Predictors of Service Use Among African American, Caucasian, and Latino Youth Referred to the Child Welfare System

Background: Despite the association between child maltreatment and poor mental health (MH) outcomes, upwards of 40% do not receive services to ameliorate negative symptomatology. The odds of services receipt for Latino and African American youth placed in foster care are three times lower than Caucasians. To understand contextual pathways through which disparities emerge and are sustained, findings from two nationally representative cohorts of youth referred to the child welfare system (CWS) in 1999 and 2009 due to allegations of maltreatment are highlighted. The study addressed the following questions among both cohorts: 1) Do disparities linger in the receipt of MH services?, 2) Controlling for age and gender, do placement characteristics, socio-environmental factors (poverty and urbanicity), and organizational climate predict service receipt among Latino, African American, and Caucasian youth?, and 3) Does organizational climate mediate the relationships between placement and socio-environmental factors and service receipt?   

Methods:  The National Survey of Child and Adolescent Well-being Cohort I (NSCAW I) and 2 (NSCAW II) recruited more than 5,000 children who were referred to the CWS between 1999-00 and between 2008-09, respectively. Analyses focused on data collected for children ages 12-17 at Wave 3 for NSCAW-I and Wave 2 for NSCAW-II. By then, all children had been referred to the CWS 18 months ago. Need for services was defined as scoring above the clinical cut-point on internalizing, externalizing, and/or total behavior problems on the Child Behavior Checklist. The dependent variable was measured by a dichotomous variable indicating whether youth received MH services. Predictors include children’s age, gender, race/ethnicity, and child maltreatment history. The Organizational Social Context Survey was used to assess caseworkers’ perceptions of organizational climate; and socio-environmental data were gathered from U.S. Census data. A series of multiple group analyses (one for each racial/ethnic group) determined if the hypothesized predictors are equivalent between Cohorts 1 and 2.

Results: Of the 751 youth identified as needing services in both cohorts, 42.5% received services. With respect to Cohort 1 (n=481), Caucasian youth (56.5%) were more likely to receive services than Latinos (13.7%) and African Americans (29.8%). In Cohort 2 (n=270), Caucasian youth (55.2%) were still significantly more likely to receive services than Latinos (23.7%) and African Americans (21.1%), indicating that disparities remain a public health concern. The multiple group analyses detected differences regarding which factors contribute to service delivery by race/ethnicity. Among Caucasians (n=387) and African Americans (n=227), placement instability decreased the likelihood of service use among those in the first and second cohorts. An engaged organizational climate increased service delivery among African Americans in the second cohort. None of the hypothesized predictors were salient in predicting service use among Latino youth (n=137). Organizational climate did not mediate outcomes.

Conclusions: To increase service utilization, it is pertinent youth are placed and remain in stable homes. Findings underscore the need to identify other contextual factors (e.g., acculturation, beliefs, and language barriers) that may influence service delivery. Recent data from the second cohort also suggest that a positive organizational climate may facilitate service delivery among African Americans.