The Role of Placement Type in the Pathway into Mental Health Care among Maltreated Youth Involved with Child Welfare

Background: This study attempts to understand the relationship between placement type and mental health help-seeking pathways among maltreated youth receiving child welfare services. The U.S. Department of Health and Human Services (2005) indicates that 899,000 youth receive child welfare services due to maltreatment. Thirty-five percent of maltreated youth receive foster care services, suggesting that a majority of youth remain home with maltreating parent(s). Research documents the need for mental health services by maltreated youth (Ciccheti & Toth, 2005; Kaplow & Widom, 2007; Leslie et al., 2005, Springer, Sheridan, Kuo, & Carnes, 2007), however, only 60 percent of maltreated youth who need mental health services actually receive them (U.S. Department of Health and Human Services, 2005). While child welfare involvement can be a gateway to mental health services (Leslie et al., 2005) it does not guarantee services receipt. The literature addressing this is scant. The purpose of this study was to describe how maltreated youth involved with child welfare come to access mental health services, and how it differs by placement, to understand how to improve mental health service use among maltreated youth.

Method: The current analysis used a sub-sample from a federally funded research project examining the psychological and developmental impact of maltreatment. The Services Assessment for Children and Adolescents was used to garner information regarding need for mental health services, referral source, and service use. The gender-balanced sample includes 84 maltreated youth who were receiving mental health treatment at intake. Youth were residing with biological parents (56%) or in foster placement (44%). The average age was 10.8 years and they were ethnically Latino (50%), African American (30%), or Other (20%). Chi square and logistic regression analyses were performed via SPSS.

Results: There was a significant relationship between placement type and from whom parents sought help. Biological caregivers were more likely to talk to family members (÷2(1) = 4.169, p<.05) and law officials such as a judge, probation officer, or lawyer (÷2(1) = 4.65, p<.05), while foster parents were more likely to talk with an individual not listed (÷2(1) = 5.23, p<.05). Youth remaining in the home of origin were more likely to have received a mental health referral from a law official (÷2(1) = 3.87, p<.05). This study also found that impoverished families were less likely to talk to religious figures (p=.037, OR= .044) and less likely to receive a referral from school personnel (p=.05, OR= 1.37) and African American youth were significantly more likely to receive a referral from law officials (p=.038, OR=8.65).

Conclusions/Implications: These findings indicate differences in mental health help-seeking depending on placement type. To retain custody, maltreating biological parents come to access mental health care by a more coercive source than foster parents. Additionally, this study supports research suggesting that child welfare system involvement is not a direct pathway into mental health care, highlighting the need to further address how maltreated youth come to access mental health services and to distinguish how this differs based on where the youth resides.