Cecilia Casanueva

Special health care needs among children in the child welfare system.

OBJECTIVE. The aim of this study was to determine levels of special health care need among children in the child welfare system and how these needs may affect childrens functioning. METHODS. Data were from the National Survey of Child and Adolescent Well-being, a national probability study of children investigated for child maltreatment. The sample consisted of 5496 children aged 0 to 15 years at baseline. For analysis, we used descriptive statistics to determine special health care needs and childrens functioning from baseline to 3-year follow-up. Logistic regression was used to examine correlates of special health care needs. RESULTS. At any point in the study period, approximately one third of the children were identified as having special health care needs. Overall, across 3 years of follow-up data, 50.3% of the children were identified as having special health care needs. Boys were significantly more likely than girls to have had special health care needs, and children aged 0 to 2 years at baseline were significantly less likely to have had special health care needs than older children. Adopted and foster children were significantly more likely to have had special health care needs than children never placed out of the home. The most commonly reported type of chronic health condition was asthma. The most commonly reported type of special need was a learning disability. CONCLUSIONS. Special health care needs are prevalent among children in the child welfare system. Many children with special health care needs have cognitive, language, adaptive, social, or behavioral functional impairments. Mechanisms are needed to ensure that this vulnerable population has access to and receives coordinated health and related social services.

Developmental needs and individualized family service plans among infants and toddlers in the child welfare system.

This study examines levels of developmental need in young children investigated by child protective services, estimates early intervention service use, and examines need and service use variations during the 5-6 years after investigation on the basis of maltreatment substantiation status. Data were from the National Survey of Child and Adolescent Well-Being, the first nationally representative study of children investigated for maltreatment. The sample comprised 1,845 children aged 0 to 36 months at baseline. Logistic regression with covariate adjustment was used to examine the relationship between having an Individualized Family Service Plan (IFSP; a proxy and marker of early intervention services through Part C of the Individuals With Disabilities Education Act) and substantiation status. A high prevalence of developmental problems was found among children with substantiated cases and children with unsubstantiated cases. Few children with developmental needs had an IFSP. Substantiation status and level of child welfare system involvement were significantly associated with having an IFSP.

Mental Health Service Use During the Transition to Adulthood for Adolescents Reported to the Child Welfare System

OBJECTIVE This study analyzed patterns of outpatient mental health service use from adolescence into early adulthood among young adults who were reported as victims of maltreatment in adolescence. METHODS Data were from the National Survey of Child and Adolescent Well-Being, a national probability study of children for whom maltreatment was investigated by the child welfare system. The sample consisted of 616 young adults aged 12 to 15 at baseline. Analysis used descriptive statistics to determine need for and use of outpatient mental health services across time. Logistic regression was used to examine predictors of use of outpatient mental health services in young adulthood. RESULTS Almost half of the young adults in this sample had one or more indicators of mental health problems. There was a significant decrease in use of specialty mental health services from adolescence to young adulthood, declining from 47.6% at baseline, to 14.3% at the five- to six- year follow-up. Among young adults with mental health problems, less than a quarter used outpatient mental health services. Logistic regression results indicated that having mental health problems, having Medicaid, and being white were positively associated with use of outpatient mental health services in young adulthood. CONCLUSIONS Mental health problems were prevalent among young adults who were suspected of being maltreated when they were adolescents, but only about a quarter of those in need used outpatient mental health services. Interventions to improve access to outpatient mental health services for this vulnerable population should particularly support outreach and engagement of young adults who are uninsured and from racial or ethnic minority groups with a history of involvement with the child welfare system in order to meet their unique developmental needs.

Mental Health and Special Education Services at School Entry for Children Who Were Involved with the Child Welfare System as Infants.

This study examines mental health and special education needs and service use at school entry among children involved in maltreatment investigations as infants. Data are from the National Survey of Child and Adolescent Well-Being, a national probability study of 5,501 children investigated for maltreatment. The study sample comprised 959 children who were infants at baseline and 5 to 6 years old at the last follow-up. Half had behavioral or cognitive needs at entry to school. About a quarter received outpatient mental health or special education services. Logistic regression showed that compared to children residing with biological parents, adopted and foster children were more likely to receive mental health services, and children adopted or in kinship care were more likely to receive educational services. Increased monitoring of behavioral and cognitive needs of infants reported for maltreatment may facilitate their access to services and ease the transition to school.

Caregiver instability and early life changes among infants reported to the child welfare system.

This study describes the extent of caregiver instability (defined as a new placement for 1 week or longer in a different household and/or with a new caregiver) in a nationally representative sample of infants, followed for 5-7 years. Data were drawn from the National Survey of Child and Adolescent Well-Being (NSCAW), a longitudinal study of 5,501 children investigated for child maltreatment. The analysis sample was restricted to 1,196 infants. Overall, 85.6% of children who were infants at the time of the index maltreatment experienced at least one caregiver instability event during their first 2 years of life. Caregiver instability was associated with the child having a chronic health condition and the caregiver being older than 40 years of age at baseline. The levels of instability reported in this study from infancy to school entry are extremely high. Children with more risk factors were significantly more likely to experience caregiver instability than children with fewer risk factors. The repeated loss of a young childs primary caregiver or unavailable, neglectful care can be experienced as traumatic. Some evidence-based programs that are designed to work with young maltreated children can make a substantial positive difference in the lives of vulnerable infants.

Illicit Drug Use From Adolescence to Young Adulthood Among Child Welfare-Involved Youths

This study examined illicit substance use among 1,004 adolescents, ages 11–21, involved with the Child Welfare System (CWS) and followed from 1999 to 2007. By the time they reached transition age, more than 60% of the sample had used an illicit substance in their lifetime. Predictors of regular use during adolescence were having a prior CWS report, externalizing behavior problems, delinquency, and any sexual experience. Exposure to physical abuse was predictive of escalating substance use trajectories. Protective factors included having a child at any point during the study, parental monitoring, and being placed in kinship care.

Prevalence, Trajectories, and Risk Factors for Depression Among Caregivers of Young Children Involved in Child Maltreatment Investigations

This study examines depression among caregivers of young children involved in investigations of child maltreatment, in terms of 12-month prevalence of depression across 5 to 6 years. Data were from the National Survey of Child and Adolescent Well-Being, a national probability study of 5,501 children investigated for maltreatment. The study sample comprised 1,244 female caregivers (95.5% biological mothers) of children not placed out of home and younger than 5 years old. About a quarter of caregivers had, at any given point, a score indicating major depression in the previous 12 months; across all follow-ups, 46% of caregivers had a score indicating major depression at some point. Depression was associated with caregivers’ report of intimate-partner violence and fair or poor health status. Caregivers of maltreated children are at substantial risk for depression that does not diminish over the course of 5 years. Assessing and providing assistance for intimate-partner violence and health problems may help decrease depression prevalence.

Measurement of Childhood Serious Emotional Disturbance: State of the Science and Issues for Consideration:

Surveys suggest that between 4.3% and 11.5% of children living in the United States have a serious emotional disturbance (SED). SED is defined in the Federal Register, and federal block grants are allocated to states based on the prevalence of SED. Accurate measurement of SED is critical, yet surveys have used different methodologies and instrumentation to obtain prevalence estimates. Two expert panels were convened by the Substance Abuse and Mental Health Services Administration (SAMHSA) in the fall of 2014 to discuss the current state of the field in operationalizing and measuring SED. The aims of this article are to (a) provide an update on SED prevalence rates from survey research, (b) summarize key discussion points that emerged during the SAMHSA expert panel meetings, and (c) make specific recommendations for next steps in measuring the prevalence of SED. Issues addressed in this article are important not only for federal allocation of service dollars to meet the needs of children with SED, but also for broader mental health surveillance efforts within the context of large national research surveys.