Mental Health Service Use During the Transition to Adulthood for Adolescents Reported to the Child Welfare System

ArticleinPsychiatric services (Washington, D.C.) 60(8):1084-91 · September 2009with19 Reads
DOI: 10.1176/appi.ps.60.8.1084 · Source: PubMed
Abstract
This study analyzed patterns of outpatient mental health service use from adolescence into early adulthood among young adults who were reported as victims of maltreatment in adolescence. Data were from the National Survey of Child and Adolescent Well-Being, a national probability study of children for whom maltreatment was investigated by the child welfare system. The sample consisted of 616 young adults aged 12 to 15 at baseline. Analysis used descriptive statistics to determine need for and use of outpatient mental health services across time. Logistic regression was used to examine predictors of use of outpatient mental health services in young adulthood. Almost half of the young adults in this sample had one or more indicators of mental health problems. There was a significant decrease in use of specialty mental health services from adolescence to young adulthood, declining from 47.6% at baseline, to 14.3% at the five- to six- year follow-up. Among young adults with mental health problems, less than a quarter used outpatient mental health services. Logistic regression results indicated that having mental health problems, having Medicaid, and being white were positively associated with use of outpatient mental health services in young adulthood. Mental health problems were prevalent among young adults who were suspected of being maltreated when they were adolescents, but only about a quarter of those in need used outpatient mental health services. Interventions to improve access to outpatient mental health services for this vulnerable population should particularly support outreach and engagement of young adults who are uninsured and from racial or ethnic minority groups with a history of involvement with the child welfare system in order to meet their unique developmental needs.
    • "However, it has the potential to serve as a cost-effective, useful screening tool, indicated prevention model, and catalyst for further treatment, if needed. Substance use is among the most serious issues facing foster youth; however, little attention has been paid to screening, assessment, prevention, or treatment of these problems (Casanueva et al., 2011; Cheng & Lo, 2010; McCarthy et al., 2007; Ringeisen et al., 2009; Schneiderman et al., 2007). Despite calls for an increase in attention to substance use among foster youth and routine screening for mental health and substance use problems (Havlicek, Garcia, & Smith, 2013), we are not aware of any intervention that specifically targets substance use among youth who are preparing to exit the foster care system. "
    [Show abstract] [Hide abstract] ABSTRACT: With an ever-increasing gap between need and availability for substance use services, more scalable and efficient interventions are needed. For youths in the foster care system, this gap is dramatic and expands as they leave care. Effective prevention services are strongly needed for this group of vulnerable young people. We propose a novel technology-driven intervention for preventing problematic substance use among youths receiving foster care services. This study extends the work in brief computerized interventions by adding a text message-based booster, dynamically tailored to each individual's readiness to change. It also combats many barriers to service receipt. Dynamically tailored interventions delivered through technologies commonly used by adolescents and young adults have the strong potential to reduce the burden of problematic substance use.
    Article · Feb 2016
    • "Despite the need, such youth rarely receive corresponding services, especially in traditional forms (SAMHSA, 2010). For alumni of foster care, this gap could become even wider as youth exit the system (Casanueva et al., 2011; Ringeisen et al., 2009), particularly as youth have less contact with service providers (Casanueva et al., 2011). Significant barriers also exist within the system, including mistrust of institutions (Davis, 2003) and lack of delivery, coordination or continuity of care, given housing instability (Horwitz et al., 2000; Kelleher & Scholle, 1995; Simms et al., 2000 ) or overburdened case managers (Schneiderman, 2004). "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Of the 463,000 children residing in United States foster care, 29,000 annually exit the system because they have "aged out," are thus dropped from supportive services, and become responsible for their own housing, finances, and health needs. Given histories of maltreatment, housing instability, and parental substance use, youth preparing to exit care are at substantial risk of developing substance use disorders. Unfortunately, access to services is often limited, both before and after exit from care. Methods: With the goal of developing a relevant substance use intervention for these youth, focus groups were conducted with foster care staff, administrators, and parents to assess the feasibility of potential approaches. Results: Participants identified several population-specific barriers to delivering adapted intervention models developed for normative populations. They expressed concerns about foster youth developing, then quickly ending, relationships with interventionists, as well as admitting to substance use, given foster care program sanctions for such behavior. Group members stressed the importance of tailoring interventions, using creative, motivational procedures. Conclusions: Foster youth seem to encounter unique barriers to receiving adequate care. In light of these results, a novel, engaging approach to overcoming these barriers is also presented.
    Article · Feb 2014
    • "The lack of trauma-informed training can also affect the worker's understanding of the child's symptoms, especially disruptive behavior problems, and the need for appropriate mental health treatment interventions. Unfortunately , many children who have experienced trauma receive no treatment or treatment not shown to be effective (Burns et al., 2004; Cohen, Mannarino, & Rogal, 2001; Kolko, Cohen, Mannarino, Baumann, & Knudsen, 2009; Ringeisen, Casanueva, Urato, & Stambaugh, 2009), further strengthening the rationale for a structured, trauma-informed approach for all children in the child welfare system. "
    [Show abstract] [Hide abstract] ABSTRACT: The use of trauma-informed practices in the child welfare system is critically important to prevent system-induced trauma and encourage timely assessment, triage and referral for care when indicated. Ultimately, such measures have the potential over time to decrease the risk for mental health problems in children exposed to a trauma. This study evaluates an initiative in Arkansas to train child welfare front-line staff members in trauma-informed care practices. We evaluated the impact of the training on knowledge and use of trauma-informed care practices among three types of child welfare staff (Caseworkers, Program Assistants and Other front-line staff). Results suggest that this training process was highly successful in improving knowledge of trauma-informed care practices, especially among staff with the least formal education and training. We also found a significant increase in staff use of trauma-informed care practices at the three-month follow-up with little difference observed across staff groups. Barriers that may prevent staff from full implementation of training concepts are described and strategies to address barriers are proposed.
    Full-text · Article · Nov 2013
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