Closing the Gap: Assessing Mental Health Needs Within 30 Days of Foster Care Entry

• In Event: Health Policy for Children

Abstract

Background: Failure to provide timely mental health (MH) services to children entering foster care (FC) can have lasting societal, economic, and developmental consequences. Untreated MH needs in childhood are linked to higher risks of school dropout, justice system involvement, substance use, and unemployment. Delays in connecting children to appropriate MH care services may also result in reliance on more reactive and expensive MH services, such as psychiatric hospitalizations or emergency room visits (rather than routine community-based MH therapy). Thus, timely assessment of MH needs following FC entry is essential to promptly refer children to appropriate MH treatment, which often have long waitlists due to provider shortages. 

Method: The aim of this longitudinal study using linked administrative child welfare and Medicaid claims records is to examine patterns of MH assessment receipt within the first 30 days following FC entry for 13,562 children who entered FC between ages 3 and 16. We use discrete time hazard models, which use the logit framework and require fewer assumptions than continuous time survival analysis. We also use a modified Hosmer-Lemeshow test specifically designed for large samples to assess model fit. 

Results: Best practice guidelines from healthcare organizations have long recommended that children receive a comprehensive MH assessment within 30 days of FC entry. We find that only 10% of children received a MH assessment within this timeframe, which is particularly concerning given that children often enter FC with prior experiences of child abuse and neglect. Interestingly, about 1 in 20 children used acute MH services in the first 30 days following FC entry, of whom 72% had not received a MH assessment. Among children who entered FC without a prior MH diagnosis, psychotropic medication prescription, or acute MH care claim, only 7% received a MH assessment within 30 days of FC entry. However, absence of MH history does not equate the absence of MH needs. Since many children had allegations of neglect (77%), physical abuse (36%), and/or sexual abuse (15%) in the past 5 years, it is likely that MH needs would be unrecognized or unmet before entering FC.Among children with a pre-entry MH history, only 14% received a MH assessment within the recommended 30-day period. Since there is often a shortage of MH providers who accept Medicaid - often resulting in long waitlists -delaying MH assessment further delays the initiation of MH treatment, which may in turn increase the risk that children will utilize costly acute MH services.
Implications: Our results reveal a significant gap in the assessment of MH needs within the first 30 days following FC entry, as recommended by best practice guidelines from professional organizations. Concurrently, we also observe an uptick in utilization of acute MH services within the same timeframe. These findings highlight a missed opportunity for early intervention and may reinforce existing disparities and inequities in access to MH services for children in FC.

Author

• Ann Swanson, University of Wisconsin-Madison
  Presenting Author