Prevalence of mental health problems among children placed in out-of-home care in Denmark Tine Egelund* and Mette Lausten† *Professor, Programme Director, The Danish National Centre for Social Research, and †Senior Researcher, The Danish National Centre for Social Research, Copenhagen K, Denmark ABSTRACT This paper concerns the prevalence of mental health problems among children in family foster and residential care within a Danish context. All children, born in Denmark in 1995, who are or formerly have been placed in out-of-home care (n = 1072), are compared with a group of vulnerable children of the same age, subjected to child protection interventions but living at home (n = 1457, referred to as the ‘in home care children’), and to all contemporaries who are not child protection clients (n = 71 321, referred to as the ‘non-welfare children’). Prevalence data are established on the basis of national administrative register data, including data on psychiatric diagnoses of the children, and on survey data scoring children in out-of-home care, in home care children, and non-welfare children by means of the Strengths and Difficulties Questionnaire (SDQ). Results show that 20% of children in out-of-home care have at least one psychiatric diagnosis compared to 3% of the non-welfare children. Almost half of the children in care (48%) are, furthermore, scored within the abnor- mal range of SDQ, compared to 5% of the non-welfare children. Correspondence: Tine Egelund, Professor and Programme Director, The Danish National Centre for Social Research, Herluf Trolles Gade 11, DK-1052 Copenhagen K, Denmark E-mail: te@sfi.dk Keywords: children in family foster and residential care, mental health problems, prevalence, psychiatric diagnoses, SDQ scores Accepted for publication: January 2009 INTRODUCTION Children’s mental health problems are a major chal- lenge in child protection/child welfare social work. This paper analyses the prevalence of mental health problems among Danish children placed outside their homes in foster and residential care. It compares the prevalence rates of the children in out-of-home care with in home care children and all Danish non-welfare children. The paper also analyses factors associated with mental health problems for the children from these three groups, with the focus on children in care. Mental health disorders are shown to be highly overrepresented among children subjected to child protection interventions, and the distress and social impairment associated with mental health problems may place serious obstacles in the way of their devel- opmental process. Wolkind & Rushton (1994) docu- mented high rates of both psychiatric disorders among children in foster and residential care and of their later psychosocial difficulties. Kjelsberg & Nygren (2004) found in a study of Norwegian children in care that 68% had pathological scores on the Child Behaviour CheckList (CBCL, Achenbach 1993). The boys in residential care scored within the abnormal range more often than did boys placed in child and adoles- cent psychiatric wards (71% and 64%, respectively). Dimigen et al. (1999) found that a considerable pro- portion of young children entering care have serious psychiatric disorders with conduct disorder and depression as the most common disorders. Pilowsky (1995) reviewed research about psychopathology in children placed in family foster care and found varied but high prevalences reported in former studies, pre- dominantly a high degree of externalizing disorders. Moreover, the mental health problems of child pro- tection clients warrant ample demand for quality mental health services that are not easily supplied, as these services are a scant resource in many countries, including Denmark, which provides the national context for this analysis. Offord et al. (1987) found in the Ontario child health study that among children with mental disorders, only one child in six receives specialized mental health services. Phillips (1997) doi:10.1111/j.1365-2206.2009.00620.x 156 Child and Family Social Work 2009, 14, pp 156–165 © 2009 Blackwell Publishing Ltd