Mental Health Needs and Service Use in Young Children Served By Child Welfare Services

Introduction: Experience of maltreatment during early childhood is detrimental as evidenced by research documenting high rates of mental health (MH) needs among the youngest victims. The majority of these studies have tended to use standardized behavioral instruments to estimate the extent of need. Our study seeks to contribute to this body of knowledge by assessing the proportion of maltreated children aged 0–5 with MH needs as indicated by a psychiatric diagnosis of clinicians and by delineating the most common diagnoses. Given research showing that preventive and early intervention (PEI) services could mitigate the sequelae of childhood maltreatment, we also investigated whether children with psychiatric diagnoses were more likely to be referred to PEI service controlling for systematic demographics (age, gender, ethnicity, maltreatment types) differences in service use.

Methods: Data came from a cohort of maltreated children aged 0–5 (N = 1163) who received a MH screening protocol between July 2011 and July 2012 that identified them as needing referral for comprehensive MH assessment. The Los Angeles County Department of Children and Family Services (DCFS) and Department of Mental Health (DMH) jointly developed the MH screening protocol as part of a collaborative effort to enhance the identification of maltreated children at risk of MH problems and expediting MH services to those in need. The following data were extracted using linked probability methodology from electronic repositories maintained by DCFS and DMH: age, gender, ethnicity, and type of maltreatment, psychiatric diagnoses of clinicians, and service use. Univariate analyses were conducted to derive descriptive statistics on the sample. A binary multivariate logistic regression model was fitted to assess the adjusted association between presence of psychiatric diagnosis and referral to PEI services.

Results:  The average age of the sample was 2.49 year (SD = 1.74). The sample comprised primarily racial and ethnic minorities (86.75%). Neglect (66.12%) was the most common type of alleged maltreatment followed by emotional abuse (14.76%). The majority of children (72.48%) received a psychiatric diagnosis. Diagnoses most common to this sample were disorders diagnosed in infancy, childhood, and adolescents (41.62%) including attention-deficit and disruptive behavior disorders (14.70%), reactive attachment disorder (2.49%), separation anxiety disorder (1.63%), and pervasive developmental disorders (1.29%). Other common diagnoses were adjustment disorder (31.30%), anxiety (12.12%), and mood disorders (5.25%). Diagnoses were not mutually exclusive, as a child could have received more than one diagnoses. Keeping the covariates constant, children with psychiatric diagnoses were significantly more likely to be referred to PEI services (OR = 7.09, 95% CI = 4.01 – 12.52). Among the covariates, older age was significantly associated with a referral to PEI services (OR = 1.24, 95% CI = 1.13 – 1.36).

 Conclusion: Seven-in-ten young victims of maltreatment in this sample have MH needs that were sufficiently severe to meet diagnostic criteria. For children with psychiatric diagnoses, the odds of being referred to PEI services were over seven times greater than the odds for young children without psychiatric diagnoses. This favorable finding could be attributed to the inter-agency collaboration between DCFS and DMH.