Identification of Mental Health Service Need among Youth in Child Welfare

By Levitt, Jessica Mass | Child Welfare, January 1, 2009 | Go to article overview

Identification of Mental Health Service Need among Youth in Child Welfare


Levitt, Jessica Mass, Child Welfare


Despite the recognized importance of mental health concerns among youth in the child welfare population, data suggest a significant gap between children who need services and children who receive services. This paper aims to address this problem by focusing on the ways in which the system identifies-or fails to identify-children as needing mental health services. The paper reviews current guidelines, policies, and practices for mental health screening and assessment of youth in child welfare including available evidence-based screening instruments that have been evaluated in child welfare or other settings. It is concluded that the use of evidence-based screening and assessment instruments will improve the identification of children needing mental health services and offer the opportunity to provide appropriate care to children who are currently being overlooked.

The child welfare system is responsible for ensuring the safety, permanency, and well-being of children and adolescents who have been maltreated. Types of maltreatment experienced by children^ in the child welfare system include physical abuse, sexual abuse, neglect, domestic violence, parental substance abuse, poverty, community violence, and numerous other insults. Children with these experiences are clearly at high risk for the development of a wide range of mental health issues, if they are not already demonstrating symptoms on entry into the system. In addition, separation from family and other changes that result from having maltreatment reported and investigated may cause additional stress, which also increases the risk of mental health issues developing once a child is part of the system. Children entering the child welfare system should therefore be assessed for mental health service need, provided services accordingly, and reassessed periodically.

Despite the recognized importance of mental health concerns among youth in the child welfare population, data suggest a significant gap between children who need services and children who receive services. According to the U.S. Department of Health and Human Services (USDHHS; 2003), approximately five million children were referred to child welfare agencies in 2001 and about three million were accepted as reports and followed with an investigation. Approximately 50% of these children are expected to need mental health services, according to epidemiological studies (Burns, Phillips, Wagner, Barth, Kolko, Campbell, & Landsverk, 2004), yet only an estimated 16% are expected to receive some form of mental health specialty services. Based on the data from 2001, an estimated 1,086,000 children were left with unmet mental health needs that year. The gap between need for and receipt of mental health services is significant. Importantly, this gap parallels the pattern found in the general population, but it is much greater due to the fact that the estimated prevalence of mental health problems among youth in contact with child welfare is 2.5 times greater than in the general population (Burns et al., 2004).

With so many children in the child welfare system in need of mental health services, mental health problems should be considered one of the most serious threats to child well-being, after physical safety is addressed. This paper aims to address the problem of unmet mental health needs among children in contact with the child welfare system by focusing on the ways in which the system identifies - or fails to identify - children as needing mental health services. The paper will review current guidelines, policies, and practices for mental health screening and assessment of youth in child welfare including evidence-based screening and assessment instruments that have been evaluated in child welfare or other settings. It is concluded that the use of evidence-based screening and assessment instruments will improve the identification of children in the child welfare system needing mental health services and offer the opportunity to provide appropriate care to children who are currently being overlooked. …

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Identification of Mental Health Service Need among Youth in Child Welfare
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