Children in foster care: Factors influencing outpatient mental health service use

Objective: To determine factors influencing outpatient mental health servic e use by children in foster care. Method: Detailed survey and administrative data were collected on 480 child ren who entered long-term foster care in San Diego County from May 1990 thr ough October 1991, These data were linked with claims data from Medicaid an d San Diego County Mental Health Services information systems. A Poisson re gression model was used to determine whether the following factors influenc ed outpatient mental health service use: age, race/ethnicity, gender, maltr eatment history, placement pattern. and behavioral problems as measured by the Achenbach Child Behavior Checklist (CBCL). Results: Except for maltreatment history. all independent variables include d in the multivariate regression model were statistically significant. The total number of outpatient mental health visits increased with age. male ge nder, and non-relative foster placements. Relative to Caucasians. visits we re lower for Latinos. and Asian/Others. but comparable for African-American s. Concerning maltreatment history, differences were only found in one cate gory; children experiencing caretaker absence received fewer visits compare d to children who did not experience caretaker absence. Children with CBCL Total Problem Scale T-scores of 60 or greater had significantly more visits than those with a score less than CO. Conclusions: Both clinical and non-clinical factors influence outpatient me ntal health service use by foster children. Limitations imposed by gender, race/ethnicity, and placement setting need to be addressed by child welfare policies. These finding suggest that guidelines are needed to systematical ly link children in Foster care with behavioral problems to appropriate ser vices. (C) 2000 Elsevier Science Ltd.