Objective-To determine the level of developmental and behavioral need in young children entering child welfare (CW), estimate early intervention services use, and examine variation in need and service use based on age and level of involvement with CW by using a national probability sample in the United States.Methods-As part of the National Survey of Child and Adolescent Well-Being, data were collected on 2813 children <6 years old for whom possible abuse or neglect was investigated by CW agencies. Analyses used descriptive statistics to determine developmental and behavioral needs across 5 domains (cognition, behavior, communication, social, and adaptive functioning) and service use. Logistic regression was used to examine the relationship between independent variables (age, gender, race-ethnicity, maltreatment history, level of CW involvement, and developmental or behavior problems) and service use.Results-Results indicate that age and level of CW involvement predict service use when controlling for need. Both toddlers (41.8%) and preschoolers (68.1%) in CW have high developmental and behavioral needs; however, few children are receiving services for these issues (22.7% overall). Children that remain with their biological parents have similar needs to those in outof-home care but are less likely to use services. Children <3 years of age are least likely to use services.Conclusions-Children referred to CW have high developmental and behavioral need regardless of the level of CW involvement. Both age and level of involvement influence service use when controlling for need. Mechanisms need to be developed to address disparities in access to intervention.Address correspondence to Aubyn C. Stahmer, PhD, Child and Adolescent Services Research Center, 3020 Children's Way, MC 5033, San Diego, CA 92123. E-mail: astahmer@casrc.org. No conflict of interest declared.The information and opinions expressed herein reflect solely the position of the authors. Nothing herein should be construed to indicate the support or endorsement of its content by the Administration on Children, Youth and Families/Department of Health and Human Services. Each year ~2.6 million referrals regarding 4.5 million children are made to child welfare (CW) agencies throughout the nation, and 1.8 million of those referrals are accepted for investigation. 1 Overall, at least 12.3 children in every 1000 have been victims of child abuse or neglect. The highest rates of abuse and neglect occur in children under the age of 6. In 2001, >30% of children in CW were between the ages of 0 and 5. 2 Because these same children are frequently seen in medical offices throughout the country, both before and after allegations of abuse are made, the medical, developmental, and behavioral issues that face them are important to pediatricians. NIH Public AccessAlthough limited data exist, local studies suggest that this population of young children is at higher risk for developmental and behavioral problems than children who have not interacted with CW. This is p...

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American Indian (AI) parents of children involved with child welfare were compared to White, Black and Hispanic parents on mental health and substance abuse problems and access to treatment. Data came from the National Study of Child and Adolescent Well-Being, a longitudinal study of a nationally representative sample of children aged 0-14 years involved with child welfare. Weighted statistics provided population estimates, and multivariate logistic regression was used to predict the likelihood of caregivers receiving mental health or substance abuse services. There were significant disparities in the likelihood of receiving mental health, but not substance abuse, services. Unmet need for mental health and substance abuse treatment characterized all parents in this study. AI parents fared the worst in obtaining mental health treatment. Parents of children at home and of older children were less likely to access mental health or substance abuse treatment.

We used data on a national sample of children involved with child welfare systems to compare American Indian caregivers with White, Black, and Hispanic caregivers in their need for, and receipt of, specialty alcohol, drug, and mental health treatment. American Indian caregivers were significantly less likely to receive services than were Hispanic caregivers (P<.05) but not significantly less likely than were White or Black caregivers. Child placement, child age, and caregiver psychiatric comorbidity were significantly associated with service receipt.