Identifying Health and Mental Health Needs and Facilitating Access to Care among Youth in Foster Care
Youth placed in foster care typically confront a host of health and mental health conditions and related concerns. To address these potential health challenges early, federal legislation stipulates the need to develop case plans and coordinate the delivery of necessary health and mental health care services. As a critical step in this coordination, the American Academy of Pediatrics (AAP) recommends that comprehensive health and mental health assessments be completed within thirty days of a youth entering custody. Despite an emphasis on these assessments within federal, state, and local policies, few efforts have examined the extent to which assessments, when conducted, adhere to the best practices and guidelines set forth by advisory and regulatory bodies, and whether they translate into improved service delivery and enhanced systems functioning. This study examines the Independent Psychological Assessments (IPAs) conducted by Teen Health Connection for youth over the age of five entering the custody of Mecklenburg County Department of Social Services (DSS)-Youth and Family Services (YFS). In addition to evaluating the degree to which the IPA practices align with best practice recommendations and guidelines, this study uses billing claims to explore the utilization of health and mental health services in the six months pre- and six months post-custody and the extent to which recommended mental health services are implemented. Results suggest that, overall, the IPAs function in alignment with existing guidelines, including those related to the use of collateral sources of information, review of records, use of standardized measures, comprehensiveness of recommendations, and dissemination of information. Although IPAs are typically not fully complete until after the recommended thirty-day timeframe, they are available prior to important court proceedings involving the youth (i.e., adjudication and disposition hearings in which the youth and family’s service plans are developed), which may be a more useful standard for these types of assessments. Billing data indicate that, within this sample, rates of mental health service utilization were high relative to those found in existing research and national samples. IPA recommendations for mental health services were associated with significant increases in the probability of subsequent service utilization, especially for outpatient mental health therapy and medication management. These results suggest that mental health diagnoses, particularly internalizing disorders (i.e., anxiety, depressive disorders, adjustment disorders, Post-Traumatic Stress and other trauma-related disorders); scores on the UCLA-PTSD Index, a measure of trauma exposure and impact; and pre-custody utilization of mental health services play significant roles in the utilization of mental health services post-custody. Factors including age, gender, race/ethnicity, placement at the time of the IPA, and previous DSS/YFS involvement were not found to be related to service utilization. The results of this study suggest that the completion of routine psychological assessments for youth entering the custody of child welfare agencies can have positive implications for the delivery of mental health services for this population. That said, while the IPAs conducted by Teen Health Connection are related to the utilization of mental health services, critical areas for improvement exist, including the delivery of mental health services to youth most critically in need of care, meaningful continuation of therapeutic services over time, coordination between child welfare agencies and local health and mental health systems to expedite service delivery, and ongoing monitoring and quality improvement.