Children Under Five Receiving Mental Health Services: A Comparison of Caregiver Self-Report and Clinician Report of Functioning by Child Welfare Status

Background & Significance: The functioning of very young children in the child welfare system has received scant attention in the literature, despite the fact that they represent one third of all substantiated cases of maltreatment. The purpose of the current study was to evaluate the functioning of young children and families entering an infant and early childhood mental health program designed for children at risk of child welfare involvement. We were interested in learning how those involved with child welfare compared with those not involved, and how clinician evaluations of clients compared with family self-assessments.

Methods: At intake, caregivers completed an extensive packet of instruments measuring child and family functioning (Parenting Stress Index, Parent Behavior Checklist, Center for Epidemiologic Studies-Depression Scale, Child Behavior Checklist). Clinicians evaluated parent and child functioning (Child and Adolescent Needs and Strengths) and made a diagnosis. Two hundred seventeen children were enrolled for mental health services at a mean age of 34.8 months (SD= 16.5; Range= 1-61). Most were boys (58.1%). Families were primarily low income (M= $1000/month) and Latino (86.6%), with CW clients less likely to be Latino (×2 =5.85, p=.025). Selecting only birth parents, we compared measures for child welfare clients and non-child welfare clients using MANOVA, ANOVA and Chi Square analyses. We then compared clinician evaluations to family self-evaluations.

Results: There were significant differences on a number of measures indicating that child welfare clients reported fewer problems. Child welfare caregivers endorsed fewer problems on 7 of the 14 subscales of the Parenting Stress Index, [Adaptability (F=7.12, p=.008), Demandingness (F =6.61, p=.011), Mood (F =8.71, p=.004), Acceptability (F=6.76, p=.010), Health (F=4.37, p=.038), Role Restriction (F=12.24 p=.001), Depression (F=6.76 p=.010), and Spouse (F=5.83, p=.017)]. They had lower scores on the CES-D than those not involved with child welfare (F=4.49, p=.036), indicating lower self-reports of depression. They also reported fewer child problems on the CBCL on Internalizing Problems (F=6.20, p=.014), Externalizing (F=5.10, p=.026, and Total Problems (F=6.36 p=.013). This contrasts with clinician's evaluations indicating that child welfare families had higher levels of child problems (F =5.00. p=.03), more risk factors (F=17.51, p=.00), and fewer strengths (F=4.93, p=.03). On clinicians' evaluations, child welfare families were more likely to score in the clinical range of problems.

Implications: This study reveals interesting differences between child welfare and non-child welfare families that require clinical consideration. Child welfare involved families portrayed themselves and their young children as functioning better than their non-child welfare involved peers, but this impression is in direct contrast to clinicians' evaluations. This may indicate reluctance for child welfare involved caregivers to endorse items indicating problems out of fear that such reports may impact custody decisions. These preliminary findings warn against reliance upon standardized instruments as the sole measures of child and family functioning at time of intake. Suggestions for better measurement include use of more qualitative data encompassing clinical impressions and gathering sensitive self- report data later in the treatment process, after trust is established.