Article

Contextual predictors of mental health service use among children open to child welfare

Child and Adolescent Services Research Center, Children's Hospital, San Diego, CA 92123, USA.
Archives of General Psychiatry (Impact Factor: 13.75). 01/2005; 61(12):1217-24. DOI: 10.1001/archpsyc.61.12.1217
Source: PubMed

ABSTRACT Children involved with child welfare systems are at high risk for emotional and behavioral problems. Many children with identified mental health problems do not receive care, especially ethnic/minority children.
To examine how patterns of specialty mental health service use among children involved with child welfare vary as a function of the degree of coordination between local child welfare and mental health agencies.
Specialty mental health service use for 1 year after contact with child welfare was examined in a nationally representative cohort of children aged 2 to 14 years. Predictors of service use were modeled at the child/family and agency/county levels. Child- and agency-level data were collected between October 15, 1999, and April 30, 2001.
Ninety-seven US counties.
A total of 2823 child welfare cases (multiple informants) from the National Survey of Child and Adolescent Well-being and agency-level key informants from the participating counties.
Specialty mental health service use during the year after contact with the child welfare system.
Only 28.3% of children received specialty mental health services during the year, although 42.4% had clinical-level Child Behavior Checklist scores. Out-of-home placement, age, and race/ethnicity were strong predictors of service use rates, even after controlling for Child Behavior Checklist scores. Increased coordination between local child welfare and mental health agencies was associated with stronger relationships between Child Behavior Checklist scores and service use and decreased differences in rates of service use between white and African American children.
Younger children and those remaining in their homes could benefit from increased specialty mental health services. They have disproportionately low rates of service use, despite high levels of need. Increases in interagency coordination may lead to more efficient allocation of service resources to children with the greatest need and to decreased racial/ethnic disparities.

Download full-text

Full-text

Available from: Richard P Barth, Aug 29, 2015
1 Follower
 · 
106 Views
  • Source
    • "Children who are placed in foster care are most likely in need of effective and timely interventions to address negative developmental outcomes, often as a result of repeated exposures to incidents of maltreatment (Chaffin and Friedrich 2004; English et al. 2005; E ´ thier et al. 2004). A significant proportion (upwards of 40 %) of children referred to the child welfare system are in need of evidencebased mental health intervention (Hurlburt et al. 2004). Thus, identifying the number of children in foster care would provide a glimpse into whether there is indeed a need for EBPs, such as MTFC. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Recent efforts have been devoted to understanding the conditions by which research evidence use (REU) is facilitated from the perspective of system leaders in the context of implementing evidence-based child mental health interventions. However, we have limited understanding of the extent to which outer contextual factors influence REU. Outer contextual factors for 37 counties in California were gathered from public records in 2008; and child welfare, juvenile justice, and mental health system leaders' perceptions of their REU were measured via a web-based survey from 2010 to 2012. Results showed that leaders with higher educational attainment and in counties with lower expenditures on inpatient mental health services were significantly associated with higher REU. Positive relationships between gathering research evidence and racial minority concentration and poverty at the county level were also detected. Results underscore the need to identify the organizational and socio-political factors by which mental health services and resources meet client demands that influence REU, and to recruit and retain providers with a graduate degree to negotiate work demands and interpret research evidence.
    Administration and Policy in Mental Health and Mental Health Services Research 02/2015; DOI:10.1007/s10488-015-0640-2 · 3.44 Impact Factor
  • Source
    • "A robust body of research showed that the odds of out-ofhome placement increase when children exhibit clinically pervasive physical, emotional, or behavioral problems (Barth et al. 2007; Becker et al. 2007; Burns et al. 2004; Farmer et al. 2008). Yet only a third of children referred to the child welfare system who are in need of mental health services actually receive them (Hurlburt et al. 2004). Osgood et al. (2010) reported that, to make matters worse, services often end abruptly for many of the youth diagnosed with physical and mental health disabilities when they make the transition to adulthood. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The etiology of poor mental health outcomes among foster care alumni of color remains largely unknown. We examined the influence of a subset of adverse childhood experiences (ACEs), placement instability, and childhood disability in uniquely predicting mental health outcomes among racially diverse foster care alumni from a private foster care agency. Multiple group path modeling was used to examine direct and indirect relationships between the individual level risk factors, mediators (perceived agency helpfulness), and past-year psychiatric disorder. Results showed that while the overall model was moderated by race/ethnicity, no significant group differences occurred in which ACEs increased the likelihood of psychiatric diagnoses. However, there were racial/ethnic differences in whether perceived agency helpfulness mediated the relationship between a subset of ACEs and diagnosis with a psychiatric disorder. Implications for future research to inform the development and implementation of effective services and supports that can promote positive developmental outcomes among racially diverse alumni are discussed.
    Journal of Child and Family Studies 01/2015; DOI:10.1007/s10826-015-0132-8 · 1.42 Impact Factor
    • "Second, studies of the evolution of cross-agency ties suggest that public child welfare agencies may develop interorganizational networks to access critical resources and expertise, thereby altering agency service technology and enhancing frontline service capacity. Research suggests that interagency agreements may help public child welfare agencies obtain community resources for clients who need services that are unavailable in-house (Bai, Wells, & Hillemeier, 2009; Chuang & Wells, 2010; Hurlburt et al., 2004). These studies imply that agencies' overall service strategies may encompass a combination of direct care to clients and subcontracted specialty services developed through targeted alliances with local providers. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This paper argues for a conceptual reorientation to research and practice that emphasizes the prominence of institutional and organizational factors in the lives of those who are involved in child welfare systems. Current child welfare reform efforts are premised on the idea that agencies—their structures, management, and internal approaches to organizing their workforce and frontline services—may be influential drivers of and barriers to innovation in practice and policy. We unpack this premise by providing an introduction to the institutional and organizational context of child welfare practice that highlights the diverse contexts and contributions of public and private child welfare agencies. We then review five domains for future research and present examples of studies that might be undertaken. The paper concludes by introducing the symposium papers and identifying their contributions to child welfare and human service research.
    Children and Youth Services Review 03/2014; 38. DOI:10.1016/j.childyouth.2014.01.014 · 1.27 Impact Factor
Show more