Service Receipt for Mental Health Disorders in Child Welfare: Results of Interagency Collaboration Between Child Welfare and Mental Health Systems in Los Angeles County

Background: Children involved with child welfare (CW) systems are at high risk of mental health problems, yet many of these children with identified mental health problems do not receive adequate care, especially ethnic minority children. Research has indicated that increases in interagency collaboration may help address this disparity; several studies found that collaboration increased odds of receiving behavioral and mental health services. This follow-up study examined an interagency collaboration between the Department of Children and Family Services (DCFS) and Department of Mental Health (DMH) in Los Angeles County, the two largest CW and mental health service-providing agencies in the United States. The objective of this study was to examine the receipt of mental health services by types of DSM-IV disorders for CW-involved children dually served by these two entities. Unique aspects of this study include: (a) using DSM-IV diagnosis criteria rather than the Child Behavioral Checklist to determine mental health needs; and (b) investigating variation in mental health service receipt across a broad range of mental health disorders.

Methods: This study used data from a cohort of CW-involved children (N = 3,194) dually served by DCFS and DMH between July 2011 and July 2012. Presence of DSM-IV-TR mental disorder diagnoses were determined by licensed mental health specialists and were categorized into the following major classes: mood disorders, anxiety disorders, attention deficit hyperactivity disorder (ADHD), behavior disorders (oppositional defiant disorder and conduct disorder), and depression. Univariate and bivariate analyses were conducted to derive descriptive statistics and examine relationships between variables of interest. Multivariate regression analyses were conducted to examine correlates (e.g., race and ethnicity, history of out-of-home placement, and history of mental health treatment) of mental health service receipt (as measured by receipt of unique therapeutic interventions) for each DSM-IV-TR disorder class.

Results: Mood disorders were the most common mental health disorders (30%, n = 956), followed by depression (25%, n = 807), anxiety disorders (20%, n = 632), and behavior disorders (9%, n = 291) and ADHD (9%, n = 291); 20% (n=536) of the children did not meet criterion for any mental health disorders. Children with behavior disorders received the most therapeutic interventions (M = 13.01, SD = 5.53), whereas children with anxiety disorders received the fewest interventions (M = 9.66, SD = 4.77). Age, history of out-of-home placement, and history of previous involvement with DMH were significantly associated with greater service receipt in all five mental health disorder classes. Black, Hispanic, and White children did not differ in terms of service receipt across each of the mental health disorders.

Conclusions and Implications: This study contributes to the literature by providing mental health service receipt outcomes of children dually served by collaborating CW and mental health service providers. Findings from this study can inform targeted action priorities and agenda in the delivery of mental health services, particularly to CW-involved children who live at home or who are using mental health services for the first time. Practice and policy implications for interagency collaboration are also discussed.