Methods
Data analyzed included Medicaid paid claims linked with child welfareadministrative
data on children who first entered care in a midwesternstate in 1997.
Diagnoses indicated on claims were used to identifya subset of children with
mental health services. Analyses included eventhistory analysis (Cox regression)
to examine differences in outcomes.
Results
Of 7,416 children who entered care during the index year, almost 18percent
(n=1,297) received mental health services. Significant predictorsto
the time of first mental health service (which was, on average, morethan
200 days after placement in foster care) were gender (hazard ratefor males
= 1.435, p<.0001), race (hazard rate for African Americans= 0.631, p<.0001)
and type of placement (hazard rate for kinship care= 0.696, p<.0001).
Mental health service use decreased the chanceof reunification with parents
by 42 percent (p<.0001), controlling forrace and gender. No children
in kinship care were reunified withparents.
Implications
Mental health problems, even when treated, present serious challengesto the
reunification of foster children. Earlier identification andtreatment
of such problems might improve outcomes. Further researchmay indicate
whether outcomes are improved by particular kinds of services. On the
other hand, perhaps a different permanency outcome should be consideredfor
these children.