Predictors of Mental Health and Developmental Service Utilization Among Children Birth to Five in Child Welfare: A Systematic Review

Background and Purpose:  Children birth to five in the child welfare system experiencing trauma are at risk for mental health problems and developmental delays but often do not receive the services they need. However, little is known about factors influencing their service utilization.  This systematic review attempts to answer the following questions: (1) What is the prevalence of mental health and developmental needs among children birth to five in child welfare? (2) What are the factors predicting mental health and developmental service utilization among children birth to five in child welfare?

Methods:  Electronic searches were conducted in June 2016 using PsycINFO, Medline, SocINDEX and Social Work Abstracts databases.  Key search terms include ("early childhood" OR "young children" OR preschool* OR "infants" OR “toddlers) AND ("child welfare" OR "foster care") AND (development* OR behavior* OR "mental health" OR "social emotional") AND (service*).  The search was limited to peer reviewed articles from 2001 to 2016, analyzing the predictors of mental health or developmental service utilization among children birth to five, involved with child welfare services and used a separate model for children birth to five years. Titles and abstracts were screened for 1,147 unduplicated articles from the initial search, 39 studies were retained for a full review with eight studies being selected for the systematic review.  Data was extracted from each study; a quality assessment tool was used and forest plots created to pool effects sizes across studies. 

Results:  The prevalence of mental health and developmental need ranged from 13% to 58%.  Mental health need, developmental need, and child welfare placement are significant predictors of mental health and developmental service use.  Studies in the systematic review included two studies on mental health service utilization, one study contained models for both mental health and developmental service utilization and five studies focused on developmental service utilization. Seven studies used NSCAW data and one study used a statewide data set.  All eight studies suggested children with greater mental health or developmental need have higher odds of receiving mental health services than children without an identified need.  Two studies suggest children placed in out of home care have greater odds of receiving mental health services than children placed with in-home settings.  Five studies identified children in out of home placement having greater odds of receiving developmental services.  Two studies indicated African American and Hispanic children have lower odds of receiving mental health or developmental services than White children. 

Conclusions and Implications:  The overall effect size from the studies in this review suggest mental health and developmental need along with placement is a significant predictor of mental health and developmental service utilization among children birth to five in the child welfare system.  Non-clinical factors such as race, culture and placement type also impact service use suggesting providers examine existing barriers for African American and Hispanic children placed with in-home services.  Further service utilization research is needed in assessing clinical and non-clinical factors, specifically with placement settings, placement disruptions, race/ethnicity, need for services and service type.