Securing Access to Mental Health Services Consistent with National Standards for Children in the Child Welfare System 

Principal Investigator: Ramesh Raghavan, PhD, PI
Funder:  National Institute of Mental Health (NIMH)
Timeframe: 02/08-03/10
Affiliation: Center of Mental Health Services Research (CMHSR)

Project Staff:  Ramesh Raghavan, PhD, PI                      
                        Barton Hamilton, PhD

                        Curtis McMillen, PhD

                        William Shannon, PhD

                        Peter Dore, MA, Director of Data Management

                        John Landsverk, PhD, Consultant

                        Susan Ettner, PhD, Consultant

Project Contact:   Ramesh Raghavan, PhD

                              Phone: (314) 935-4469

                              Email: rraghavan@wustl.edu
                             
                                         
Project Update as of 11/28/2007:

 

Description:

Children in the child welfare system are among the highest child users of mental health services, yet little is known about the quality of the services they use. While child welfare systems are required under federal law to increase the quality of care delivered to these children, there is no regulation operationalizing the steps necessary to achieve this mandate. Instead, the Child Welfare League of America (CWLA), the American Academy of Pediatrics (AAP), and the American Association of Child and Adolescent Psychiatry (AACAP) have all proposed nearly identical procedural standards of care for these children to be implemented by child welfare agencies. These standards suggest that child welfare systems should identify children with mental health needs, have them assessed by mental health providers to identify the nature of initial and ongoing needs, and then refer children with such needs to appropriate mental health services.

Currently, there is no information at the child-level on the extent to which children in the child welfare system receive care that is consistent with these national standards. The availability of the country’s first nationally representative panel study of children coming into contact with child welfare agencies – the National Survey of Child and Adolescent Well-Being – offers a unique and unprecedented opportunity to examine the extent to which children in the child welfare system actually receive care consistent with national standards. Its linkage with a national survey of county-level policies – the Caring for Children in Child Welfare study – offers the ability to examine the impact of health financing policies on care consistent with these standards. Such examination is critical for Medicaid programs, which have become important stakeholders in ensuring quality, and which insure the majority of children in the child welfare system. Currently, there is no empirical policy research on the extent to which Medicaid policies directed toward children in child welfare settings can ensure care that is consistent with national standards.

This study will conduct multilevel analysis using these datasets to study the effects of child-, caregiver-, and policy-level predictors on child-level receipt of mental health care of high procedural quality, operationalized as receipt of care consistent with these national standards. Following are the aims of the study:

1. To identify the characteristics of Medicaid-enrolled children coming into contact with child welfare agencies nationwide who are at most risk for not receiving care consistent with national standards
2. To identify individual-level deficiencies in Medicaid coverage (primarily disenrollment from Medicaid coverage over time) that affect receipt of care consistent with national standards
3. To identify county-level Medicaid policies positively associated with receipt of care consistent with national standards