Relationship between placement change during foster care and utilization of emergency mental health services
Highlights
► Placement change is related to use of emergency mental health services. ► The relationship is bidirectional. ► Interventions should target both mental health needs and placement instability.
Introduction
The U.S. foster care system is plagued by a high rate of mental health problems among foster children and by placement instability during foster care. Approximately 40–80% of children in the child welfare system suffer from psychiatric disorders (Burns et al., 2004, Clausen et al., 1998, Garland et al., 2001). The rate of placement instability varies by states and by counties, but in too many instances placement instability rates are quite high (Connell et al., 2006, James, Landsverk, Slymen and Leslie, 2004). One national study of 725 children in foster care found that 18% of the children had four or more placement changes within 3 years (Barth et al., 2007).
Mental health problems and placement instability are linked: children in foster care who have experienced placement instability are more likely than other children in foster care to show symptoms of mental health disorders (Aarons et al., 2010, Barber and Delfabbro, 2003, Newton et al., 2000, Rubin et al., 2004) and to receive outpatient mental health treatment (James, Landsverk and Slymen, 2004, James, Landsverk, Slymen and Leslie, 2004). Not only is placement change associated with mental health problems, it is also a disruptive experience — when children change placements they must break ties with former caregivers, move to a new environment, and establish an attachment to their new families. Thus, one would expect that children who experience frequent placement change would be more likely to utilize emergency mental health care than other foster children. To date, little is known about the relationship between placement instability and use of emergency mental health services.
The purpose of this study is to examine this relationship. It is important to determine if placement instability is related to use of emergency psychiatric care, which will be defined in this paper as use of crisis services and inpatient hospitalization, because they are both negative outcomes. Frequent placement changes prevent children in foster care from forming lasting attachments with families. Meanwhile, crisis and inpatient services are among the most expensive treatments in the mental health continuum of care. Although they may be necessary for children who are a danger to themselves or others, they are not an optimal form of mental health care: because they are brief services designed to stabilize crises rather than to treat ongoing, serious mental health problems (American Academy of Pediatrics, Committee of Pediatric Emergency Medicine, 2006). If placement instability and use of emergency mental health services are linked, service providers can be alerted to this relationship and help children in foster care who have significant mental health problems avoid both of these outcomes.
Section snippets
Literature review
While the connection between placement instability and emergency mental health care utilization has not been extensively studied, there is some evidence to suggest that children in foster care who change placements frequently may be more likely to use crisis and psychiatric inpatient services. For example, one study of 1635 children in foster care in Philadelphia found that children who changed placements frequently had greater odds of using costly mental health services (Rubin et al., 2004).
Data
The data consisted of Medi-Cal paid claims and foster care placement records. The Medi-Cal claims were for mental health services delivered to youth under age 18 between July 1, 1998 and June 30, 2001, and they were provided by the California Department of Mental Health. These data files included variables measuring client age, gender, ethnicity, diagnosis, Medi-Cal eligibility code and a unique client identifier. In addition to client characteristics, the data files reported on type of
Sample description
Descriptive information regarding the entire sample, crisis service users, and children who were hospitalized is shown in Table 1. The racial and ethnic demographics of the sample were as follows: Hispanic (38%), White (34%), Black (23%), Asian (3%), and Other (2%). There were slightly more females (54%) than males (46%), and the mean age was approximately 11-years-old at the start of the episode.
Children who used crisis and inpatient psychiatric services were more likely to be White and less
Discussion
Children who use crisis services and psychiatric hospitalization during their first 3 months in foster care are a unique group. They tend to enter foster care at older ages and are more likely than other youth to have received mental health treatment prior to their foster care episode. This finding suggests that youth who end up using emergency mental health care during their episode are more likely than other children to enter foster care with pre-existing mental health problems.
These problems
References (28)
- et al.
Behavior problems and placement change in a national child welfare sample: A prospective study
Journal of the American Academy of Child and Adolescent Psychiatry
(2010) - et al.
Mental health need and access to mental health services by youths involved with child welfare: A national survey
Journal of the American Academy of Child and Adolescent Psychiatry
(2004) - et al.
Effects of Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) on reducing permanent placement failures among children with placement instability
Children and Youth Services Review
(2009) - et al.
Prevalence of psychiatric disorders among youths across five sectors of care
American Journal of Child and Adolescent Psychiatry
(2001) - et al.
Placement movement in out-of-home care: Patterns and predictors
Children and Youth Services Review
(2004) - et al.
Children and youth in foster care: Disentangling the relationship between problem behaviors and number of placements
Child Abuse & Neglect
(2000) - et al.
Rates and correlates of recurrent psychiatric crisis episodes among children and adolescents in state custody
Children and Youth Services Review
(2009) - et al.
School change, academic progress, and behavior problems in a sample of foster youth
Children and Youth Services Review
(2010) Pediatric mental health emergencies in the emergency medical services system
Pediatrics
(2006)- et al.
Placement stability and the psychosocial well-being of children in foster care
Research on Social Work Practice
(2003)
Predictors of unsuccessful transition to foster care
Journal of Child Psychology and Psychiatry
Characteristics of out-of-home caregiving environments provided under child welfare services
Child Welfare
Predictors of placement moves among children with and without emotional and behavioral disorders
Journal of Emotional and Behavioral Disorders
Effective treatment for mental disorders in children and adolescents
Clinical Child and Family Psychology Review
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