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.

    • "Certain risk factors for suicidal ideation are more pronounced and relatively unique to CW-involved youths. For example, CW-involved youths are 2.5 times more likely than the general population to have a mental health need and are at greater risk of poor mental health outcomes than any other subpopulation of children in the United States (Aarons et al., 2010; Burns et al., 2004; Leslie et al., 2005). Additionally, type of child maltreatment (e.g., sexual, physical, and neglect) and type of placement have been associated with adolescent suicidal ideation (Anderson, 2011; Miller, Esposito-Smythers, Weismoore, & Renshaw, 2013). "
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    ABSTRACT: Using data from the National Survey of Child and Adolescent Well-Being, this study examined the relationship between connectedness in major social domains (i.e., caregiver, peers, deviant peers, and school) and suicidal ideation among adolescents (11-17 years old) investigated by child welfare agencies (N=995). Weighted logistic regression models were used to evaluate the relationships between connectedness variables and suicidal ideation, after adjusting for covariates. Youths with a stronger connection to caregivers were much less likely to report suicidal ideation, whereas youths with stronger deviant peer relationships were significantly more likely to report suicidal ideation. Significant associations found between primary caregiver and deviant peer connectedness and suicidal ideation highlight the need for attentive consideration of these relationships when working with this highly vulnerable population. Identifying domain-specific connectedness factors related to suicidal ideation presents an opportunity for the development of targeted early intervention for child welfare-involved youths. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · Mar 2015 · Child abuse & neglect
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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.
    Full-text · Article · May 2013 · Journal of Child and Family Studies
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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.
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