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Mental Health Care Scarce for Kids in Child-Welfare System

Posted: August 06, 2012

Young children who are the subject of investigations by child-welfare agencies because of allegations of maltreatment have a higher prevalence of mental health problems than their peers, and very few receive treatment for those problems. This is the focus of a new study titled Mental health problems in young children investigated by U.S. child welfare agencies published in the Journal of the American Academy of Child and Adolescent Psychiatry.

Sarah McCue Horwitz, Ph.D., a professor in the Department of Pediatrics and the Centers for Health Policy and Primary Care and Outcomes Research at Stanford University, and colleagues made that pronouncement after evaluating data from the second National Survey of Child and Adolescent Well-Being (NSCAW II), a longitudinal study of 5,872 children from infancy to age 17.5 referred to child-welfare agencies for an investigation of potential maltreatment. The investigations were completed during the sampling period, February 2008 to April 2009. 

For children aged 12 to 18 months who were part of the survey, caregivers were administered the Brief Infant-Toddler Social Emotional Assessment (BITSEA), a 42-item screening tool designed to identify children at risk for social-emotional problems and low social competence. For children aged 19 to 36 months, caregivers were administered the Child Behavior Checklist 1.5-5 (CBCL 1.5-5).

The results were disturbing: in all, the scores for 34.6 percent of children aged 12 to 18 months were high on the Problem Scale of the BITSEA, and 20.9 percent on the Competence Scale, while for 10 percent of those aged 19 to 36 months the scores were over the CBCL clinical cutoff, indicating the need for mental health services. Children of black ethnicity were less likely to have elevated scores on the BITSEA Problem Scale, and children who lived with a never-married caregiver were five times more likely to have elevated scores.

Competence problems were associated with prior child-welfare-system history, and elevated CBCL scores were associated with living with a depressed caregiver. But what the researchers found distressing was that few of the children with identified mental health problems—only 2.2 percent— received mental health services.

Read more on Psychiatry News Online. Read the abstract of the study.

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