Does mental health screening and assessment in child welfare improve mental health service receipt, child safety, and permanence for children in out-of-home care? An evaluation of the Gateway CALL demonstration

Implementation and Mental Health Outcomes of a Service Cascade Linking Child Welfare and Children’s Mental Health Systems: A Case Study of the Gateway CALL Demonstration

“…While the severity of children's behavior problems might improve naturally over time once their living situations have stabilized (Rubin et al, 2007), the results of our linear mixed models suggest that children's behavior problems improved more with greater numbers of mental health service visits. Our study design does not allow us to make inferences about whether service visits caused these improvements, although our earlier study findings suggest that the Gateway CALL intervention was effective for increasing the number of mental health service visits (Bunger et al, 2021). Attending more mental health service visits denotes stronger treatment retention, which is likely necessary for delivering a full dose of evidence-based interventions, and has been linked to better functioning outcomes for children (Foster, 2000).…”

“…Gateway CALL was rolled out in two waves across eight child welfare intake units responsible for investigating screened-in reports of child maltreatment (selected by agency leadership) beginning in February 2015 through July 2016. The larger study used a quasi-experimental design to examine whether Gateway CALL improved mental health service receipt, safety, and permanence outcomes for children in out-of-home care (Bunger et al, 2021 ). To address the aims of this manuscript, we draw on the longitudinal data from the experimental group only, which followed children in the study through January 31, 2017.…”

“…CALL clinicians shared results from the re-assessments with ongoing child welfare workers and provided consultation on treatment progress and child welfare case planning. (For additional intervention and implementation detail see Bunger et al, 2017Bunger et al, , 2021.…”

“…Although nearly all the children in the demonstration had some type of mental health diagnosis, fewer than half (47%) received treatment. Based on a quasi-experimental evaluation design (using a matched comparison group) Gateway CALL appeared to have no impact on children’s likelihood of receiving mental health services, although it might have increased the number of children’s mental health service visits (Bunger et al, 2021 ). In evaluations of similar types of demonstrations (that did not include the same type of intensive co-location), these types of cascades have demonstrated promise for quickly identifying children with extensive needs and recommending them for treatment (Akin et al, 2021 ; Verbist et al, 2020 ).…”

“…However, implementing service cascades requires the introduction and alignment of multiple components across multiple organizations. The challenges of implementing service cascades with fidelity have been well-described (Akin et al, 2017 ; Van Deinse et al, 2019 ) and may explain, in part, mixed evidence of their effectiveness for improving treatment access and outcomes for children in child welfare (Bunger et al, 2021 ; Pullmann et al, 2018 ). This study examines the implementation fidelity of Gateway CALL (Consultation, Assessment, Linkage, and Liaison), a service cascade designed to improve access to mental health treatment for children in out-of-home placements and the effect of service receipt on children’s mental health.…”