A Preliminary Analysis of the Receipt of Mental Health Services Consistent With National Standards Among Children in the Child Welfare System

• DOI: 10.2105/ajph.2008.151472
• Publication Date: 2009-07-17T01:48:25Z
• Authors: Ramesh Raghavan; Megumi Inoue; Susan L. Ettner; Barton H. Hamilton; John Landsverk
• Keywords: Mental Health Services; Adolescent; 1. No poverty; Child Welfare; 16. Peace & justice; Health Services Accessibility; United States; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Health Care Surveys; Odds Ratio; Humans; Child Abuse; Child; 10. No inequality

Objectives. We sought to examine the extent to which children in the child welfare system receive mental health care consistent with national standards. Methods. We used data from 4 waves (3 years of follow-up) of the National Survey of Child and Adolescent Well-Being, the nation's first longitudinal study of children in the child welfare system, and the Area Resource File to examine rates of screening, assessment, and referral to mental health services among 3802 youths presenting to child welfare agencies. Weighted population-averaged logistic regression models were used to identify variables associated with standards-consistent care. Results. Only half of all children in the sample received care consistent with any 1 national standard, and less than one tenth received care consistent with all of them. Older children, those exhibiting externalizing behaviors, and those placed in foster care had, on average, higher odds of receiving care consistent with national standards. Conclusions. Adverse consequences of childhood disadvantage cannot be reduced unless greater collaboration occurs between child welfare and mental health agencies. Current changes to Medicaid regulations that weaken entitlements to screening and assessment may also worsen mental health disparities among these vulnerable children.