System Challenges and Mental Health Services for Children in Foster Care: The Illinois Experience

Background and Purpose:

Many children in foster care need mental health services but do not receive them. Systemic obstacles such as difficulties identifying children in need, finding service providers, and paying for services impede mental health service delivery. This presentation combines quantitative and qualitative methods to measure the shortfall in mental health services in Illinois in 2004 and to link these results to systemic reviews of Illinois' child services and a description of Illinois' reform efforts. Illinois' experience is instructive because it shows clear links between empirical data about service delivery, system analysis, and system reforms and raises questions about effective methods of change.

Methods:

In the quantitative component, standardized measures of children's mental health and service delivery were collected in a random sample of 554 children and youths in foster care in Illinois in September 2003. Analysis compared Illinois data to data from the National Survey of Child and Adolescent Well-Being (NSCAW), a national probability study of children involved with child welfare.

The qualitative component involved document review and key informant interviews about three different published reviews of children's services in Illinois: a) a 1989 lawsuit against the Illinois Department of Child and Family Services (DCFS), b) the 2003 Federal Child and Family Service Review of DCFS, and c) a 2003 children's mental health report by a coalition of Illinois service organizations.

Results:

Over half of children and youth in foster care in Illinois scored in the clinical or borderline range on standardized measures -- roughly comparable to the percentage in the national sample. Many children in need in foster care both in Illinois and nationally did not receive mental health services, but the proportion was larger in Illinois than nationally. The largest difference was in the proportion of children in foster care who received services from a mental health center or community mental health center, which was 5.2% in Illinois versus 15.5% nationally.

Reviews of Illinois service systems suggest a number of obstacles to mental health services delivery for children in foster care, including:

•The press of DCFS' responsibilities for safety and permanence

•Lack of skilled assessment of children in care

•Cumbersome Medicaid procedures and lack of Medicaid providers

•Inadequate information about and contracting with potential providers

Reform efforts have spawned new initiatives, including a sophisticated assessment program and an extensive new database of mental health service providers. However, attention and resources for mental health services for children in foster care are limited within the broad scope of child welfare and children's mental health reform efforts in Illinois.

Conclusions and Implications:

Treatment for children in foster care is prone to the systemic obstacles endemic to children's mental health care in general as well as its child welfare context. Improvement may lag behind other priorities in broad system change efforts, and mental health care for this population may require special advocacy. The use of technology in this effort is particularly promising. Empirical service data over time is needed to test the effects of system reforms.