Research That Matters (January 17 - 20, 2008)

Purpose: Planning child welfare services to ensure that children receive adequate mental health care requires a clear understanding of children's psychological needs. To date, the few studies that report the prevalence of mental health problems among child welfare-involved children are limited to specific subgroups, primarily children in foster care, older children and adolescents, and abused, rather than neglected, children. This study aims to provide the first nationally-representative, detailed view of the prevalence of mental health concerns among the larger group of children involved with child welfare services. Prevalence and rates of change are reported for the nine syndrome constructs and broader dimensions of the Child Behavior Checklist, self-reported depression using the Children's Depression Inventory, and posttraumatic stress using the Trauma Symptom Checklist for Children.

Method: Data are from the National Survey of Child and Adolescent Well-being, a longitudinal study of 5,501 children investigated for maltreatment. The study includes children ages 2 to 14 at the time of the investigation (n=3,801). Descriptive analyses were used to estimate the proportion of children with each problem at baseline, 18, and 36 months post-baseline, and at any point over these three years. Bivariate analyses were used to test differences in rates by child demographic characteristics. Conditional probability tables were used to describe change in the proportion of children experiencing an outcome at 36 months conditioned on their status at baseline.

Results: Most children exhibited clinical-level problems on at least one emotional-behavioral measure at some point over three years (62%). One-half of children (49%) scored in the clinical-range of total problem behavior, 33% showed internalizing problems, and 46% showed externalizing problems. Most prevalent over three years were thought problems (25%), aggressive and delinquent behavior (21% and 20%), depression (20%), posttraumatic stress (19%), and attention problems (18%). Children's scores were highest at baseline. A few findings were unexpected, including that: (1) boys showed significantly higher rates of caregiver-reported internalizing problems compared with girls, (2) thought and attention problems were among the most prevalent and persistent, and (3) rates of sexual behavior problems were significantly higher among White and Hispanic children compared with Black children. Among symptomatic children at baseline, the majority (58%) remained there 36 months later. Clinical status improved for 42% of children, and worsened for 18% of children.

Conclusions and Implications: Results suggest that some children experience an emotional or behavioral reaction to the circumstances surrounding the maltreatment or the investigation that may not precipitate long-term difficulties. Services may also be effective in reducing children's level of distress. Many children continue to experience attention and thought-related problems suggesting that services may not sufficiently target these symptoms. Sexualized behavior problems appear predominantly among White and Hispanic children, suggesting that services ought to target these groups. Other child welfare-involved children may be most at risk for sexual victimization by children in these groups. Workers may need to actively elicit internalizing symptoms in boys, and be attentive to how caregivers assess their children's emotions and behavior, which may influence parenting styles.