Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Marina Room (Hyatt Regency San Francisco)

Rates of Mental Health and Substance Use Diagnoses and Service Use among Youth Exiting the Child Welfare System

Thomas E. Keller, PhD, University of Chicago and Amy L. Dworsky, PhD, University of Chicago.

Purpose Young adults in the child welfare system vary in their preparation for independent living and in the level of continuing support they receive. Many youth are emancipated at age 18, while some jurisdictions permit wards to remain in state care longer. In theory, those staying in care have greater access to needed services. Because the likelihood of negative outcomes in the transition to adulthood is greater for adolescents with psychiatric disorders or problems with substance use, the current study reports rates of mental health and substance use diagnoses and investigates how participation in counseling and treatment services may be associated with care status at age 19.

Method The public child welfare agencies in three states identified all active cases involving youth 17 years or older who had been in out-of-home care at least one year. Systematic random sampling yielded 732 study participants (95% response of eligible). Follow-up interviews were conducted at age 19 with 603 participants (82%). At both timepoints, comprehensive in-person interviews were conducted, and mental health diagnoses were assessed with the Composite International Diagnostic Interview. Diagnoses were obtained for alcohol dependence/abuse, substance dependence/abuse, and several mental health diagnoses: depression, dysthymia, social phobia, general anxiety disorder. Dichotomous items indicated whether participants had received counseling for emotional or psychological problems or received any alcohol/drug treatment services in the past year.

Results At age 19, the proportion of the sample with a mental health diagnosis was 18% and with an alcohol/drug diagnosis was 21%. Approximately half the sample (46.8%) remained in care. Rates of diagnosis tended to be higher for those no longer in care, and differences were statistically significant for alcohol abuse, alcohol dependence, substance abuse, and dysthymia. These differences for alcohol/substance diagnoses also existed at age 17. Overall, youth in care were twice as likely (28% vs. 14%) to report counseling services, and this difference was notable among those with mental health problems (49% in care vs. 31%) and those without a diagnosis (24% in care vs. 9%). However, the percentage receiving drug and alcohol treatment (7%) did not differ by care status. Rates of treatment by care status were comparable among youth with no alcohol/substance diagnosis (5% in care vs. 4%) and only somewhat different for those with alcohol/substance problems (22% in care vs. 16%).

Implications The rate of participation in drug and alcohol treatment programs for youth who emancipate from the child welfare system early is equal to or less than for those remaining in care at age 19, even though the former have greater alcohol and substance use problems. In addition, youth who remain in care are more likely to receive counseling services than youth who emancipate early regardless of the presence or absence of diagnostic criteria. Both findings suggest leaving the child welfare system may reduce access to services compared to continued engagement in the system. Such a conclusion would support extending time in care or providing a continuum of services to ensure vulnerable youth receive appropriate services during the difficult transition to adulthood.