Service use and multi-sector use for mental health problems by youth in contact with child welfare Elizabeth M.Z. Farmer a, ⁎, Sarah A. Mustillo b , H. Ryan Wagner c , Barbara J. Burns c , David J. Kolko d , Richard P. Barth e , Laurel K. Leslie f a Pennsylvania State University, Department of Health Policy and Administration, 601E Ford Building, University Park, PA 16802, United States b Purdue University, Department of Sociology, United States c Services Effectiveness Research Program, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, United States d Department of Psychiatry, University of Pittsburgh School of Medicine; Special Services Unit, Western Psychiatric Institute and Clinic, United States e School of Social Work, University of Maryland, United States f Departments of Medicine and Pediatrics, Tufts Medical Center, Floating Hospital for Children, United States abstract article info Article history: Received 27 January 2010 Accepted 27 January 2010 Available online 4 February 2010 Keywords: Mental health services Systems of care Children's mental health Child welfare This article uses data from the National Survey of Child and Adolescent Well-Being (NSCAW) to examine multi-sector service use for mental health problems by youth in contact with social service agencies. At 18-months post-investigation for abuse/neglect, 24% was receiving some service for a mental health problem. Among served youth, 33% received services from multiple sectors. Likelihood of service use was higher for youth who were older, male, in non-kin foster care, had more severe mental health problems, and more parental risk factors. Among service users, few factors differentiated youth who used multiple sectors from those served in only one sector. © 2010 Elsevier Ltd. All rights reserved. 1. Introduction Youths who come into contact with child welfare services display high rates of mental health problems and come from families affected by multiple problems (e.g., Burns et al., 2004; Farmer et al., 2001; Kolko Selelyo, & Brown, 1999; Landsverk, Garland, & Leslie, 2002). As such, they are likely to require services from a variety of child-serving sectors (e.g., specialty mental health, education, juvenile justice, general medicine) to meet these multiple needs. In response to this often extended and broad need for services, system of care principles have been utilized during the past two decades in an attempt to more adequately serve these youth with multifaceted needs (e.g., Kutash, Duchnowski, & Friedman, 2004; Pumariega & Winters, 2003; Stroul, 1996; Stroul & Friedman, 1986). This paper builds upon previous research to examine cross-sectional patterns of multi-sector service use and predictors of such patterns across a broad range of communities. Previous work has shown that contact with child welfare may play a ‘gatekeeping’ role that increases access to mental health services (Blumberg, Landsverk, Ellis-McLeod, Ganger, & Culver, 1996; Farmer et al., 2001; Halfon, Berkowitz, & Klee, 1992; Takayama, Bergman, & Connell, 1994). However, a high level of unmet need remains among such youth (Burns et al., 2004; Farmer et al., 2001; Horwitz, Hurlburt, & Zhang, 2010). In addition, previous work has shown that it is crucial to recognize the broad range of child-serving sectors (not just the specialty mental health sector) that provide services to address these youths' mental health problems (Burchard, Burchard, Sewell, & VanDenBerg, 1993; Burns, et al., 1995; Farmer et al., 2001; Staghezza-Jaramillo, Bird, Gould, & Canino, 1995; Stroul, 1993; Zahner & Deskalakis, 1997). A growing body of research has focused on factors related to the receipt of mental health treatment for the youth in contact with child welfare services (CWS). The severity of the child's mental health problems has frequently been related to increased likelihood of receiving treatment (Burns et al., 2004; Garland, Landsverk, Hough, & Ellis-McLeod, 1996; Leslie et al., 2000, 2004). However, even this factor has not consistently predicted such services (Kolko, Bauman, & Caldwell, 2003). Race has also been linked to service use, with the majority youth being more likely to receive treatment than the minority youth (Farmer et al., 2001; Garland & Besinger, 1997; Kolko et al., 1999; Leslie et al., 2004; McMillen, Scott, Zima, Ollie, Munson, & Spitznagel, 2004; Walrath & Liao, 2004). However, not all analyses have found this pattern (e.g., Zima, Bussing, Yang, & Berlin, 2000). There has also been evidence that where (and whether) a child is placed may affect service use. Youth placed in non-relative foster care are more likely to receive services than those living in kinship care (Leslie et al., 2000; McMillen et al., 2004) or at home (Burns et al., 2004). The type and severity of abuse has also been linked with increased rates of service use, with more severe abuse and sexual abuse related to increased use of services (Garland et al., 1996; Kolko Children and Youth Services Review 32 (2010) 815–821 ⁎ Corresponding author. Tel.: + 814 863 7333; fax: + 814 863 2905. E-mail address: emf13@psu.edu (E.M.Z. Farmer). 0190-7409/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.childyouth.2010.01.019 Contents lists available at ScienceDirect Children and Youth Services Review journal homepage: www.elsevier.com/locate/childyouth