Context Matters: The State of Racial Disparities in Mental Health Services Among Youth Reported to Child Welfare in 1999 and 2009.
Garcia, Antonio R. Kim, Minseop. DeNard, Christina.
Published: July 2016
Children and Youth Services Review
Vol. 66 , p. 101-108
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Upwards of 50% of youth reported to the child welfare system (CWS) do not receive mental health services, despite need. While children of color are less likely to receive services than Caucasians, the mechanisms through which disparities are sustained remain largely unknown. Data come from two nationally representative cohorts of youth who were referred to the CWS in 1999 and 2009. Results showed that while need for mental health services decreased, significant differences in the number of children who received services was not detected between cohorts. African American youth were less likely to receive services compared to their Caucasian counterparts, even after controlling for age, gender, type of maltreatment, and placement instability. However, after taking into account urbanicity, poverty, and the organizational-social context, the disparity between African American and Caucasian youth dissipated. Service disparities between Latino and Caucasian youth were not detected. The odds of service receipt were lower among youth nested within stressful organizational climates and urban (versus rural) counties, and the organizational-social context did not moderate the relationship between race and service receipt. Findings underscore the need to develop and implement strategies to increase access to services in urban counties and to promote an organizational climate conducive to reducing racial disparities.In 2013, over 400,000 children were placed in the foster care system (UDHHS, 2014). Due to exposure to a number of repeated incidents of maltreatment, youth in foster care are more likely to be diagnosed with a psychiatric disorder than same aged youth in the general population (Clausen et al., 1998, Havlicek et al., 2013, Del Vecchio et al., 2012, Trickett et al., 2011, Landsverk and Garland, 1999 and Leslie et al., 2000). A significant proportion of the youth, however, do not receive mental health services. In fact, Burns et al. (2004) found that nearly 50% of a nationally representative sample of youth who were investigated for maltreatment occurrence had significant emotional or behavioral problems, but only half of them received any specialty mental health care in the past 12 months. A number of studies document that children of color investigated for maltreatment and/or placed in foster care are less likely to access services than their Caucasian counterparts, even after controlling for age, gender, history of maltreatment, caregiver impairment, family income, and placement instability (Burns et al., 2004, Garcia and Courtney, 2011, Garland and Bassinger, 1997, Garland et al., 2003 and Hurlburt et al., 2004). Garcia and Courtney (2011), in particular found that African American teens in foster care are three times less likely to access services than their Caucasian counterparts.While racial disparities are well documented, we still are uncertain as to how and under what conditions disparities continue to be observed in child welfare. Garcia, Palinkas, Snowden, and Landsverk (2013) argue that efforts must be devoted to elucidating the direct and indirect individual, socio-environmental and organizational contextual factors that influence mental health service use experiences among youth of color in the foster care system. To that end, this study relied upon an extant national database to identify the contextually driven factors that contribute to mental health service use among youth referred to the child welfare system (CWS) due to an allegation of child maltreatment. (Author abstract)
mental health services; Racial factors; foster children; African Americans; utilization