Ensuring Mental Health Screening for Child Welfare-Involved Children through Interagency Collaboration

Background: The prevalence of mental health needs is high among children served by child protective services (CPS). Research indicates that there are disparities between the need for and the receipt of mental health services, with one reason being challenges in screening CPS involved youth for mental health difficulties.  Interagency collaboration between CPS and mental health service organizations shows promise in facilitating the screening and referral of youth in need of mental health services.  Los Angeles County Department of Children and Family Services (LACDCFS) and Los Angeles County Department of Mental Health (LACDMH) serve as a prime example of the utilization of interagency collaborative efforts including co-locating staff, developing a child welfare specific mental health screening tool, and data-sharing practices.

Objective: This study determined the prevalence of mental disorders, duration of mental health treatment, and number of therapeutic interventions received in a sample of CPS-involved children screened through this interagency collaboration between two of the largest CPS and mental health services organizations in the United States. We also investigated the influence of demographic and clinical factors including age, gender, ethnicity, out-of-home placement history, allegation type, history of mental health treatment, and presence of psychiatric diagnosis on mental health service use in this sample of CPS-involved children.

Methods: Data came from a cohort of CPS-involved children (N = 3194) who received specialized mental health screening between July 2011 to July 2012. Univariate analyses were conducted to derive descriptive statistics and to assess the prevalence of different categories of DSM-IV-TRdiagnosis and level of mental health service use. A multivariate ordinary least squares linear regression model was fitted to identify demographic and clinical predictors of duration of mental health treatment.

Results: The average age of the sample was 8.31 years (SD=5.38, Range=0-20), with an even distribution of the genders (Males = 51.25%). The sample was ethnically diverse with Latinos making up the majority of cases (59.33%), followed by African Americans (19.43%), Whites (13.24%), and other ethnicities (8.00%). General neglect was the most common allegation of maltreatment (42.21%). Approximately 56% of the sample had a prior out-of-home placement. Interagency collaboration between these entities resulted in the identification of diagnosable mental health conditions in 84.66% of positively screened cases and led to referrals for mental health treatment commensurate with the level of need based on DSM-IV-TR criteria. On average, the sample received about 100 days of mental health treatment (SD=105.77, Range =0–513 days). The span of mental health treatment yielded an average of 7.80 (SD=4.90, Range = 1-30) types therapeutic interventions. Longer duration of mental health treatment was significantly associated with types of maltreatment, no history with LACDMH (β=-0.24) prior to contact with LACDCFS, and presence of mental disorder diagnosis (β=0.27).

Conclusion: Findings indicate that interagency collaboration between LACDCFS and LACDMH was successful in identifying a sub-sample of maltreated children at elevated risk for mental health problems. The collaboration also resulted in referrals for mental treatment commensurate with the level of need. Taken together, these findings demonstrate the benefits of interagency collaboration.