Heather Ringeisen

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.

Workforce development and the organization of work: the science we need.

The industrialization of health care, underway for several decades, offers instructive guidance and models for speeding access of children and families to clinically and cost effective preventive, treatment, and palliative interventions. This industrialization—i.e., the systematized production of goods or services in large-scale enterprises—has the potential to increase the value and effects of care for consumers, providers, and payers (Hayes and Gregg in Integrated behavioral healthcare: Positioning mental health practice with medical/surgical practice. Academic Press, San Diego, 2001), and to generate efficiencies in care delivery, in part because workforce responsibilities become more functional and differentiated such that individuals with diverse educational and professional backgrounds can effectively execute substantive clinical roles (Rees in Clin Exp Dermatol, 33, 39–393, 2008). To date, however, the models suggested by this industrialization have not been applied to children’s mental health services. A combination of policy, regulatory, fiscal, systemic, and organizational changes will be needed to fully penetrate the mental health and substance abuse service sectors. In addition, problems with the availability, preparation, functioning, and status of the mental health workforce decried for over a decade will need to be addressed if consumers and payers are to gain access to effective interventions irrespective of geographic location, ethnic background, or financial status. This paper suggests that critical knowledge gaps exist regarding (a) the knowledge, skills, and competencies of a workforce prepared to deliver effective interventions; (b) the efficient and effective organization of work; and (c) the development and replication of effective workforce training and support strategies to sustain effective services. Three sets of questions are identified for which evidence-based answers are needed. Suggestions are provided to inform the development of a scientific agenda to answer these questions.

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.

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.

A framework for measurement feedback to improve decision-making in mental health

The authors present a multi-level framework for conceptualizing and designing measurement systems to improve decision-making in the treatment and prevention of child and adolescent mental health problems as well as the promotion of well-being. Also included is a description of the recommended drivers of the development and refinement of these measurement systems and the importance of the architecture upon which these measurement systems are built. The authors conclude with a set of recommendations for the next steps for the field.

Mental Health Service Use in Adolescence: Findings From the National Survey on Drug Use and Health

OBJECTIVE This study examined mental health service use, by service type, of adolescents ages 12-17. METHODS Data were from approximately 113,000 adolescents who participated in the 2008-2012 National Survey on Drug Use and Health, an annual nationally representative survey of the civilian, noninstitutionalized U.S. POPULATION Polynomial contrasts tested for linear and quadratic changes across age in the use of three types of past-year mental health services: school-based services, outpatient therapist or clinic, and overnight hospital stay. RESULTS Although mental health service use increased from age 12 to age 14 across all service types, it decreased or stabilized from age 15 to 17. School-based services were the most commonly used service and showed the steepest decline in use from age 12 to 17. CONCLUSIONS Although adolescence can be marked by an increasing prevalence of mental disorders, mental health service use declined or leveled off for many service types by age 14 or 15.

Postsecondary Students With Psychiatric Disabilities Identify Core Services and Key Ingredients to Supporting Education Goals.

Objective: Accessing and successfully completing postsecondary educational opportunities may be challenging for those living with psychiatric disabilities. This exploratory study highlights the experiences of individuals with psychiatric disabilities participating in postsecondary educational support initiatives. Method: Investigators conducted case studies with 3 education support initiatives across the United States. Focus groups revealed what concrete supported education services were helpful and key ingredients in delivering education supports. Results: Access to specialists, mindfulness techniques, help with time management and procrastination, and facilitating classroom accommodations were identified as critical. Developing authentic relationships with supported education staff, flexibility in service delivery and access to student peers living with psychiatric disabilities were noted as key ingredients in service delivery. Conclusions and Implications for Practice: Incorporating the voice of students with psychiatric disabilities into supported education services can increase access, involvement, and retention, therein providing more supports to students with psychiatric disabilities achieving their postsecondary education goals.

Correlates of Mental Health Service Use Among Young Adults With Mental Illness: Results From the National Survey on Drug Use and Health.

OBJECTIVE This study examined correlates of use of outpatient and inpatient mental health services and psychotropic medication in a large, nationally representative sample of young adults ages 18-26 with mental illness (N=22,600). METHODS Data were from the 2008-2012 National Survey on Drug Use and Health, an annual nationally representative survey of the civilian, noninstitutionalized U.S. POPULATION Separate logistic regression models examined past-year use of three mental health service types (outpatient services, inpatient services, and psychotropic medication). Correlates included demographic characteristics, factors developmentally relevant to young adults, and general medical and mental health status. RESULTS Within this sample of young adults with mental illness, 20.4% used outpatient services, 3.6% used inpatient services, and 25.4% used psychotropic medication. Variables associated with use of one or more types of mental health services included being female (outpatient and medication), one to two moves in the past year (medication), having health insurance (all types), past-year criminal justice involvement (all types), poor health (inpatient and medication), substance use disorders (inpatient and medication), and mental illness with severe impairment (all types). Non-Hispanic blacks, Asians, and Hispanics were less likely than non-Hispanic whites to receive outpatient mental health services or psychotropic medications. Surprisingly, young adults employed full-time were less likely than those who were unemployed to receive services, and living with a partner (versus living alone) was not associated with a likelihood of using outpatient services. CONCLUSIONS Results support the unique nature of young adulthood and the need to tailor mental health services to close gaps in service use during this developmental period.