Leslie, L.K., Hurlburt, M., James, S., Landsverk, J., Slymen, D.J., & Zhang, J. (2005). Relationship between entry into child welfare and mental health service use. Psychiatric Services, 56 (8), 981-987 ( 8/2005 )
Objective: To examine the relationship between initiation of outpatient mental health service use and level of child welfare involvement (in-home, no child welfare services; in-home, child welfare services; out-of-home). Methods: Longitudinal data were collected on a subsample of children (n=3592), ages 2-14 years, enrolled in the National Survey of Child and Adolescent Well-being (NSCAW), a nationally representative sample of children undergoing investigation for abuse or neglect. Event history analysis was used to model relative risk of initiation of mental health service use over time. Results: Hazard functions revealed a large increase in onset of mental health services at the time of contact with child welfare, varying by level of child welfare involvement, and leveling off by three months following initial contact with child welfare. The multivariate Cox proportional-hazards model indicated that children in in-home care receiving no child welfare services were about one third as likely [RR=0.31, 95% CI: 0.20, 0.47] to use mental health services compared to children in out-of-home care; children in in-home care receiving child welfare services were half as likely [RR=0.45, 95% CI: 0.29, 0.68]. Other covariates in the model predicted mental health service use, including older age, Caucasian race/ethnicity, maltreatment history (specifically, physical abuse, physical neglect or abandonment) and need for mental health services as measured by the Child Behavior Checklist. Conclusions: Contact with child welfare functions as a gateway into mental health services for children in child welfare, even when controlling for need. Differences in service use by level of involvement deserve further exploration.