Using longitudinal data from the National Survey on Child and Adolescent Well-Being (NSCAW), this study investigates entry into intensive or restrictive settings over a 36-month study period. Specifically, this analysis examines entry into treatment foster care, group homes, residential treatment and inpatient psychiatric care for youth placed into out-of-home care (n=981). It aims to determine at what point in their first out-of-home episodes and for what reasons youth entered such settings. As NSCAW used a national probability sampling design, this analysis provides national estimates about entry into intensive or restrictive settings for youth in out-of-home care. Twenty-five percent of youth (n=280) experienced an intensive or restrictive setting during their first out-of-home care episode; 70 percent were in either group homes (33.2%) or residential treatment settings (37.0%). Half (48.9%) were placed into intensive or restrictive settings as a first placement during their first out-of-home episode. Logistic regression points to four statistically significant predictors of entry into intensive or restrictive settings: male gender, older age, behavior problems, and fewer placements in other settings prior to entry into such settings. Findings raise important questions about the role of intensive or restrictive settings in the continuum of services available to children in out-of-home care.

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.

This study examines the reasons for placement changes in foster care and analyzes determinates of the rate of behavior-related placement change. Findings indicate that 20 percent of all changes are behavior-related. Older age, externalizing behaviors, and emotional abuse increase the hazard of behavior-related changes. Risk is lower when the child spends more days in kinship care. Having numerous system- or policy-related moves does not increase risk of behavior-related changes. Risk is highest during the 100 days after entry into care, suggesting that factors contributing to behavior-related placement change might be present at or near the time a child enters care.

This study examined the relationship between placement change and outpatient mental health service use. It is based on (1) conceptual propositions about the impact of the foster care living context on mental health service use, and (2) empirical knowledge about the adverse consequences of placement change. Results of the study, which were based on a cohort of 570 children in foster care in San Diego County, suggest an association between placement changes in child welfare and use of outpatient mental health services. Specifically, an increase in the number of placement changes predicted a greater rate of outpatient mental health visits. The study further found that children who experienced behavior-related placement changes received more outpatient mental health visits than children who experienced placement changes for other reasons. Follow-up analyses of the144 children who experienced any behavior-related placement changes further indicated that the rate of outpatient mental health service use almost doubled in the 90 days following the first behavior-related placement change. Findings from this study have implications for both the practice/policy and research fields in child welfare as well as mental health.