Original article
Pediatric to Adult Mental Health Service Use of Young People Leaving the Foster Care System

https://doi.org/10.1016/j.jadohealth.2008.04.015Get rights and content

Abstract

Purpose

To assess and predict changes in mental health service use as older youth leave the foster care system.

Methods

Participants were 325 19-year-olds participating in a longitudinal study of older youth leaving the foster care system in Missouri. All were in the foster care system at age 17. Participants were interviewed nine times between their 17th and 19th birthdays using the Service Assessment for Children and Adolescents and a history calendar to improve recall of service history. Analyses included Cox proportional hazards regression to predict time to service stoppage and McNemar's test to assess difference in rates of service use between age 17 and 19.

Results

Mental health service use dropped dramatically across the study period for all services. Service rates dropped most steeply for youth who left the foster care system. Service use rates declined by roughly 60% from the month prior to leaving the foster care system to the month after leaving the system. Most young adults who stopped pharmacotherapy following discharge from foster care reported they did so of their own volition.

Conclusions

Practitioners should be aware of the possibility of patient-initiated mental health service discontinuation following exit from the foster care system and plan accordingly.

Section snippets

Patients and Methods

The study used a longitudinal cohort design, with older youth interviewed about their mental health service use every 3 months from age 17 to 19 (nine interviews).

Results

Multivariate logistic regression analyses to predict retention revealed that the following characteristics were associated with decreased odds of being retained in the study: being male (odds radio [OR] = 0.34, p < .001), having past year posttraumatic stress disorder at initial interview (OR = 0.36, p = .025), having a history of juvenile detention by first interview (OR = .26, p = .016), and being released from the state's custody prior to age 19 (OR = .26, p < .0001). The resulting sample

Discussion

This is the first study known to systematically examine mental health service use as older youth leave the foster care system. Four findings deserve discussion: the severe drop-off in service use, the terminations often initiated by the patient, the role of Medicaid in service use, and the lack of predictors of continued service use.

Service discontinuity in mental health services was the norm for youth leaving the foster care system. Rates of mental health service utilization for youth from the

Acknowledgments

This work was supported by grants from the National Institute of Mental Health (R01 MH61404 and P30 MH068579).

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    It is therefore unsurprising that, when making the transition away from a system of care intended to provide space and support for healing, youth with emotional disabilities (and unresolved trauma) struggle to succeed. Leaving care may jeopardize youth’s access to health insurance and healthcare, including mental health services (McMillen & Raghavan, 2009), and may shift the burden of advocacy for services and accommodations from the foster care system to the youth, themselves. Whether due to costs of care, stigma associated with mental healthcare (Brannan & Heflinger, 2006; Mukolo, Heflinger, & Wallston, 2010), or hesitancy to reach out for help (Okpych & Courtney, 2019), many youth with emotional disabilities will find this new responsibility of self-care to be a significant, and in some cases, insurmountable challenge.

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