Mental Health Management Among 17-Year Olds in the Child Welfare System in California

Background and Purpose: Important changes occur during the transition to adulthood, not the least of which is a shift toward youth more independently managing their own mental health (Holmbeck, 2002). Managing mental health can be complicated, and it often includes the need to take psychotropic medication(s) and/or consistently attend counseling. The purpose of the present study was to examine the rates of psychotropic medication use and outpatient counseling use of 17-year olds involved with the child welfare system in California, and to examine factors that predict medication use, counseling use, and the youths’ perceived level of preparedness to manage their mental health.

Method: Data were drawn from Wave 1 of the CalYOUTH Study (n=727). The three outcomes include past year counseling use, past year medication use, and youths’ perceptions of their level of preparedness to manage their mental health need. Preparation to manage mental health was measured by asking, “How prepared do you feel to manage your mental health?” Options ranged from 1 (not prepared) to 4 (very prepared). OLS regression was used to assess predictors of preparation to manage mental health, and logistic regression was used to assess predictors of counseling use and medication use. Predictors included age, sex, race/ethnicity, maltreatment (presence of physical abuse, neglect, and sexual abuse), mental health disorder, and county size. Presence of a mental health (MH) disorder was assessed using the Mini International Neuropsychiatric Interview, and was indicated by a positive screen for a mood, anxiety, or behavior disorders. Sample weights were applied to adjust for features of the study design.

Conclusions and Implications: Results suggest youth in California’s foster care system are heavy users of MH services. As expected, youth with a MH disorder had higher rates of use. Less expected, the study found that rural youth were more likely to use counseling than urban youth. Lower scores on perceived preparedness to manage MH for those with MH disorders suggests that the child welfare system may improve overall transition programming by including a curriculum on MH management, particularly for those with an identified MH disorder.