervention provided for close to one half of each group, and the distribution of other services received (such as clinical case management and collateral services) is similar, regardless of living situation. However, the predictors of medication use differ for the two groups. Among foster care youth, only presenting problems of depressed mood, being withdrawn, and suicidality significantly increase the odds of medication; among youth with families, sociodemographic characteristics (male gender), and a range of clinical factors (disruptive behavior disorder, presenting problems of hyperactivity and sleep disturbance, prior mental health service receipt, and inpatient or residential care referral sources) increase the likelihood of medication. The conclusion that distinct sets of factors predict medication for the two groups was reinforced by results of multivariate analyses; foster care status moderates the association between medication receipt and only one of the correlates examined (gender). Implications, limitations, and areas for future research are presented.
    Journal of Child and Family Studies 05/2013; 23(4). DOI:10.1007/s10826-013-9885-0 · 1.42 Impact Factor
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    • "The core of in-home child protection is facilitation of whatever services each family needs combined with continued monitoring for progress toward independent assurance of child safety. Often such case management entails initiation of mental health care for children (Leslie et al., 2005). Such services can help adolescents with behavioral disturbances function more successfully at home (Clarke, Schaefer, Burchard, & Welkowitz, 1992) and reduce the likelihood of out of home placement(Glisson & Green, 2006).If the child is subsequently removed from home, counseling may improve placement stability by addressing by pre-existing behavioral health problems as well as the additional stressors of separation. "
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    ABSTRACT: National survey data were used to assess whether child welfare agency ties to behavioral health care providers improved placement stability for adolescents served by both systems. Adolescents initially at home who were later removed tended to have fewer moves when child welfare and behavioral health were in the same larger agency. Joint training of child welfare and behavioral health staff was negatively associated with numbers of moves and numbers of days out of home.
    Child welfare 08/2012; 91(1):79-100. · 0.59 Impact Factor
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    • "Foster care history played a substantial role in increasing the likelihood of both inpatient and ambulatory mental health service use, independent of homeless experiences. This finding is consistent with literature showing that children in foster care, because of the circumstances leading to their placement, have a high level of need for mental health services, and that foster care placement facilitates children's access to such services (Hurlburt et al., 2004; Leslie et al., 2005). This elevated risk, along with sheltered children having much higher rates of foster care placement than the low-income housed children, combined to leave more children facing a greater likelihood of receiving mental health services. "
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    ABSTRACT: This study examined whether children who become homeless differ from other low-income children in their mental health service use before and after their first homeless episode, and to what extent homelessness is associated with an increased likelihood of mental health service use. Differences between children with and without new onset of sheltered homelessness in the use of mental health services emerged following homelessness and widened over time. Sheltered homelessness and foster care placement history were associated with increased odds of receiving inpatient and ambulatory mental health services. Findings underscore the importance of collaborations between homeless assistance, foster care, and mental healthcare in efforts to mitigate family homelessness and collateral needs among homeless children.
    Children and Youth Services Review 01/2012; 34(1):261-265. DOI:10.1016/j.childyouth.2011.10.022 · 1.27 Impact Factor
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