Children involved with child welfare systems are at high risk for emotional
and behavioral problems. Many children with identified mental health problems
do not receive care, especially ethnic/minority children.
To examine how patterns of specialty mental health service use among
children involved with child welfare vary as a function of the degree of coordination
between local child welfare and mental health agencies.
Specialty mental health service use for 1 year after contact with child
welfare was examined in a nationally representative cohort of children aged
2 to 14 years. Predictors of service use were modeled at the child/family
and agency/county levels. Child- and agency-level data were collected between
October 15, 1999, and April 30, 2001.
Ninety-seven US counties.
A total of 2823 child welfare cases (multiple informants) from the National
Survey of Child and Adolescent Well-being and agency-level key informants
from the participating counties.
Main Outcome Measures
Specialty mental health service use during the year after contact with
the child welfare system.
Only 28.3% of children received specialty mental health services during
the year, although 42.4% had clinical-level Child Behavior Checklist scores.
Out-of-home placement, age, and race/ethnicity were strong predictors of service
use rates, even after controlling for Child Behavior Checklist scores. Increased
coordination between local child welfare and mental health agencies was associated
with stronger relationships between Child Behavior Checklist scores and service
use and decreased differences in rates of service use between white and African
Younger children and those remaining in their homes could benefit from
increased specialty mental health services. They have disproportionately low
rates of service use, despite high levels of need. Increases in interagency
coordination may lead to more efficient allocation of service resources to
children with the greatest need and to decreased racial/ethnic disparities.