Mental Health Service Use by Children and Youth in the Child Welfare System: A Focus on Caregivers as Gatekeepers

Background/Purpose: Studies have consistently documented that children in the foster care system are at a higher risk for psychopathology than children in the general population, but few children receive the needed services. One area that lacks attention and may help to explain the underutilization of mental health services is the influence that the caregiver has on a child's utilization of services. Caregivers serve as gatekeepers for children while in the child welfare system, but few studies have focused on the caregiver and the factors that influence the use of mental health services for their children. Of these studies the majority has focused only on kin caregivers, but children in foster care are supervised by more than one type of caregiver. The purpose of this study was to examine the child's psychopathology, level of stress, depression, and social support of the caregiver and the utilization of mental health services by their children by caregiver type (i.e., birth parent, relative caregiver, and foster parent).

Method: Data comes from the Patterns of Care study of five public sectors of care during fiscal year 1996-1997 in San Diego, CA. The present study examined parents/caregivers and youth from only the child welfare sector (N=430). Using established standardized measures data were collected on mental health use, needs, and other factors potentially associated with mental health service use.

Results: The sample consisted of 38% birth parents, 26% relative caregivers, and 36% foster parents. Using bivariate analyses, statistically significant differences were found with birth parents having children with a higher externalizing behavior score (as evidenced by the CBCL) than relative caregivers (mean difference = 4.03, p = .039). Birth parents also had a higher level of stress than relative caregivers (mean difference = .265, p = .004) and foster parents (mean difference = .277, p = .001) and a higher level of depression than relative caregivers (mean difference = 6.47, p = .001) and foster parents (mean difference = 8.41, p = .001). Relative caregivers had a higher level of support than birth parents (mean difference = - .181, p = .013), but foster parents had a higher level of support than relative caregivers (mean difference = -.204, p = .006). There were also differences in the utilization of mental health services by the children under their care among caregiver type (c²(2) = 10.46, p <.05) with foster parents (56.2%) having the highest service use and birth parents (37.1%) having the lowest service use.

Conclusions/Implications: Findings suggest that while birth parents were more likely to enforce more risk factors for themselves and the children under their care had a higher level of mental health need they were the least likely to utilize mental health services for the children under their care. This highlights the need for mental health delivery systems and the child welfare system to work collaboratively to focus on providing services for this population of caregivers, as children who remain or are returned home may be at a greater risk for re-abuse.