Changes in Mental Health Service Use over a Decade: Evidence from Two Cohorts of Youth Involved in the Child Welfare System

Recent policies have the potential to address the gaps between need for and access to mental health (MH) services among youth involved in the child welfare system (CWS). Yet, little is known about whether changes in the pattern of MH service use have occurred. This study sought to uncover whether the rates and predictors of MH service use among CWS-involved youth have changed over the past decade. This study relied on administrative data of CWS-involved youth in a large mid-Atlantic city of the United States. The sample consisted of two cohorts of youth who entered the CWS in 2003 and 2012, respectively. Logistic and negative binomial regression models were conducted to examine utilization and dosage of MH services in relation to individual (e.g., cohort, gender, age, and race/ethnicity) and case characteristics (e.g., placement type/instability, and juvenile justice system involvement). Both utilization and dosage of MH services were found to have increased between cohorts, even after controlling for individual and case characteristics. There were also promising trends toward more equitable access and utilization of MH services along age and racial lines. However, disparities by gender and placement type were still prevailing problems. Potential positive effects of the recent policies are likely reflected in our findings of increased MH service use between the two cohorts. Given disparate MH service utilization based on gender and placement type, however, additional efforts to adhere to recent mandates to enhance child well-being are warranted.