Best Practices for Mental Health in Child Welfare: Screening, Assessment, and Treatment Guidelines

Article excerpt

The Best Practices for Mental Health in Child Welfare Consensus Conference focused on developing guidelines in five key areas (screening and assessment, psychosocial interventions, psychopharmacologic treatment, parent engagement, and youth empowerment) related to children's mental health. This paper provides an overview of issues related to the first three areas, presents the guidelines developed in these areas, and discusses the implications these guidelines have for the field of child welfare.

In October 2007, parent and youth child welfare advocates and research, policy, and services experts in the fields of child welfare and mental health gathered for the Best Practices for Mental Health in Child Welfare Consensus Conference sponsored by Casey Family Programs, the Annie E. Casey Foundation, and the Resource for Advancing Children's Health (REACH) Institute. The conference aimed to develop best practice guidelines for addressing mental health in child welfare by focusing on five key areas screening and assessment, psychosocial interventions, psychopharmacologic treatment, parent engagement, and youth empowerment. This paper focuses on the guidelines developed in the first three areas, and is the first of two guideline papers emerging from the conference.

This paper begins with an overview of the issues related to mental health screening and assessment, psychosocial interventions, and psychopharmacologic treatment for youth in child welfare. Next, we describe the guidelines development process. The screening and assessment, psychosocial interventions, and psychopharmacologic treatment guidelines follow along with their rationale. The paper ends with a discussion of the implications these guidelines have for child welfare.

Mental Health Screening and Assessment

Despite the recognized importance of mental health concerns among youth in the child welfare population, there is a significant gap between the need and receipt of services for children. A major problem is that many children in need of mental health services are not being identified and offered help. This is related to the ways that the current system identifies and refers children for mental health services. Child welfare agencies in many regions do not systematically screen children in the system for mental health problems, and among the agencies that do, only a questionable percentage report using reliable and valid screening instruments as part of their procedures.

Concerns about poor identification of mental health problems in the foster care system are reflected by the publication of several guidelines that endorse universal mental health screening (American Academy of Child and Adolescent Psychiatry [AACAP] and Child Welfare League of America [CWLA], 2002; American Academy of Pediatrics [AAP], 1994, 2002; CWLA, 1988; National Academy of Sciences, 1993). The AACAP and CWLA issued a joint policy statement stressing the importance of screening children in foster care for mental health problems and substance use.

Psychosocial Interventions

Recent child welfare initiatives, legal proceedings, and published research demonstrate increased attention to the use of psychosocial interventions in child welfare settings, with a current strong focus on the evidence base for those interventions being used with children in the child welfare population. Child welfare initiatives at the federal and state levels, such as the child and family service reviews, are including child well-being as a comparable element in the mission of child welfare along with safety and permanence (Wulczyn, Barth, Yuan, Jones-Harden, & Landsverk, 2005). Recent consent decrees and settlements arising from class action suits (e.g., the Braam case in Washington state and the Katie A. case in California) involve a strong emphasis on mental health care for children in foster care with movement toward stipulating the use of specific evidence-based treatments. …