How Can Child Welfare and Behavioral Health Care Agencies Work Together to Help Youth Stay at Home?

Background and Purpose: Behavioral problems are a significant predictor of placement instability for youth involved with child welfare. Although the majority of child welfare investigations and assessments initially allow youth to remain at home, youth with behavioral problems are at substantial risk of subsequent removal as well as for multiple placements out-of-home. Placement instability in turn has been shown to negatively impact youth behavioral well-being and to increase youth mental health care costs. Recent evidence suggests that staff at child welfare and behavioral health agencies may better support youth receiving these services if they work together well. However, there is a lack of research examining associations between specific types of inter-agency ties and youth outcomes. The current study examines associations between two types of inter-agency ties, cross-training and joint budgeting, and youth placement stability.

Methods: Data were drawn from the National Survey of Child and Adolescent Well-Being (NSCAW), a longitudinal study of families engaged with the child welfare system. These data include interviews with child welfare caseworkers, agency directors, and youth aged 11 years or older conducted at baseline, or shortly after the initial child welfare investigation or assessment; at 18 months; and at 36 months. The current study focused on 261 youth who were still located in-home at baseline and also receiving behavioral health services. Stata's complex survey design features were used to accommodate probability weights, stratification, and clustering of children within agencies. A logistic regression model was used to examine associations between inter-agency ties and youth odds of any out-of-home placement within 36 months. For the 107 youth who experienced at least one out-of-home placement within 36 months after the initial child welfare investigation or assessment, Poisson and negative binomial models were used to predict the total number of out-of-home placements experienced by youth and the cumulative number of days youth spent out-of-home, respectively.

Results: Cross-training between child welfare agencies and behavioral health providers was not significantly associated with youth odds of having any out-of-home placements. However, for youth who experienced at least one out-of-home placement after baseline, cross-training decreased the total number of placements by a factor of 0.56, or by -44% (p<0.01) and the number of days spent out-of-home by a factor of 0.60, or by -40% (p<0.05). Joint budgeting between child welfare agencies and behavioral health providers was not significantly associated with any measure of youth placement stability.

Conclusion and Implications: Research suggests that child welfare and behavioral health agencies often face challenges to collaboration because agency staff have very different priorities and lack knowledge of how other agencies operate. Cross-training has been described as a potential means of developing positive relationships between staff in different agencies. The current study findings suggest that cross-training of child welfare and behavioral health agency staff may have some impact on subsequent placement instability for youth initially assessed by the child welfare agency as being able to remain in-home.