Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Background: Children at risk for maltreatment (i.e., child abuse or neglect) are at an increased risk of experiencing mental health (MH) problems, yet many of these children do not receive care. Families, primary caregivers in particular, can play a key role regarding how mental health symptoms are defined and expressed among maltreated children, and whether MH services are accessed. In order to improve the likelihood that maltreated children with MH problems access treatment early and to improve MH outcomes for this group, we need to better understand the influence of caregivers on child MH need and service use.

Method: Sample: One thousand, one hundred eighteen (48% male, 51% female) eight-year old children and their caregivers who completed the year 8 Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) interview. Fifty-five percent of the sample was African American, 26% Caucasian-American, 12% Hispanic-American, and 7% other. Eighty percent of the primary caregivers were mothers. Procedure: This study was a secondary data analysis of the LONGSCAN data. Measures: MH service use was operationalized as formal services received at age 8. Child MH need was operationalized with Child Behavior Checklist (CBCL) internalizing and externalizing scores. Caregiver network was operationalized as neighborhood satisfaction and perceived support. Caregiver capacity was operationalized as Brief Symptom Inventory global score, CAGE total score, and CES-D total depressive symptoms score. Data analysis: A structural equation model was created with caregiver network and capacity as the exogenous variables and child MH need and service use as the endogenous variables. Analyses were conducted with AMOS 4.01.

Results: All paths in the model were significant, and the full model fit the data (c² (16) = 105, p = .00, c² /df = 6.557, NFI = .99, CFI = .99, RMSEA = .07). The model accounted for 34% of variance in child MH service use. Caregivers with less supportive networks and whose capacity to parent was challenged by alcohol, depression, or other MH problems, had children with higher MH needs as indicated by elevated CBCL scores. However, these children were not likely to access services, especially as caregivers had more challenges regarding their MH and substance abuse problems.

Implications: Although the importance of family variables in children's MH treatment has long been articulated, it is too often ignored in clinical and services research. This study highlights caregiver influences on child MH need and service use among children at risk for maltreatment. Social workers working with caregivers who present with co-occurring MH and substance abuse problems and who have limited social support should take precaution to assess children's MH needs. In addition to prioritizing routine screening of MH need, social workers should identify strategies to increase access to MH services for maltreated children and families. Implications regarding recognition and diagnosis of MH problems, and improving access to treatment among caregivers and maltreated children will be discussed.