problems, and Black girls with more severe abuse by an unrelated
person and multiple family problems. Service referral and receipt
rates were just 4% to 7%, respectively, among children in these
groups. Hispanic adolescents and children of other races/ethnici-
ties, in contrast, appear to be connected to services when they
Designing child welfare services that better protect the mental
health of sexually abused children will require interventions that
meet the individual needs of children and families. This study
shows that at least some children receive a mental health service
response based more on worker concerns when abuse is substan-
tiated rather than on specific assessment of children’s individual
needs. Factors that might account for this are agency resources that
are accessible in concert with substantiated abuse or family disin-
terest in receiving or following through with mental health services
when it is not clear that the abuse took place. Because there is “no
specific test that can convincingly conclude that sexual abuse has
not occurred” (Runyan, 1998, p. 494) and because there is evi-
dence that substantiation status is not a reliable gauge of maltreat-
ment risk, nonoccurrence, or family needs (Drake, 1995), services
that are guided by indicators other than child need are likely either
to underestimate the number of children who would benefit from
services or to misdirect resources.
Children’s psychological symptoms do show relation to patterns
of both their exposure to sexual abuse and other family problems,
supporting the provision of services that are abuse-informed but
not exclusively abuse-focused (Saunders et al., 2001). Moving
child welfare practice toward service provision that is based on a
tailored assessment of individual children rather than on gross
classifications of abuse experiences may aid the design of child
welfare services that better protect children’s mental health. Men-
tal health providers, in turn, ought to be cognizant of these patterns
and work with child welfare agencies to ensure that sexually
abused children are provided psychological care that is appropriate
to their level of need and that is sensitive to other significant
experiences in children’s lives that may contribute to their psy-
chopathology symptoms or risk.
Achenbach, T. M. (1993). Empirically based taxonomy: How to use
syndromes and profile types derived from the CBCL/4–18, TRF, and
YSR. Burlington: University of Vermont, Department of Psychiatry.
Avery, L., Massat, C. R., & Lundy, M. (2000). Posttraumatic stress and
mental health functioning of sexually abused children. Child and Ado-
lescent Social Work Journal, 17, 19–34.
Bagley, C., & Mallick, K. (2000). Prediction of sexual, emotional, and
physical maltreatment and mental health outcomes in a longitudinal
cohort of 290 adolescent women. Child Maltreatment, 5, 218–226.
Barnett, D., Manly, J. T., & Cicchetti, D. (1993). Defining child maltreat-
ment: The interface between policy and child research. In D. Cicchetti &
S. L. Toth (Eds.), Child abuse, child development, and social policy:
Advances in applied developmental psychology (Vol 8, pp. 7–73). Nor-
wood, NJ: Ablex.
Beitchman, J. H., Zucker, K. J., Hood, J. E., daCosta, G. A., & Akman, D.
(1991). A review of the short-term effects of child sexual abuse. Child
Abuse & Neglect, 15, 537–556.
Beichtman, J., Zucker, K., Hood, J., DaCosta, G., Akman, S., & Cassavia,
E. A. (1993). A review of the long-term effects of child sexual abuse.
Child Abuse & Neglect, 191, 101–117.
Berrick, J. D., Needell, B., Barth, R. P., & Jonson-Reid, M. (1998). The
tender years: Toward developmentally sensitive child welfare services
for very young children. New York: Oxford University Press.
Bolger, K. E., & Patterson, C. J. (2001). Pathways from child maltreatment
to internalizing problems: Perceptions of control as mediators and mod-
erators. Development and Psychopathology, 13, 913–940.
Briere, J. (1996). Trauma Symptom Checklist for children: Professional
manual. Odessa, FL: Psychological Assessment Resources.
Burns, B. J., Phillips, S. D., Wagner, H. R., Barth, R. P., Kolko, D. J.,
Campbell, Y., & Landsverk, J. (2004). Mental health need and access to
mental health services by youths involved with child welfare: A national
survey. Journal of the American Academy of Child and Adolescent
Psychiatry, 43, 960–970.
Cohen, J. A., & Mannarino, A. P. (1996). Factors that mediate treatment
outcome of sexually abused preschool children. Journal of the American
Academy of Child and Adolescent Psychiatry, 37, 44 –51.
Danielson, C. K., deArellano, M. A., Kilpatrick, D. G., Saunders, B. E., &
Resnick, H. S. (2005). Child maltreatment in depressed adolescents:
Differences in symptomatology based on history of abuse. Child Mal-
treatment, 10, 37–48.
Dong, M., Anda, R. F., Dube, S. R., Giles, W. H., & Felitti, V. J. (2003).
The relationship of exposure to childhood sexual abuse to other forms of
abuse, neglect, and household dysfunction during childhood. Child
Abuse & Neglect, 27, 625–239.
Drake, B. (1995). Associations between reporter type and assessment
outcomes in child protective services referrals. Children and Youth
Services Review, 17, 503–522.
Finkelhor, D., & Berliner, L. (1995). Research on the treatment of sexually
abused children: A review and recommendations. Journal of the Amer-
ican Academy of Child and Adolescent Psychiatry, 34, 1408–1423.
Fergusson, D. M. & Mullen, P. E. (1999). Childhood Sexual Abuse: An
Evidence Based Perspective (Developmental clinical psychology and
psychiatry series, Vol. 40). Thousand Oaks, CA: Sage.
Garland, A. F., Landsverk, J. L., Hough, R. L., & Ellis-MacLeod, E.
(1996). Type of maltreatment as a predictor of mental health service use
for children in foster care. Child Abuse & Neglect, 20, 675– 688.
Hurlburt, M. S., Leslie, L. K., Landsverk, J., Barth, R. P., Burns, B. J.,
Gibbons, R. D., et al. 2004 Contextual predictors of mental health
service use among a cohort of children open to child welfare. Archives
of General Psychiatry, 61, 1217–1224.
Jonson-Reid, M., Drake, B., Chung, S., & Way, I. (2003). Cross-type
recidivism among child maltreatment victims and perpetrators. Child
Abuse & Neglect, 27, 899 –917.
Kellogg, N. D., & Menard, S. W. (2003). Violence among family members
of children and adolescents evaluated for sexual abuse. Child Abuse &
Neglect, 27, 1367–1376.
Kendall-Tackett, K. A., Williams, L. M., & Finkelhor, D. (1993). Impact
of sexual abuse on children: A review and synthesis of recent empirical
studies. Psychological Bulletin, 113, 164 –180.
Kessler, R. C., Andrews, G., Mroczek, D., Ustun, T. B., & Wittchen, H. U.
(1998). The World Health Organization Composite International Diag-
nostic Interview—Short Form (CIDI–SF). International Journal of
Methods in Psychiatric Research, 7, 171–185.
Kilpatrick, D. G., Ruggiero, K. J., Acierno, R., Saunders, B. E., Resnick,
H. S., & Best, C. L. (2003). Violence and risk of PTSD, major depres-
sion, substance abuse/dependence, and comorbidity: Results from the
National Survey of Adolescents. Journal of Consulting and Clinical
Psychology, 71, 692–700.
Kolko, D. J., Barth, R. P., Burns, B. J., Zhang, J., Leslie, L., & Fairbank,
J. A. 2005. Posttraumatic stress in children receiving child welfare
services: A national sample of in-home and out-of-home care. Manu-
script submitted for publication.
Kovacs, M. (1992). Children’s depression inventory. North Tonawanda,
NY: Multi-Health Systems.
Lau, A. S., Leeb, R. T., English, D., Christopher-Gram, J., Briggs, E. C.,
MCCRAE, CHAPMAN, AND CHRIST