Assessing the Mental Health Needs of Bipoc Transition Age Youth with a History of Child Welfare System Involvement: A Mixed Methods Scoping Review

Background and Purpose: Black, Indigenous, and people of color (BIPOC) children and youth are disproportionately represented in child welfare system and face significant challenges when aging out of foster care. In addition, racial disparities and inequities within the child welfare system placed BIPOC transition age youth (TAY) at greater risks for underutilization of mental health services and adverse mental health outcomes. This review aims to understand mental health needs of BIPOC TAY involved in child welfare system. The findings have research and practice implications on improving mental health outcomes for BIPOC TAY.

Methods: Guided by the five steps defined by Arksey and O’Malley and using the search terms: mental health, BIPOC, transition-age youth, and child welfare history, this scoping review identified studies through electronic databases, including CINAHL, ERIC, Family Studies Abstracts, PsycINFO, Social Work Abstracts, SocINDEX, PubMed, SSCI, and Academic Search Complete. The search yielded 856 articles. Inclusion criteria were (1) empirical studies on mental health needs BIPOC TAY with child welfare history; (2) English language articles; (3) published articles in peer-reviewed journals between 2000 and 2022. This review used Mixed Methods Appraisal Tool (MMAT; Hong, et al., 2018) to assess methodological rigor of research design, sample characteristics, sampling method, transparency, and reporting quality.

Results: A final set of 12 articles with 10 quantitative studies and 2 qualitative studies were included in this scoping review. Quantitative studies examined mental health diagnoses (n=3), mental health service utilization (n=6), dosage of mental health services (n=3), satisfaction of mental health services (n=1), and attitudes towards mental health services professionals (n=1). Qualitative studies (n=2) focused on exploring mental health needs of BIPOC TAY. Racial disparities in mental health among BIPOC TAY manifest in three aspects: mental health diagnoses, mental health service utilization, and dosages of mental health service. African American youth were less likely to receive mental health services and received fewer services in monthly duration than their Caucasian counterparts. In addition, African American youth were less likely to meet diagnostic criteria for depression. Both barriers and protective factors to mental health service use are identified. Barriers to mental health service included mistrust towards mental health service providers, lack of healthcare insurance, and lack of access to mental health services. Protective factors related to mental health/service use were staying in foster care, having a support network, and education. In addition, BIPOC TAY demonstrated the capacity to cope with mental health struggles through art and journaling. These themes emerged across findings of both quantitative and qualitative studies.

Conclusion and Implications: This review highlights the importance of efforts at multiple levels to enhance mental health outcomes of BIPOC TAY involved in the care. Building a community of support is critical as they become independent from the care. Trauma-informed and cultural respectful/responsive approaches are key to future interventions/programs designed for BIPOC TAY. In addition, there is a need to diversify the racial and ethnic backgrounds of stakeholders and service providers to be representative of the demographic composition of BIPOC TAY.