Associations of Mental Health Service Utilization and Mental Health Diagnosis with Placement Instability Among Foster Children in a Southeastern State

Abstract

Placement instability for children in foster care is high, with children experiencing nearly 4.5 placement moves per 1,000 days in care on average. While prior research has demonstrated a predictive relationship between mental health problems and placement instability, few studies have examined the associations of specific mental health diagnoses or utilization of mental health (MH) services. To this end, this study seeks to investigate associations between MH service utilization, mental health diagnosis, and placement instability (rate of placement moves) for foster children. We analyzed statewide integrated administrative data to examine MH service utilization and mental health diagnosis on placement instability among foster children. We used SAS 9.4 to conduct descriptive, bivariate, and multiple linear regression models to address the objectives of the study. The retrospective cohort was composed of 1,002 children in foster care. The multivariable linear regression reveals that receiving in-patient services, receiving out-patient services, being diagnosed with conduct disorder, being Black children, older children, and female children, being placed in intensive case management, being sexually abused, having a single household family structure at time of removal, and having a high number of intakes significantly increased the rate of placement moves. The findings of this study have significant implications for the provision of mental health services to foster children and the promotion of placement stability, highlighting the role of child welfare professionals in fostering protective factors and mitigating risk factors to promote placement stability. Implications for practice and policy improvement are discussed.