An Examination of Family and Health Risks and Services on Permanency Outcomes for Multisystem Youth
Abstract
Multisystem youth, or youth involved with the juvenile court and child welfare systems, are a high-need population about which research is still-emerging. These youth tend to experience considerable adversity and risk across domains (e.g., health and mental health, family functioning) and settings (e.g., home, school, community), and research has begun to focus on the role of multidisciplinary services to reduce recidivism and promote health, safety, and stability for these youth. For instance, multisystem youth face a high level of family-related risk by nature of their involvement with the child welfare system, and research points to the importance of the family unit as a target of intervention for multisystem youth. However, little is known about how family-related services mitigate the impact of family risk on outcomes of salience for multisystem youth, such as permanency goal achievement (i.e., reunification, adoption, or guardianship). In addition, research shows that multisystem youth experience challenges that can be characterized as health-related risks – they are diagnosed with mental health problems at a high rate, may have issues maintaining healthcare coverage, and often experience placement instability. Notwithstanding this high level of health-related risks, it is unclear how health services are used to address such risks and mitigate their impact on permanency goal achievement for multisystem youth. Better understanding these risks and the impact of services on multisystem youths’ system outcomes can have meaningful implications for practice and policy change across the child welfare, juvenile court, and Medicaid systems.This project sought to explore multisystem youth’s experience of risks and services across the domains of family and health, examine how the provision of services in these domains may affect the relation between risk and permanency goal achievement, and investigate differences in experiences across subpopulations of multisystem youth (i.e., boys and girls, youth who achieved their permanency goal and youth who did not). Using administrative data from a legal services case management system, records were examined and coded for a final sample of 74 multisystem youth, representing youth who were served via a nonprofit’s specialized legal team over a nine-year period. Overall, family services and health risks had the greatest impact on youth permanency. Youth in this sample experienced a low level of family risk (i.e., more than two-thirds of youth experienced neither of the two family risks tracked) yet generally received family services (i.e., more than two-thirds of youth received at least one of the three tracked family services). While a limited number of family-related risks and services were tracked, results suggest that these may have important implications for permanency and functioning. Specifically, a mediated linear regression revealed that family services predicted permanency but did not mediate the relation between family risks and permanency. Results point to the potential benefit of less formal services which engage families in case planning and assist them in navigating public systems. The sample’s youth experienced a moderate level of health risks (i.e., over half of the sample experienced three or more of the five health risks tracked) and health services (i.e., of the five services tracked, over three-fourths of the youth received at least one service, and over one-fourth received two or more). Contrary to expectations, a linear mediated regression revealed that health services were not predictive of permanency, but higher health risks were related to permanency achievement. This finding may suggest that, in light of these youths’ diverse needs, a broader array of services than what was tracked in this study may be needed to support multisystem youth. Further analysis via means testing (i.e., t-tests) explored differential experiences of risk and services across subpopulations of multisystem youth (i.e., by gender and permanency outcome) and revealed that boys and youth who aged out of the system tended to experience higher health risks. This study builds on a limited research base to elucidate potential risks that multisystem youth may encounter as well as how service provision may mitigate these risks. Its findings underscore the importance of the domains of family and health for multisystem youth and reaffirms the need to focus on holistic, multidisciplinary supports and services. Implications for future research, policy, and practice are discussed.