Determinants of Mental Health Service Use among Maltreated Children

Purpose: While the prevalence of mental health problems among maltreated children has been widely studied (Howe & Parke, 2001), fewer studies have investigated why a substantial number of maltreated children fail to receive proper mental health services and what factors might affect the use of such services (Burns et al., 2004). Moreover, most of the previous studies have solely focused on children's characteristics (demographics, maltreatment type, and placement type). However, access to service is commonly decided by caregivers. Thus, caregivers' characteristics (age, race/ethnicity, and education) also need to be considered. To better identify predictors of service use, this study includes a broad set of factors. More specifically, based on Andersen's Behavioral Model, this study examines (a) children's demographic factors, maltreatment type, placement type, and caregivers' mental health status and demographic characteristics as predisposing factors, (b) family income and child insurance coverage as enabling factors, and (c) evaluated mental health need as a need factor.

Method: Using the longitudinal national data set, National Survey of Child and Adolescent Well-Being (NSCAW), 1778 children aged 5-14 years were drawn for this study, who had been investigated for child abuse and neglect between 1999 and 2000. Data include child, caregiver, caseworker, and teacher interviews across five waves. For examining factors related to mental health service use, this included predictors (at baseline) and the outcome variable of mental health service use (at wave 3). Mental health service use was completed by caregiver and was coded as a dummy variable. Mental health service use included any of the following: specialty mental health, community mental health services, private professionals, schools, day treatment, in-home counseling, and general medical doctor. Data analyses included descriptive statistics, bivariate and multivariate analyses.

Results: Logistic regression analyses revealed several statistically significant findings: For children's receipt of mental health services, children's predisposing factors included: gender (female) (OR=.50, p<.01) and older children (aged 11-14) (OR=1.85, p<.01), along with those placed in non-kinship settings (vs. in-home care) (OR=3.76, p<.01). Caregivers' predisposing factors: ethnicity (black) (OR=.22, p<.01) and age (> 54 years) (OR=2.83, p<.05). For enabling factors, children without any medical insurance had lower odds of accessing services than children with Medicaid or state-funded medical program (OR=.27, p<.001). As need factors, children with clinical needs (CBCL≥60; clinical range) had higher odds (OR=3.60, p<.001).

Conclusions and Implications: The findings of this study contribute to the development of better policies that improve the well-being of maltreated children by decreasing barriers to the appropriate use of mental health services for children. As findings showed that female and younger children and children without clinical behavior problems were less likely to use mental health services, this study suggests specific targets that policymakers should focus on. Also, the results provide information about which placement types coupled with specific caregiver characteristics that were more likely to result in access to services for maltreated children. Study results may be helpful in guiding placement decisions for maltreated children with specific behavioral impairments.