Abstract
Children in foster care suffer from an extremely high prevalence of mental health problems, yet, it remains unclear if they consistently use mental health treatments, such as therapy. To determine whether these children receive treatment more often when they have specific types of mental health problems, we examined the prevalence and associations between mental health problems, as identified by standardized screening, and mental health treatment utilization. Using descriptive statistics, multivariate models, and moderation and exploratory mediation analysis, we analyzed data for 237 children in foster care, aged 5–17 years. We found 71 % were identified with a mental health problem in at least one of the sub-domains examined (emotional, conduct, inattention/hyperactivity, peer, and prosocial), and 61 % of children received mental health treatment (p = .001). Yet, the only sub-domains predictive of treatment utilization were peer problems (p = .004) and low prosocial behaviors (p = .030). Moderation analysis revealed that the relation between peer problems and treatment utilization was strongest among white children (p = .012). Exploratory mediation analysis suggested that peer problems may increase the likelihood of treatment for children with emotional (95 % CI 0.05, 0.53) and conduct problems (95 % CI 0.05, 0.58). It remains unknown whether this occurs because peer problems are associated with overt symptoms, or because peers problems can exacerbate existing social–emotional problems. Routine screening for mental health problems among children in foster care can facilitate timely treatment, and potentially improve the present and future quality of life for this high risk population.
Similar content being viewed by others
References
Aarons, G. A., James, S., Monn, A. R., Raghavan, R., Wells, R. S., & Leslie, L. K. (2010). Behavior problems and placement change in a national child welfare sample: A prospective study. Journal of the American Academy of Child and Adolescent Psychology, 49(1), 70–80.
Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms & profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.
Bean, D. L., Leibowitz, A., Rotheram-Borus, M., Horwitz, S. M., Jordan, D., & Hoagwood, K. (2000). False-negative reporting and mental health services utilization: Parents’ reports about child and adolescent services. Mental Health Services Research, 2(4), 239.
Beck, C. T. (1999). Maternal depression and child behaviour problems: A meta-analysis. Journal of Advanced Nursing, 29, 623–629.
Burns, B. J., Phillips, S. D., Wagner, H. R., Barth, R. P., Kolko, D. J., Campbell, Y., & Landsverk, J. (2004). 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, 43(8), 960–970.
Callaghan, J., Young, B., Pace, F., & Vostanis, P. (2004). Evaluation of a new mental health service for looked after children. Clinical Child Psychology and Psychiatry, 9, 130–148.
Cederna-Meko, C., Koch, S., & Wall, J. (2014). Youth with oppositional defiant disorder at entry into home-based treatment, foster care, and residential treatment. Journal of Child and Family Studies, 23(5), 895–906.
Clausen, J. M., Landsverk, J., Ganger, W., Chadwick, D., & Litrownik, A. (1998). Mental health problems of children in foster care. Journal of Child and Family Studies, 7(3), 283–296.
Conn, A.-M., Calais, C., Szilagyi, M. A., Baldwin, C., & Jee, S. H. (2014). Youth in out-of-home care: Relation of engagement in structured group activities with social and mental health measures. Children and Youth Services Review, 36, 201–205.
Conn, A.-M., Szilagyi, M. A., Franke, T. M., Albertin, C. A., Blumkin, A. K., & Szilagyi, P. G. (2013). Trends in child welfare investigation and out-of-home care. Pediatrics, 132(4), 712–719.
Cummings, E. M., & Davies, P. T. (1994). Maternal depression and child development. Journal of Child Psychology and Psychiatry and Allied Disciplines, 35, 73–112.
Dodge, K. A., Lansford, J. E., Burks, V. S., Bates, J. E., Pettit, G. S., Fontaine, R., & Price, J. M. (2003). Peer rejection and social information-processing factors in the development of aggressive behavior problems in children. Child Development, 74, 374–393.
Ezzell, C. E., Swenson, C. C., & Faldowski, R. A. (1999). Child, family and case characteristics: Links with service utilization in physically abused children. Journal of Child and Family Studies, 8(3), 271–284.
Felitti, V. J. (1993). Childhood sexual abuse, depression, and family dysfunction in adult obese patients—A case–control study. Southern Medical Journal, 86, 732–736.
Garland, A. F., Landsverk, J. A., Hough, R. L., & Ellis-McLeod, E. (1996). Type of maltreatment as a predictor of mental health service use for children in foster care. Child Abuse and Neglect, 20(8), 675–688.
Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A research note. Journal of Child Psychiatry and Psychology, 38, 581–586.
Goodman, R., Ford, T., Corbin, T., & Meltzer, H. (2004). Using the Strengths and Difficulties Questionnaire (SDQ) multi informant algorithm to screen looked after children for psychiatric disorders. European Child and Adolescent Psychiatry, 13, 1125–1131.
Goodman, R., & Scott, S. (1999). Comparing the Strengths and Difficulties Questionnaire and child behavior checklist: Is small beautiful? Journal of Abnormal Psychology, 27, 17–24.
Hayes, A. F., & Matthes, J. (2009). Computational procedures for probing interactions in OLS and logistic regression: SPSS and SAS implementations. Behavior Research Methods, 41, 924–936.
Hill, C. R., & Hughes, J. N. (2007). An examination of the convergent and discriminant validity of the Strengths and Difficulties Questionnaire. School Psychology Quarterly, 22, 380–406.
Hoagwood, K., Horwitz, S., Stiffman, A., Weisz, J., Bean, D., Rae, D., et al. (2000). Concordance between parent reports of children’s mental health services and service records: The services assessment for children and adolescents (SACA). Journal of Child and Family Studies, 9(3), 315–331.
Horwitz, S. M., Hurlburt, M. S., Heneghan, A., Zhang, J., Rolls-Reutz, J., Fisher, E., et al. (2012). Mental health problems in young children investigated by U.S. child welfare agencies. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 572–581.
Jee, S. H., Conn, A.-M., Szilagyi, P. G., Blumkin, A., Baldwin, C. D., & Szilagyi, M. A. (2010a). Identification of social–emotional problems among young children in foster care. Journal of Child Psychology and Psychiatry, 51, 1351–1358.
Jee, S. H., Couderc, J. P., Swanson, D., Gallegos, A., Hilliard, C., Blumkin, A., et al. (2015). A pilot randomized trial teaching mindfulness-based stress reduction to traumatized youth in foster care. Complementary Therapies in Clinical Practice, 21, 201–209.
Jee, S. H., Halterman, J., Szilagyi, M., Conn, A.-M., Allpert-Gillis, L., & Szilagyi, P. (2011a). Use of a brief, standardized screening instrument in a primary care setting to enhance detection of social–emotional problems among youth in foster care. Academic Pediatrics, 11, 409–413.
Jee, S., Szilagyi, M., Blatt, S., Meguid, V., Auinger, P., & Szilagyi, P. (2010b). Timely identification of mental health problems in two foster care medical homes. Children and Youth Services Review, 32, 685–690.
Jee, S., Szilagyi, M., Conn, A.-M., Nilsen, W., Toth, S., Baldwin, C., & Szilagyi, P. (2011b). Validating office-based screening for psychosocial strengths and difficulties among youths in foster care. Pediatrics, 127, 904–910.
Jee, S., Szilagyi, M., Ovenshire, C., Norton, M., Conn, A.-M., Blumkin, A., & Szilagyi, P. G. (2010c). Improved detection of developmental delays among children in foster care. Pediatrics, 125, 282–289.
Jose, P. E. (2013). Doing statistical mediation and moderation. New York, NY: Guildford Press.
Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. The American Journal of Psychiatry, 159(9), 1548–1555.
Kerker, B., & Dore, M. (2006). Mental health needs and treatment of foster youth: Barriers and opportunities. American Journal of Orthopsychiatry, 76, 138–147.
Ladd, G. (2006). Peer rejection, aggressive or withdrawn behavior, and psychological maladjustment from ages 5 to 12: An examination of four predictive models. Child Development, 77, 822–846.
Leslie, L. K., Hurlburt, M. S., James, S., Landsverk, J., Slymen, D. J., & Zhang, J. (2005). Relationship between entry into child welfare and mental health service use. Psychiatric Services, 56(8), 981–987.
Milburn, N. L., Lynch, M., & Jackson, J. (2008). Early identification of mental health needs for children in care: A therapeutic assessment programme for statutory clients of child protection. Clinical Child Psychology and Psychiatry, 13, 31–47.
Morgan, A. J., Mackinnon, A. J., & Jorm, A. F. (2013). Behavior change through automated e-mails: Mediation analysis of self-help strategy use for depressive symptoms. Behavior Research and Therapy, 51, 57–62.
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.
Rizzo, C. J., Esposito-Smythers, C., Swenson, L., Birmaher, B., Ryan, N., Strober, M., et al. (2007). Factors associated with mental health service utilization among bipolar youth. Bipolar Disorders, 9, 839–850.
Shin, S. H. (2005). Need for and actual use of mental health service by adolescents in the child welfare system. Children and Youth Services Review, 27, 1071–1083.
Shonkoff, J. P., & Bales, S. N. (2011). Science does not speak for itself: Translating child development research for the public and its policymakers. Child Development, 82, 17–32.
Simms, M. D., Dubowitz, H., & Szilagyi, M. A. (2000). Health care needs of children in the foster care system. Pediatrics, 106(4), 909–918.
Tarren-Sweeney, M. (2010). Concordance of mental health impairment and service utilization among children in care. Clinical Child Psychology and Psychiatry, 15, 481–495.
Teti, D. M., Gelfand, D. M., Messinger, D. S., & Isabella, R. (1995). Maternal depression and the quality of early attachment: An examination of infants, preschoolers, and their mothers. Developmental Psychology, 31, 364–376.
van der Meer, M., Dixon, A., & Rose, D. (2008). Parent and child agreement on reports of problem behaviour obtained from a screening questionnaire, the SDQ. European Child and Adolescent Psychiatry, 17, 491–497.
Verhulst, F. C., & Van Der Ende, J. (1997). Factors associated with child mental health service use in the community. Journal of the American Academy of Child and Adolescent Psychiatry, 36(7), 901–909.
Wright, M., Banerjee, R., Hoek, W., Rieffe, C., & Novin, S. (2010). Depression and social anxiety in children: Differential links with coping strategies. Journal of Abnormal Child Psychology, 38(3), 405–419.
Wu, P., Hoven, C. W., Bird, H. R., Moore, R. E., Cohen, P., Alegria, M., et al. (1999). Depressive and disruptive disorders and mental health service utilization in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1081–1090.
Acknowledgments
We gratefully acknowledge Peter Szilagyi, MD, MPH for his contribution to the final editing of this manuscript. Supported by: NIH T32 training Grant, # 0258-3627/HHSN275201100002C (AMC) and Robert Wood Johnson Physician Faculty scholar Award (SHJ). Presented at the American Psychological Association Annual Convention, August 2009.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Conn, AM., Szilagyi, M.A., Alpert-Gillis, L. et al. Mental Health Problems that Mediate Treatment Utilization Among Children in Foster Care. J Child Fam Stud 25, 969–978 (2016). https://doi.org/10.1007/s10826-015-0276-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10826-015-0276-6