Background and Purpose: Child welfare consumers are exceptionally heavy users of mental health services, but little information exists about the quality of these services. This presentation focuses on two research questions. How do child welfare and mental health professionals view the quality of mental health care received by child welfare consumers? And, what drives referrals for mental health services?

Methods: These research questions were pursued through the analysis of qualitative interview data obtained from 20 one-on-one interviews and 16 group interviews (total n = 126) involving key informants from the court, mental health, and child welfare systems. The interviews and focus groups utilized an evolving qualitative guide, and were transcribed and imported into NViVo. Analyses involved the identification of regularities in the data (themes) and differences in views across professional roles. Themes were identified and agreed upon by independent readers. Codebooks were created from these themes and used to code the complete set of transcripts. Inter-coder agreement was ascertained using 10% of the transcripts before coding began.

Results: Child welfare, mental health and court professionals expressed serious concerns about the quality of mental health services received by child welfare consumers. Concerns included overmedication of children, overuse of psychotherapy, overuse and inappropriate use of psychological testing, overdiagnosis, and unfocused, unproductive psychotherapy. All professionals except psychiatrists expressed concerns about overmedication. All professionals except psychologists expressed concerns about “cookie cutter” psychological evaluations. Child welfare professionals expressed concerns about brief sessions with psychiatrists that resulted in medication prescriptions and psychiatric reports that carried weight with the court. Continuity in psychiatric care was also reported as problematic as youth changed psychiatrists and medications as they changed placements.

Overuse of services was reported to be caused by judges ordering therapy and evaluations for all clients and case workers' fears that judges would question them if their clients were not in therapy. Judges, on the other hand, reported wanting as much information from as many professionals as possible to help guide their decisions. Overmedication was thought to be driven by the requests for psychiatric evaluations, attempts to “save” at-risk placements, and child welfare workers' reluctance to challenge or question psychiatrists. Overdiagnosis was driven by payment requirements.

Child welfare professionals chose mental health providers for their clients based on reputation for quality among their peers, prior experience, a low “hassle factor,” the willingness of providers to provide timely reports, and the child welfare workers' ability to get reports from providers that supported their own recommendations. A select group of mental health professionals of dubious quality was identified who receive all or almost all of their business from child welfare professionals because of their abilities to meet these latter requirements.

Implications: Study findings suggest several targets for the development of interventions to change practices and improve quality in mental health services received by child welfare consumers. These include ways to better conduct and use psychological and psychiatric evaluations, educate child welfare and court professionals on mental health matters and reduce inappropriate use of psychotropic medication.