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Mental Health Need and Access to Mental Health Services by Youths Involved With Child Welfare: A National Survey

https://doi.org/10.1097/01.chi.0000127590.95585.65Get rights and content

ABSTRACT

Objective

This study assessed the relationship between the need for and use of mental health services among a nationally representative sample of children who were investigated by child welfare agencies after reported maltreatment.

Method

Data were collected at study entry into the National Survey of Child and Adolescent Well-Being and were weighted to provide population estimates.

Results

Nearly half (47.9%) of the youths aged 2 to 14 years (N = 3,803) with completed child welfare investigations had clinically significant emotional or behavioral problems. Youths with mental health need (defined by a clinical range score on the Child Behavior Checklist) were much more likely to receive mental health services than lower scoring youth; still, only one fourth of such youths received any specialty mental health care during the previous 12 months. Clinical need was related to receipt of mental health care across all age groups (odds ratio = 2.7–3.5). In addition, for young children (2–5 years), sexual abuse (versus neglect) increased access to mental health services. For latency-age youths, African-American race and living at home significantly reduced the likelihood of care. Adolescents living at home were also less likely to receive services, whereas having a parent with severe mental illness increased (odds ratio = 2.4) the likelihood of service use.

Conclusions

Routine screening for mental health need and increasing access to mental health professionals for further evaluation and treatment should be a priority for children early in their contact with the child welfare system.

Section snippets

METHOD

NSCAW consists of two cohorts of children randomly selected (between October 1999 and December 2000) to take part in this survey, along with their associated caregivers and child welfare workers. The main cohort examined in this report consists of 5,504 youths sampled from investigations and/or assessments completed during the sampling period. Initial interviews were conducted within about 6 months of completed investigations; thus, the 1-year time frame for reporting mental health service use

Sample Demographics

Thirty percent of the sample included in these analyses fell into the preschool group (2–5 years), 42% in the school-age group (6–10 years), and 28% in the adolescent group (11–14 years). Approximately half were white (47.6%), almost one third were African American (28%), and the remainder were Hispanic (17.5%) or other racial/ethnic groups (7%). Males and females were equally represented. The majority of youths (89.7%) were living at home with their permanent primary caregiver; the remainder

DISCUSSION

The NSCAW has provided the first national estimates of mental health need and service use in the child welfare population. These NSCAW findings about clinical need and the gap between need and mental health service use can be extrapolated to national reporting data on maltreatment. In 2000, child welfare agencies across the country investigated allegations of maltreatment involving an estimated 1.7 million children (U.S. DHHS, 2002). Applying the population estimates obtained in this survey,

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    The study is funded by the NIMH (MH59672). The Caring for Children in Child Welfare project (CCCW) is a collaborative effort between the Child and Adolescent Services Research Group (CASRC) at Children's Hospital-San Diego, the Department of Psychiatry at the University of Pittsburgh (Pittsburgh), the Columbus Children's Hospital, the Services Effectiveness Research Program at Duke University School of Medicine (Duke), and the Research Triangle Institute (RTI). Key personnel for the collaborative study include PIs John A. Landsverk (CASRC), Kelly J. Kelleher (Columbus Children's Hospital), Barbara J. Burns (Duke), Paul P. Biemer (RTI); (CO-PI) Laurel K. Leslie (CASRC); Investigators Richard P. Barth (University of North Carolina), John A. Fairbank (Duke), Michael S. Hurlburt (CASRC), David J. Kolko (Pittsburgh), Don J. Slymen (CASRC); (Project Coordinator) Jennifer A. Rolls (CASRC). Key consultants include Jon B. Christianson (University of Minnesota), Anne M. Libby (University of Colorado), and Jan R. McCarthy (Georgetown University).

    It should be noted that this document includes data from the National Survey on Child and Adolescent Well-Being (NSCAW), which was developed under contract with the Administration on Children and Families, U.S. Department of Health and Human Services (ACF/DHHS). The CCCW also maintains ongoing collaboration with the NSCAW Research Group.

    The information and opinions expressed herein reflect solely the position of the author(s). Nothing herein should be construed to indicate the support or endorsement of its content by ACF/DHHS or NIMH and may not reflect the opinions of the researchers on the masthead.

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