Racial/Ethnic Differences in Mental Health Service Use By Foster Youth Aging Out: Who Uses and Who Continues to Use After Care?

BACKGROUND:  Studies have shown that foster care youth have a higher prevalence of psychiatric symptoms, but not all youth receive the mental health services they need.  Consequently, studies have shown that foster care alumni have disproportionally high rates of poor mental health outcomes compared to the general population.  Few studies, however, have examined the receipt of mental health services pre and post foster care, and even fewer studies have examined racial/ethnic differences.  Only one study to date has examined racial/ethnic differences in the receipt of mental health services during and after foster care with only African American youth.   As such, the purpose of this study is to examine differences in mental health service use for Latino, African American, and Caucasian youth while in foster care and upon exit from the foster care system.     

METHODS:  Secondary data were used to identify a cohort of 17 year old youth (N=3,813), pre foster care discharge, from a large, ethnically diverse child welfare system.  Mental health service use data were examined for youth prior to discharge (N=1,414) and post-discharge (N=798) from the foster care system. 

RESULTS:  Results of Chi-Square tests indicate that there are racial/ethnic differences in mental health service use while in care X² (2, N=1589) =23.18, p=.001 and upon exit from the foster care system X² (2, N=1589) = 22.60, p=.001.   Results of a logistic regression indicate that allegations of emotional abuse (OR=2.97), physical abuse (OR=2.47), and sexual abuse (OR=3.90), and youth awaiting family reunification (OR=3.19) were more likely to use services, while African American youth (OR=.517) were the least likely to use mental health services while in care.  A second logistic regression indicates that Latino youth (OR=.623), and youth in permanency planning while in care (OR=.676) were the least likely to use services after foster care exit.  African American youth used the most crisis intervention services and group therapy, but used the least family therapy, while Latino youth used the least crisis intervention services and medication, but used the most day treatment services while in foster care.  Upon exit from the foster care system, African American youth used the most group therapy and day treatment, but the least crisis intervention and medication, while Latino youth used the most crisis intervention, individual therapy and medication, but the least group therapy.                     

IMPLICATIONS:  Findings from this study suggest racial/ethnic service disparities among youth while in foster care and upon exit from the foster care system in the utilization of mental health services and service type.  Social workers and mental health service providers need to develop mental health interventions to specifically target African American youth who do not receive the needed mental health services while in care, possibly making it the reason for their high service use upon exit as service use may be mandated through the judicial system.  Latino youth also should be the focus of these interventions as their need for mental health services may continue, but may otherwise not receive services after exiting care due to cultural issues.