Citation

Fong HF, Alegria M, Bair-Merritt MH, Beardslee W. Child Abuse Negl. 2018; 79: 401-412.

Affiliation

Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Department of Psychiatry, Boston Children's Hospital, Boston, MA, United States.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.chiabu.2018.01.020

PMID

29529594

Abstract

Although child welfare caseworkers are responsible for facilitating mental health services access for maltreated children, little is known about caseworkers' decisions to refer children to services. We aimed to identify factors associated with caseworker referral of children to mental health services after a maltreatment investigation. We analyzed data from 1956 children 2-17 years old from the Second National Survey of Child and Adolescent Well-being. We examined associations of children's predisposing, enabling, and need-related factors and caseworkers' work environment characteristics with referral to mental health services. Caseworkers referred 21.0% of children to mental health services. In multivariable analyses controlling for potential covariates, factors associated with increased odds of caseworker referral included: older child age; child sexual abuse (versus neglect); child out-of-home placement; caregiver mental health problems; prior maltreatment reports; clinically significant child behavioral problems; and child welfare agency collaborative ties with mental health providers (all p < .05). Factors associated with decreased odds of caseworker referral included child Black race (versus White race) and lack of insurance (versus Private insurance) (all p < .05). In summary, children's need for mental health services was positively associated with caseworker referral to services but certain predisposing and enabling factors and caseworker work environment characteristics also correlated with services referral. Interventions to reduce disparities in services referral by race and insurance type are critically needed. These may include child welfare agency implementation of policies for mental health screening, assessment, and services referral based on clinical need and establishment of child welfare-mental health agency collaborative ties.

Copyright © 2018 Elsevier Ltd. All rights reserved.

Language: en

Keywords

Caseworker; Child; Child welfare; Maltreatment; Mental health services; Referrals