Naming Racial/Ethnic Gaps in Mental Health Service Delivery Among Youth and Families in the Child Welfare System

Background: Over 40% of children in foster care suffer from clinically pervasive mental, emotional, and behavioral problems, but only a third of them receive specialty mental health services. While research over the past fifteen years shows the gap between need for and access to mental health services is even wider for children of color in the child welfare system, little is known about why these disparities linger. To address this gap, a qualitative study was conducted in a large Mid-Atlantic City. The primary objective was to illuminate caseworkers’ perceptions of barriers and facilitators to delivering effective mental health services among African American and Latino youth and families, who account for ninety percent of the clients served by a recently transitioned privatized child welfare system.

Methods: Thirty-six caseworkers, most of who were female (89%), African American (67%) or Latino (14%), and on average 34 years of age, participated in one of five focus groups at their place of employment. Focus groups were 90 to 120 minutes long and were audio recorded, transcribed, and reviewed for accuracy. Grounded Theory Methods were implemented, relying on ATLAS/ti software. The first step involved identifying and labeling phenomena (open coding), followed by “focused coding” in which the most significant codes were identified. Next, connections between categories were observed, generating themes to the emerging analysis (axial coding). Rigor was achieved through reflexivity, memoing and maintaining records of personal biases, and by reaching consensus amongst members’ of the research team on the selection of codes, themes, and quotes to support them.

Results: Caseworkers are likely to experience barriers and facilitators in delivering services to children and families of color at the micro, meso, and macro practice levels. At the macro level, “dissemination” of effective practice was emphasized. “Awareness” of effective practices was identified at the meso- level; and “implementation” was the focus at the micro-level. At the macro-level, funding, development of effective practice strategies, and proximity to effective services are likely to influence “dissemination”. Secondly, caseworkers agreed that at the meso-level, job support is needed to facilitate “awareness”, but to feel supported, they need effective training and opportunities to engage in interagency collaboration. Finally, at the micro-level, they suggested that cultural competence influences “implementation” of effective services. However, increased awareness around the social ills of stigma and the salience of “insider work” (i.e., engaging in reflexive practice) are needed to increase cultural competence.

Conclusions: Increased access to and use of effective services are reported by caseworkers where supports are cultivated at the macro, meso, and micro levels of social service delivery. Emphasis on securing resources to 1) promote positive organizational culture and climate, and 2) communication and collaboration between mental health and child welfare agencies will likely play a role in ameliorating racial service disparities. Future research is warranted to support these emerging findings. Ongoing training is needed to decrease stigma around mental illness and increase awareness of existing or emerging effective practice strategies in the community.