Abstract: Mental Health Diagnoses and Child Protection Involvement Among Children on Medicaid (Society for Social Work and Research 26th Annual Conference - Social Work Science for Racial, Social, and Political Justice)

Mental Health Diagnoses and Child Protection Involvement Among Children on Medicaid

Sunday, January 16, 2022
Marquis BR Salon 12, ML 2 (Marriott Marquis Washington, DC)
* noted as presenting author
Emily Putnam-Hornstein, PhD, John A. Tate Distinguished Professor for Children in Need, University of North Carolina at Chapel Hill, Chapel Hill, NC
Regan Foust, PhD, Research Scientist, University of Southern California, Los Angeles, CA
Stephanie Cuccaro-Alamin, PhD, Research Associate, University of Southern California, Los Angeles, CA
John Prindle, PhD, Research Faculty, University of Southern California, Los Angeles, CA
Huy Nghiem, BA, Computer Scientist, University of Southern California, Los Angeles, CA
Lindsey Palmer, MSW, PhD Student, University of Southern California, Los Angeles, CA
BACKGROUND AND PURPOSE: Research has consistently documented a relationship between childhood maltreatment and mental health (MH) disorders. These findings, however, have emerged largely through studies of children placed in out-of-home foster care, a small subset of all maltreated children. In the current study, we linked population-based Medicaid eligibility and claim records to longitudinal child protection records from California. Using these data, we assessed both the prevalence of MH diagnoses among Medicaid-insured children and the share of those children who had a history of child protection involvement.

METHODS: Our cohort consisted of the full population of children who were enrolled in California’s Medicaid program for at least one month between 2014 and 2015 and who had at least one claim during that period (n=3,352,886). Records for these Medicaid-insured children were probabilistically linked to statewide child protection records dating back to 1998. For each child, we recorded whether or not they had a primary or secondary MH diagnosis classified using International Classification of Disease (ICD) codes. Medicaid-insured children were defined as having had CPS involvement if they were linked to one or more child abuse or neglect allegations, regardless of whether the allegation was investigated or substantiated. To assess bivariate relationship between child protection involvement and MH diagnostic categories, we used pairwise Chi Square tests. Finally, we ran a series of multivariable generalized linear models to document the adjusted relative risk of a MH diagnosis by level of CPS involvement, after controlling for demographic differences. These same models were then run by diagnostic group (e.g., ADHD, depressive disorders).

RESULTS: Overall, 14% (n=470,513) of children in our cohort had a documented MH diagnosis. Among those with a MH diagnosis, 50.4% (n=237,082) had a history of child protection involvement compared to only 26.9% (n=903,019) of all children on Medicaid. This finding held across all diagnostic groups, but with notable variations in magnitude. At the low end of CPS involvement were children with learning disorders (29.5%) and autism spectrum disorders (37.2%). Meanwhile, among children diagnosed with bipolar disorder and schizophrenia/other psychotic disorders, the percentage with historical or current CPS involvement was 75.1% and 72.4%, respectively. Among children who had been referred only, the adjusted risk of a MH diagnosis was roughly 1.9 times that of Medicaid-insured children without any CPS involvement (RR: 1.87; 95% CI: 1.86-1.89). Compared with the children with any past or current involvement with child protective services, children substantiated as victims were diagnosed at 2.3 times the rate (RR: 2.28; 95% CI: 2.26-2.30) and those placed in foster care were diagnosed at nearly 4 times the rate (RR: 3.98; 95% CI: 3.95-4.01).

CONCLUSIONS AND IMPLICATIONS: Findings document high rates of both MH diagnoses and past child protection involvement among a population of low-income children in California. Our findings corroborate prior research indicating higher rates of MH disorders among children placed in foster care due to substantiated abuse or neglect. Additionally, they fill a gap in the literature by examining the much larger population of children who have contact with CPS.