Tracing the pathway from mental health screening to services for children and youth in foster care

Pullmann, Michael D.; Jacobson, Jedediah; Parker, Elizabeth M.; Cevasco, Molly; Uomoto, Jacqueline A.; Putnam, Barbara; Benshoof, Trishia; Kerns, Suzanne E. U.

doi:10.1016/j.childyouth.2018.04.038

Cited by 26 publications

(16 citation statements)

References 55 publications

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“…The majority of children entering substitute care through the child welfare system in the US receive an initial mental health screening, as all states have adopted mandates for universal screening for either behavioral or trauma symptoms at entry into care (Pullman et al, 2018). An estimated 50–70% with a significant mental health need also receive some type of mental health service such as therapy while in out-of-home care (Petrenko et al, 2011; Pullmann et al, 2018; Tarren-Sweeney, 2010). Behavior problems and entry into substitute care predict both referral to services and initiation of services (Fong et al, 2018).…”

Section: Provision Of Mental Health Services In Out-of-home Carementioning

confidence: 99%

“…Child welfare systems increase access to assessment, treatment, and respite services (Farmer et al, 2001; Leslie et al, 2005) with the potential to shift these outcomes, but the extent that effective services reach children with the greatest needs and across all racial groups is unclear. Although children with behavior problems are more likely to receive mental health services than other children in care (Burns et al, 2004; Pullmann et al, 2018), placement moves resulting from behavior problems frequently disrupt services provided by both community agencies and schools, potentially leading to gaps in services and undermining effectiveness (Raghavan et al, 2007).…”

mentioning

confidence: 99%

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Mental health services and psychotropic medications provided to children at risk for placement instability in foster care

Leathers

Voort

Melka-Kaffer

2021

Developmental Child Welfare

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Children at risk for placement instability are subpopulation in out-of-home care with a critical need for enhanced mental health services, but little is known about the types and adequacy of the mental services they receive. This descriptive study sought to identify the types of mental health services and psychotropic medications provided to children with a risk for moves, foster parents’ perceptions of their adequacy, consistency of therapy services with evidence-based models, and racial and gender differences in service provision. Foster parents completed telephone surveys for a randomly selected sample of 144 children aged 8–14 in specialized or traditional family foster care with a history of placement moves or hospitalizations in a large state in the US. Over two-thirds of children were reported to have mental health diagnoses, with ADHD most frequent (52%). Most children with a diagnosis received psychotherapy (75%) and psychotropic medications (90%). The majority did not receive additional services. A quarter received therapy supporting use of behavioral interventions in foster homes, with 40% of foster parents reporting this was inadequate. Additionally, half reported inadequate initial training. No racial differences in services were reported. However, girls were more likely to receive therapy described as trauma-focused than boys (30.9% and 5.6%, respectively); more boys received treatment for anger (17%) and psychotropic medication (60%). Findings indicate that children at risk for multiple moves receive a high level of services, but questions are raised about the content and adequacy of these services. Evidence-based psychosocial interventions are needed to support positive outcomes and potentially reduce psychotropic medication use.

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Section: Provision Of Mental Health Services In Out-of-home Carementioning

confidence: 99%

mentioning

confidence: 99%

Mental health services and psychotropic medications provided to children at risk for placement instability in foster care

Leathers

Voort

Melka-Kaffer

2021

Developmental Child Welfare

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“…Children, adolescents, and young adults involved in the child welfare system often have multiple health care needs. [59][60][61][62][63][64][65][66] Because children who have been in foster care may move through multiple placements, the resulting fracture of medical care places children at risk for having medical, developmental, and psychiatric needs that remain either unaddressed and/or untreated. In addition to developmental delays and behavioral issues that can occur because of neglect and early environmental deprivation, physical and sexual abuse can lead to marked behavioral challenges at any age.…”

Section: Medical Issuesmentioning

confidence: 99%

“…In addition, a comprehensive medical evaluation, including behavioral health assessment by using validated tools to identify needs, is most effective when completed soon after placement. 61,62,66 An early evaluation allows the pediatrician to identify and address existing medical diagnoses, uncover issues unaddressed before placement, discuss developmental and behavioral concerns with parents, and make appropriate referrals when appropriate. 61,62,66 Other issues for exploration, particularly in the adolescent and young adult population, include a history of their own substance use, mental health history, and the potential of the adolescent or young adult to be involved in sex trafficking.…”

Section: Medical Issuesmentioning

confidence: 99%

Pediatrician Guidance in Supporting Families of Children Who Are Adopted, Fostered, or in Kinship Care

2020

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The child welfare system strives to provide children and adolescents in foster care with a safe, nurturing environment through kinship and nonkinship foster care placement with the goal of either reunification with birth parents or adoption. Pediatricians can support families who care for children and adolescents who are fostered and adopted while attending to children' s medical needs and helping each child attain their developmental potential. Although this report primarily focuses on children in the US child welfare system, private and internationally adopted children often have similar needs. THE FACES OF CHILD WELFARE IN THE UNITED STATES The child welfare system strives to protect the safety of children while supporting families whose children are placed in foster care. In this document, the term "child" includes infants, children, adolescents, and young adults. The child welfare system also serves as a bridge to the primary goal of permanency through reunification or adoption. On September 30, 2018, the Adoption and Foster Care Analysis and Reporting System reported that 437 283 children and adolescents were in foster care. 1 Of these children, 262 956 entered foster care during the fiscal year of 2018, with 250 103 exiting foster care. The number of children served in the foster care system during 2018 was 687 345. There were 125 422 children waiting to be adopted, with 71 254 having parental rights terminated and 63 123 subsequently being adopted from care. Primary reasons for entering foster care include neglect (62%), parental substance use (36%), poor coping skills of the caregiver (14%), physical abuse (13%), and inadequate housing (10%). Other reasons that account for less than 10% in each category include child behavior problems, parental incarceration, parental alcoholism, abandonment, sexual abuse, child disability, relinquishment, parental death, and child alcohol and other substance use. 1 A growing number of children, estimated to be 5% to 10%

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“…In this system, a designated "screening specialist" reviews the results and then notifies the social worker if a mental health referral or other action is indicated. Pullmann et al (Pullmann et al 2018) studied the flow of children through the system and found that 61% screened positive (defined as scoring above the "clinically significant" threshold for at least one of the CHET screen assessments). Unfortunately, there are no data available on whether children underwent full clinical assessment and subsequently received a diagnosis, which might help determine whether these were "true" or "false" positives.…”

Section: Examples Of Targeted Screeningmentioning

confidence: 99%

Screening Methods and When to Use Them

Newlove‐Delgado¹,

Ford²

2020

Mental Health and Illness Worldwide

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In terms of child and adolescent mental health, screening can be conceptualized as identifying those young people who are at high risk of having a psychiatric disorder, due to having risk factors for the development of a disorder, and/or already having raised levels of psychopathology or experiencing psychiatric symptoms. The intention of screening should be to improve outcomes via prevention or early intervention. In child and adolescent psychiatry, there is often a significant window of time in which risk factors or early symptoms can be detected prior to the diagnosis of a full psychiatric disorder, making them suitable for screening. Screening tools used in psychiatry are usually questionnaires or measures which have a threshold for determining whether or not a child is "screenpositive." These tools can be used on an opportunistic basis or as part of a systematic program of targeted or universal screeningfor example, in young offenders or school pupils. Those screening positive can then be referred for more comprehensive assessment. However, no screening measures are completely accurate. Therefore, before deciding to use a tool in practice, it is important to consider whether it is validated for that population, the potential harms and benefits, and the impact of a falsenegative or false-positive result. Finally, the decision to screen should also be influenced by how the result will inform management. It is potentially unethical to identify young people who may need further assessments and intervention, if the availability and/or effectiveness of these is limited.

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Tracing the pathway from mental health screening to services for children and youth in foster care

Cited by 26 publications

References 55 publications

Mental health services and psychotropic medications provided to children at risk for placement instability in foster care

Mental health services and psychotropic medications provided to children at risk for placement instability in foster care

Pediatrician Guidance in Supporting Families of Children Who Are Adopted, Fostered, or in Kinship Care

Screening Methods and When to Use Them

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