Purpose: Although research suggests that mothers with serious mental illness (SMI) experience challenges to successful parenting and an increased risk of losing child custody, limited information is available on the extent of these families' interactions with the child welfare system compared to other mothers. This study extends existing research by examining differences between mothers with SMI and other mothers in the extent to which their children were placed in out-of-home care and receive non-placement preventive services through the child welfare system. This study also examines, among mothers with SMI, the relationship between diagnosis and type of treatment services and child welfare system involvement.

Method: The analyses were conducted using Medicaid claims records, Medicaid eligibility records, and child welfare records from Philadelphia between 1996 and 2000. The sample comprised 4,558 mothers between the ages of 15 and 45 years who became eligible for Medicaid for the first time between 1995 and 1996 and who had at least one child less than 17 years of age at the beginning of the study period. Child welfare system involvement was measured as being placed in out-of-home care or receiving non-placement preventive services. SMI was measured using claims associated with ICD codes 295 and 296. Claims linked to ICD codes from 290 through 319 except for 295 and 296 were categorized as other psychiatric diagnosis. Univariate analyses were conducted to examine the distribution of type of diagnosis, type of treatment, and demographic characteristics. ANOVA models were used to describe the association between diagnosis, place of treatment, and child welfare system involvement.

Results: Among families involved with the child welfare system, approximately 86% had children placed in out-of-home care and 14% received non-placement preventive services. Children of 8.0% of mothers with SMI were placed in out-of-home care or received preventive services during the study period, compared with 5.4% of mothers with other psychiatric diagnoses and 1.6% of those without psychiatric diagnoses. Mothers with a history of inpatient treatment were particularly at risk for these outcomes.

Implications: These findings confirm that mothers with SMI are at higher risk than other mothers for losing custody of their children or receiving non-placement preventive services. The results suggest that these families may benefit from integration between mental health and child welfare systems and continued follow-up in order to reduce the risk of losing child custody. Costs associated with these interventions would be offset by the considerable public costs associated with children's placement in the child welfare system.