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Original Article
December 2004

Contextual Predictors of Mental Health Service Use Among Children Opento Child Welfare

Author Affiliations

Author Affiliations: Child and Adolescent ServicesResearch Center, Children’s Hospital, San Diego (Drs Hurlburt, Leslie,and Landsverk and Ms Zhang), Department of Pediatrics, University of California,San Diego (Dr Leslie), and School of Social Work (Dr Landsverk) and GraduateSchool of Public Health (Dr Slymen), San Diego State University, San DiegoSchool of Social Work, University of North Carolina, Chapel Hill (Dr Barth);Department of Psychiatry and Behavioral Sciences, Duke University School ofMedicine, Durham, NC (Dr Burns); and Center for Health Statistics, Universityof Illinois at Chicago (Dr Gibbons).

Arch Gen Psychiatry. 2004;61(12):1217-1224. doi:10.1001/archpsyc.61.12.1217

Background  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.

Objective  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.

Design  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.

Setting  Ninety-seven US counties.

Participants  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.

Results  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 American children.

Conclusions  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.