Emotional and behavioral problems of children in residential care: Screening detection and referrals to mental health services Carla González-García a , Amaia Bravo a, ⁎, Ignacia Arruabarrena b , Eduardo Martín c , Iriana Santos d , Jorge F. Del Valle a a Universidad de Oviedo, Spain b Universidad del País Vasco, Spain c Universidad de La Laguna, Spain d Universidad de Cantabria, Spain abstract article info Article history: Received 28 September 2016 Received in revised form 12 December 2016 Accepted 12 December 2016 Available online 13 December 2016 Adverse family conditions, abuse and neglect during childhood present important risk factors for the appearance of emotional and behavioral problems. The main aim of this paper is to describe the presence of these kinds of disorders in children in residential child care and to explore individual, socio-family and care process factors as- sociated with the use of mental health services. The sample consisted of 1216 children 6–18 years old in residen- tial care in several Spanish regions. Information about emotional and behavioral problems was gathered according to two criteria: receiving some kind of treatment services and/or being identified as within the clinical range in the Child Behavior Checklist (CBCL). Results showed that 49% of cases were receiving some kind of men- tal health treatment and 61% were identified as within the clinical range in some of the broad band scales of the CBCL. In terms of agreement between referral to treatment and CBCL scores, results showed that four out of ten cases identified as within the clinical range were not receiving any kind of treatment. Several factors related to the type of problems detected in the CBCL, personal variables, and child care arrangements are associated with greater use of mental health services. © 2016 Elsevier Ltd. All rights reserved. Keywords: Psychological disorders Residential child care Mental health services CBCL 1. Introduction National child welfare statistics show that in Spain 35,682 children and adolescents were in an out-of-home placement due to severe situ- ations of abuse or neglect at the end of 2014, of that number 13,563 were in residential care (Observatorio de la Infancia [Child Observatory], 2016). These children have experienced very unfavorable circumstances, living in family environments with many problems such as adverse economic situations, gender violence, mental health prob- lems, and drug addiction (Sainero, Bravo, & Del Valle, 2014). Research has shown clear evidence of the way in which these adverse conditions jeopardize psychological functioning, encourage the appearance of emotional and behavioral disorders (D'Andrea, Ford, Stolbach, Spinazzola, & van der Kolk, 2012; Greger, Myhre, Lydersen, & Jozefiak, 2015; McLaughlin et al., 2012; Segura, Pereda, Guilera, & Abad, 2016) and can lead to maladaptation, not only in childhood, but adulthood as well (Jonson-Reid, Kohl, & Drake, 2012; Ramiro, Madrid, & Brown, 2010). Research by Raviv, Taussig, Culhane, and Garrido (2010), demon- strated the cumulative effect of adverse experiences; the more risk fac- tors that are present, the more probable the presence of mental health problems. Other studies identified factors like exposure to violence, presence of severe neglect, age at first placement and number of place- ments as predictors of various psychiatric disorders (Lehmann, Havik, Havik, & Heiervang, 2013). Instability of care placement (foster and res- idential) has been shown to be a factor with a significant impact on the mental health of children and adolescents. Several changes of foster family and residential placement have been associated with the pres- ence of externalizing and internalizing emotional and behavioral prob- lems (Del Valle, Bravo, Álvarez, & Fernanz, 2008; Newton, Litrownik, & Landsverk, 2000; Rubin, O'Reilly, Luan, & Localio, 2007). Consequently, these children present varied mental health prob- lems, with externalizing disorders being particularly significant (Schmid, Goldbeck, Nuetzel, & Fegert, 2008; Vanschoonlandt, Vanderfaeillie, Van Holen, De Maeyer, & Robberechts, 2013). Keil and Price (2006), analyzing a wide range of studies, estimated that an aver- age of 42% of these children have this type of disorder. Other diagnoses, such as depression (Jozefiak et al., 2016) and post-traumatic stress Children and Youth Services Review 73 (2017) 100–106 Abbreviations: CBCL, Child Behavior Checklist; UASC, unaccompanied asylum seeking children. ⁎ Corresponding author at: Amaia Bravo. Facultad de Psicología, Plaza Feijoo s/n, 33003 Oviedo, Spain. E-mail addresses: carla.gonzalez.garcia@gmail.com (C. González-García), amaiabravo@uniovi.es (A. Bravo), ignacia.arruabarrena@ehu.es (I. Arruabarrena), edmartin@ull.edu.es (E. Martín), iriana.santos@unican.es (I. Santos), jvalle@uniovi.es (J.F. Del Valle). http://dx.doi.org/10.1016/j.childyouth.2016.12.011 0190-7409/© 2016 Elsevier Ltd. All rights reserved. Contents lists available at ScienceDirect Children and Youth Services Review journal homepage: www.elsevier.com/locate/childyouth