Experience of child welfare services and long-term adult mental health outcomes: a scoping review

Purpose

This is the first comprehensive review of empirical research that investigated the association between receipt of child welfare services and adult mental health outcomes. The review summarised the results of studies about mental health outcomes of adults with a history of child welfare involvement.

Methods

A scoping review methodology was used to search five electronic databases (MEDLINE, EMBASE, PsychINFO, IBSS, Social Policy and Practice). Studies were included if they examined any child welfare exposure (including receipt of services while remaining at home/being placed in care) and adult mental health status.

Results

In total 4591 records were retrieved, of which 55 met the eligibility criteria. Overall, receipt of child welfare services was associated with an increased risk of adult mental ill-health, suicide attempt and completed suicide. Results regarding potential moderating factors, such as gender and care-related experiences, were mixed. Relatively few studies investigated the reasons for requiring child welfare services, the experience of abuse or neglect or the adult outcomes of child welfare service users who remained in their own homes. Mental ill-health was defined and measured heterogeneously and details about the nature and type of welfare service utilisation were lacking.

Conclusion

There is a need for detailed, longitudinal studies to better understand the relative contribution of pre-existing adversity versus experiences during and after exposure to child welfare services on adult mental health outcomes. More standardised measures of mental ill-health and greater detail from authors on specific care exposure are also needed.

     

Parental arrest and children involved with child welfare services agencies

Data from the National Survey of Child and Adolescent Well-Being show that approximately 1 in 8 (12.5%) children who are subjects of reports of maltreatment investigated by child welfare services (CWS) agencies have parents who were recently arrested. Compared with other children who come to the attention of CWS agencies, those with arrested parents are younger, disproportionately African American, and significantly more likely tp be in out-of-home care. Approximately 2 in 5 children age 2 and older with arrested parents had a clinically significant emotional or behavioral problem, yet only 1 in 10 received mental health care. Although parent characteristics varied by race, rates of substance abuse, serious mental illness, domestic violence, and problems meeting basic needs were higher among arrested parents than among other parents.     

Continuity of psychopathology in youths referred to mental health services

OBJECTIVE: To investigate the stability and predictive strength of behavioral and emotional problems in childhood and adolescence. METHOD: A referred sample (N = 1,652), aged 4 to 18 years at initial assessment, was followed up after a mean interval of 6.2 years. Problem scores derived from Child Behavior Checklist, Youth Self-Report, and Teacher's Report Form at initial assessment (T1) were related to scores on the same instruments at follow-up (T2). RESULTS: Correlations between T1 and corresponding T2 problem scores averaged 0.41 intrainformant (range 0.22-0.61) and 0.22 interinformant (range -0.09-0.57). Stabilities were similar across gender, and larger for Externalizing versus Internalizing scores, except on youths' self-reports. Psychopathology scores at follow-up were predicted by corresponding T1 scores. Girls were predicted to have higher T2 Somatic Complaints, Anxious/Depressed, Thought Problems, and Internalizing scores than boys. Children younger at intake were predicted to have higher scores than older children on T2 Social and Attention Problems. CONCLUSIONS: Findings indicate continuity of specific behavioral and emotional problems in clinically referred children and adolescents.     

Perceived barriers to mental health services among youths in detention

OBJECTIVE: To examine perceived barriers to mental health service use among male and female juvenile detainees. METHOD: The sample included 1,829 juveniles newly detained in Chicago. The Diagnostic Interview Schedule for Children and Children's Global Assessment Scale were used to determine the need for services. Service use and barriers to services were assessed with the Service Utilization and Risk Factors interview. RESULTS: Approximately 85% of youths with psychiatric disorders reported at least one perceived barrier to services. Most common was the belief that problems would go away without help. Generally, attitudes toward services were remarkably similar across sex and race. Among females, significantly more youths with past service use or referral to services reported this barrier than did youths who had never received or been referred to services. Among males, significantly more youths who had been referred, but never received, services were unsure about where to go for help than youths with past service use. Significantly more youths with no past service use or referrals were concerned about the cost of services than youths with past service use. CONCLUSIONS: Despite the pervasive need for mental health services, the findings of this study suggest that detained youths do not perceive the mental health system as an important or accessible resource. Youths who believe their problems can be solved without assistance are unlikely to cooperate with referrals or to independently seek mental health services. Service providers must be sensitive to clients' perceived barriers to mental health services and work to reduce negative perceptions of services.     

Home visits for social withdrawal cases in community mental health and child welfare services

Home visits are one of the intervention and assistance methods anticipated to be useful in cases of social withdrawal. This study aims at investigating the current status of home visits that are carried out in the regional mental health and child welfare sectors, targeting socially withdrawn adolescents, and at examining the efficacy of this method. We conducted a survey using questionnaires targeting 59 institutions, such as public health centers, health and welfare offices, and child guidance centers, and found that home visits were carried out by public health nurses and child welfare personnel in about 20% of the adolescent social withdrawal cases. Answers to the question sheets were obtained for 54 cases, and investigation revealed that some form of improvement was seen as a result of these visits in 22 cases, or 40.7%. Typical answers included: "the visit encouraged the adolescent to go to a medical institution and/or a consultation agency for examination or consultation," and the "incidence of domestic violence by the adolescent declined." The survey also revealed that 19 of the social withdrawal cases, or 35.2%, inflicted acts of violence on family members; however, 8 cases, or 42.1% showed the improvement of violence through home visits.     

Parent experiences questionnaire for outpatient child and adolescent mental health services (PEQ-CAMHS Outpatients): reliability and validity following a national survey

Background

Mood disorders including depression and bipolar disorders are a major cause of morbidity in childhood and adolescence, and hospitalizations for mood disorders are the leading diagnosis for all hospitalizations in general hospitals for children age 13 to 17. We describe characteristics of these hospitalizations in the U.S. focusing on duration of stay, charges, and geographic variation.

Methods

The Kids' Inpatient Database was analyzed to calculate hospitalization rates for 2000, 2003, and 2006. For each year, information was available for over 2 million hospitalizations, representing 6.3 to 6.5 million hospital stays annually in acute care, non-psychiatric hospitals.

Results

The rate of pediatric hospitalizations with a principal diagnosis of a mood disorder was 12.4/10,000 in 2000, 13.0 in 2003, and 12.1 in 2006. In the same period, the incidence of hospitalizations for depressive disorders decreased from 9.1 to 6.4/10,000 children while the incidence of hospitalizations for bipolar disorders increased from 3.3 to 5.7/10,000 children. The mean length of stay increased from 7.1 to 7.7 days, while inflation-adjusted hospital charges increased from $10,600 in 2000, to $13,700 in 2003, to $16,300 in 2006. The proportion of mood disorder stays paid by government increased from 35.3% to 45.2%. The Western region experienced the lowest rates (9.9/10,000, 11.6 and 10.2 in 2000, 2003 and 2006) while the Midwest had the highest rates (26.4, 27.6, and 25.4).

Conclusions

Mood disorders are a major reason for hospitalization during development, especially in adolescence. Mood disorder hospitalizations remained relatively constant from 2000-2006, but diagnoses of depressive disorders decreased while diagnoses of bipolar disorders increased. Hospitalization rates vary widely by region of the country.     

User satisfaction with child and adolescent mental health services

BACKGROUND: Child and adolescent mental health service units (CAMHS) play an important role in the supply of services to children and adolescents with mental illness. The purpose of this study was to examine the service unit effect on parent satisfaction with outpatient treatment. METHOD: The study was undertaken in 49 of 72 Norwegian outpatient CAMHS in 2004. A total of 2253 of the parents who were asked to participate (87%) responded. Parent satisfaction was measured using two summated scales: clinician interaction/information and treatment outcome. Multilevel analyses were used to assess the contribution of the service units to satisfaction and to investigate patient level predictors of parent satisfaction. RESULTS: About 96-98% of the parent satisfaction variance could be attributed to factors within CAMHS, leaving only 2-4% of the variance attributable to the CAMHS level. Parents of patients aged 0-6 years were more satisfied than older patients' parents. Longer treatment episodes were positively associated with satisfaction. Parents whose children had been referred with externalizing symptoms were less satisfied with treatment outcome than those referred for internalizing symptoms. Waiting time was negatively associated with treatment outcome satisfaction. Adjustments for patient characteristics did not substantially change the relative effect of CAMHS on satisfaction ratings. CONCLUSION: The results indicate that information from user satisfaction surveys has clear limitations as an indicator of CAMHS quality. From a quality improvement perspective, the factors affecting the variance within CAMHS are of dominating importance compared to factors affecting between CAMHS variance.     

Occupation and mental health in a national UK survey

Objectives  

To measure the prevalence of common mental disorder (CMD) by occupation in a representative sample of Great Britain and to identify occupations with increased and decreased risk of CMD.     

Monitoring outcomes of services to children and youths with severe emotional disorders: an economical follow-up procedure for mental health and child care agencies

Human services have been slow to develop and implement procedures for measuring the outcomes they are committed to achieve with clients. This is as true in child mental health and child care services as in other services. A method is described for getting follow-up data on youngsters with severe maladjustment (emotional disturbance, behavior disorder) at modest cost, yet high relevance. The method is part of the program monitoring and evaluation conducted routinely by the Pressley Ridge Schools and involves telephone interviews with each youngster and others during the summer of the year after the youngster's discharge from treatment. The process yields two kinds of reports with different functions: quantitative summaries of data and individual narratives that sketch each youngster's experience. The method, developed over eight years, has had favorable effects on the agency's services.     

The role of providers in mental health services offered to American-Indian youths

OBJECTIVE: American-Indian adolescents have high rates of addiction and mental health problems but low rates of service use. The gap between service need and use appears to be even larger than the known gap for the general population, and few of the services are provided by specialists. This study examined receipt of treatment by American-Indian youths for addictions or mental health problems, the service provider who first identified a problem and sent a youth to treatment, and the extent to which the provider's knowledge and assessment predicted variance in service actions. METHODS: A sample of 401 American-Indian youths (196 from an urban area and 205 from a reservation) aged 12 to 19 years was first interviewed in person in 2001. A total of 188 of the youths' treatment providers were then interviewed. RESULTS: Structural equation modeling showed that 30 percent of the variance in addictions or mental health services provided to youths was predicted by the provider's assessment of the youth's mental health, the provider's resource knowledge, and provider type. CONCLUSIONS: The results demonstrate that professional, informal, and traditional providers play a pivotal role in providing treatment services offered to American-Indian youths and that these providers were more likely to identify a youth's problems and to offer and refer services when the provider knew more about community resources for the youth and about the youth's personal and environmental problems.     

Using litigation to improve child mental health services: promises and pitfalls

Litigation against state governments has been one of the strategies to improve services for children with emotional and behavioral problems. The results of such litigation have been spotty in terms of expanding and improving services. Cases in North Carolina and Hawaii are used as examples of successful litigation that had substantial impacts, resulting in new, more appropriate services and expanded budgets. The similarities and differences in these two cases are discussed, as are the elements that appear to contribute to success and the risks associated with such litigation.     

Preference, need and utilization of mental health services, Singapore National Mental Health Survey

OBJECTIVE: To ascertain the extent of the community's preference, needs for and utilization of mental health services, and their socio-demographic determinants in the multi-ethnic Asian community in Singapore. The extent to which need, enabling and predisposing factors determine the likelihood to seek professional help was also examined. METHOD: Data were analyzed from the Singapore National Mental Health Survey of 1996, based on a stratified random sample of 2947 Chinese, Malay and Indian subjects of the general population aged 13-64 years. RESULTS: An estimated 37% of the general population indicated they would seek professional help if they experienced a serious emotional or mental problem. Although 16.9% were determined by their high general health questionnaire (GHQ) score to need mental health services, only 2.6% in the population used the services of any professional caregiver. Among persons with high GHQ scores, only 5.9% sought any professional help. Among those with a high GHQ score and who were receptive to professional help, only 10.4% actually sought professional help. General practitioners were the most commonly preferred caregiver (49.3%), and were used by 41.1% of those who sought help. Those who sought professional help were more likely to have a high GHQ score and to be inclined to seek professional help. Malays used mental health services more than Chinese, but they did not show a significantly greater prevalence of high GHQ scores, or a greater preference to seek professional help. Receptivity to professional help, high GHQ score, and Malay ethnicity were independent significant predictors of use of mental health service. CONCLUSION: Need and attitudinal factors predict mental health service utilization, but they still do not explain why a large majority of the population chose not to use mental health services.