Outpatient mental health services for children in foster care: a national perspective

• Published in: Child abuse & neglect 2004-06, Vol.28 (6), p.697-712
• Main Authors: Leslie, Laurel K, Hurlburt, Michael S, Landsverk, John, Barth, Richard, Slymen, Donald J
• Format: Article
• Language: English
• Subjects: Adolescent; African American Children; African Americans; Behavior Rating Scales; Biological and medical sciences; Check Lists; Child; Child abuse; Child abuse & neglect; Child Behavior; Child Behavior Checklist; Child Health Services - utilization; Child Neglect; Child, Preschool; Children; Community Mental Health Services - utilization; Ethnic differences; European Continental Ancestry Group; Female; Foster Care; Foster Home Care; Health Care Surveys; Health Personnel; Health Services; Humans; Infant; Male; Medicaid; Medical sciences; Mental Disorders - therapy; Mental Health; Mental health care; Mental Health Programs; Mental health services; National Surveys; Organization of mental health. Health systems; Outpatient care facilities; Outpatient treatment; Outpatients; Polls & surveys; Predictor Variables; Predictors; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Race; Race/ethnicity; Racial Differences; Regression (Statistics); Risk Factors; Sexual Abuse; Social psychiatry. Ethnopsychiatry; State Surveys; United States; USA; Whites
• ISSN: 0145-2134; 1873-7757
• DOI: 10.1016/j.chiabu.2004.01.004

Objective: To determine factors influencing the use of outpatient mental health services provided by mental health professionals (OMHS) for children in foster care using a national probability sample in the United States. Method: As part of the National Survey of Child and Adolescent Well-being, detailed survey data were collected on 462 children, ages 2–15, who had been in out-of-home care for approximately 12 months at the time of sampling. A multivariate logistic regression model was used to determine how clinical need, as measured by a Total Problem, Externalizing, or Internalizing Scale T-score of 64 or greater on the Achenbach Child Behavior Checklist (CBCL), and non-clinical factors affected OSMHS use. Results: Over half of the children in the sample received at least one OMHS. Need, older age, and history of sexual abuse history all positively predicted OMHS. A history of physical neglect negatively predicted OSMHS. African-Americans used fewer services than children of Caucasian ancestry at all values on the CBCL. This finding was particularly salient at lower levels of CBCL scores; at higher levels, the discrepancy in the use of services diminished but the proportion of children receiving services remained lower for African-American children. Conclusions: This national study confirms previous findings regarding the use of mental health services based on regional data. Limitations in the use of services imposed by non-clinical factors, specifically, age, race/ethnicity and type of abuse, need to be examined in order to address implicit and explicit policies and practices that may result in inequitable distribution of services. French-language abstract not available at time of publication. Objetivo: Determinar los factores influyentes en el uso de servicios externos de salud mental de profesionales de salud mental (OMHS) para niños en acogimiento, haciendo uso de una muestra nacional de probabilidad en los Estados Unidos. Método: Como parte del National Survey of Child and Adolescent Well-being, se recogieron cuestionarios detallados de datos de 462 niños, de edades 2–15 años, que habı́an estado fuera del cuidado familiar durante aproximadamente 12 meses en el momento del muestreo. Un modelo de regresión logı́stica multivariado se utilizó para determinar la necesidad clı́nica, según fue medida de las puntuaciones T de 64 o mayor en las escalas de Problemas Total, Externalizando, o Internalizando del Achenbach Child Behavior Checklist (CBCL) y facto