Predicting level of mental health care among children served in a deliverysystem in a rural state

The purpose of this study was to establish benchmark data to assist in iden tifying factors associated with mental health service needs and level of ca re for children living, in a rural state. Clinical and psycho-social needs and strengths were assessed using retrospective chart review, for all child ren and adolescents (n =150) with symptoms or a diagnosis of reactive attac hment disorder who presented to a comprehensive treatment facility between January 1997 and December 1999. Logistic regression was used to predict fac tors associated with in-patient admission (n = 15) vs. community-based care (n = 135). Significant individual contributor's to the prediction of inpat ient care were more limited clinical/psycho-social strengths, history of in patient use and history of sexual abuse. Although 80 percent of children ad mitted to inpatient care had a history of hospitalization, two-thirds had n o history of receiving community-based services and presented to current tr eatment with a two-year or longer history of symptoms. Approximately two-th irds of children admitted to inpatient care had a history of sexual abuse; however, One-third of these children had no history of mental health servic e use and Presented to Current treatment with a two-year or longer history of symptoms. Findings raise concerns about current efforts in public health education, community awareness and health prevention and early interventio n programs for children with mental/behavioral health challenges and childr en and families at risk for abuse and/or neglect living in rural areas.