Mental Health Problems that Mediate Treatment Utilization Among Children in Foster Care

Abstract

Children in foster care suffer from an extremely high prevalence of mental health problems, yet, it remains unclear if they consistently use mental health treatments, such as therapy. To determine whether these children receive treatment more often when they have specific types of mental health problems, we examined the prevalence and associations between mental health problems, as identified by standardized screening, and mental health treatment utilization. Using descriptive statistics, multivariate models, and moderation and exploratory mediation analysis, we analyzed data for 237 children in foster care, aged 5-17 years. We found 71 % were identified with a mental health problem in at least one of the sub-domains examined (emotional, conduct, inattention/hyperactivity, peer, and prosocial), and 61 % of children received mental health treatment (p = .001). Yet, the only sub-domains predictive of treatment utilization were peer problems (p = .004) and low prosocial behaviors (p = .030). Moderation analysis revealed that the relation between peer problems and treatment utilization was strongest among white children (p = .012). Exploratory mediation analysis suggested that peer problems may increase the likelihood of treatment for children with emotional (95 % CI 0.05, 0.53) and conduct problems (95 % CI 0.05, 0.58). It remains unknown whether this occurs because peer problems are associated with overt symptoms, or because peers problems can exacerbate existing social-emotional problems. Routine screening for mental health problems among children in foster care can facilitate timely treatment, and potentially improve the present and future quality of life for this high risk population.

The Peer Relationships of Those Who Have Experienced Adoption or Foster Care: A Meta‐Analysis

“…In addition to having difficulty forming peer relationships, foster youth are also identified as having higher levels of peer problems than comparison groups (e.g., Millward, Kennedy, Towlson, & Minnis, 2006). Furthermore, a large proportion of foster youth are identified as having levels of peer problems warranting clinical intervention (Conn, Szilagyi, Alpert-Gillis, Baldwin, & Jee, 2015;Minnis, Everett, Pelosi, Dunn, & Knapp, 2006). Foster youths' peer relationships are often characterized by negative behaviors (M. C. Smith, 1995) and perceived as being lower quality (Flynn, Ghazal, Legault, Vandermeulen, & Petrick, 2004;Stein, 1997).…”

Exploratory Mediation Analysis via Regularization

“…Erickson and colleagues referred to their mediation analysis as exploratory due to an inability to establish a temporal precedence between the levels of brain-derived neurotrophic factor and hippocampal deterioration (Erickson et al, 2010). Finally, in their study of mental health treatment utilization for children in foster care, Conn et al used the term to denote post-hoc analyses done to test hypotheses derived after conducting other statistical tests (Conn, Szilagyi, Alpert-Gillis, Baldwin, & Jee, 2016). …”

Understanding How School Climate Affects Overall Mood in Residential Care: Perspectives of Adolescent Girls in Foster Care and Juvenile Justice Systems

“…The unpredictable and traumatic events that adolescents, particularly girls in the foster care and juvenile justice system, experience precede their placement in out‐of‐home care (e.g., residential care programs) and often leads to emotional and behavioral problems (Conn, Szilagyi, Alpert‐Gillis, Baldwin, & Jee, ). Many studies have shown that in general, youth in the foster care (Conn et al., ; Jones, ; Tarren‐Sweeney, ) and juvenile justice system (Callahan, Cocozza, Steadman, & Tillman, ; Vincent, Grisso, Terry, & Banks, ) exhibit higher rate of behavior problems and academic risks relative to their peers in the general population. In a representative sample of 230 adolescents residing in foster care, Tarren‐Sweeney () reported that about half of adolescents in foster care have mental health problems that require referral to treatment services.…”