Linking Immigrant Youth in Child Welfare with Mental Health Services

Background and Purpose: Youth involved in child welfare are more likely to have mental health conditions. However, participation in mental health services is lower than the need would suggest, indicating that many youth are underserved, and this gap in service use has persisted over the past decade. Racial and ethnic disparities exist in access to and utilization of mental health services such that racial and ethnic minority youth in child welfare are more likely to be diagnosed with a mental health disorder, but less likely to receive services. To address the mental health needs of youth in child welfare, the 2011 Katie A. v. Bonta court ruling in California mandated that public child welfare and mental health systems improve service coordination. This qualitative data mining study, initiated approximately five years following the Katie A. decision, explores progress in improving linkages to mental health for youth in the child welfare system.

Methods: The research team partnered with a small county-based child welfare agency in California. Sixteen case records, purposively selected to be diverse in age, sex, race/ethnicity, placement experiences, mental health needs, and immigration background were reviewed. Our team reviewed an average of 48 documents for each case, with a range of 6-77. Documents spanned the trajectory of the case and consisted of emergency response notes, case contact notes, court documents, initial case plans, and case plan updates. The data were extracted using a qualitative data mining technique developed by Henry et al. (2014). A codebook informed by the literature and research interests of our county partners was applied. Initial team-based coding sessions were used to allow team members to clarify and refine the codebook together. To augment coding, members wrote analytical memos summarizing each case and reviewed these along with coded data in analysis. For this paper, cases involving immigrant youth in the sample (n=5) were analyzed for experiences specific to culture, language, and immigration.

Findings: Experiences of immigration, cultural differences, and language barriers contributed to case complexity. Child welfare workers made vigorous efforts to support youth with multiple service needs and to liaison with mental health providers. However, when combined with developmental issues, family stresses, mental health needs, and service system fragmentation, immigrant youth experienced unique challenges in accessing mental health care as well as school-based services and supports. For example, in one case, the youth and family expressed openness to family therapy, but while waiting to be matched with a bilingual provider, the parent became homeless and difficult to reach. These challenges contributed to difficulties in offering family-based services, delays in accessing services, and service refusal.

Conclusion and Implications: This study underscores the need for child welfare and mental health systems to offer culturally and linguistically responsive services that can meet the needs of immigrant youth, and to continue efforts to build a more coordinated system of care. Child welfare workers operating within a fragmented system need to have manageable caseloads and be recognized for their persistence in linking youth to mental health care.