Children at risk of maltreatment more likely to have mental health concerns but less likely to receive services

Date Published
Source

Thompson, R., Lindsey, M.A., English, D.J., Hawley, K.M., Lambert, S. & Browne, D.C. (2007). The influence of family environment on mental health need and service use among vulnerable children. Child Welfare, 86(5), 57-74.

Reviewed by
Jonathan D. Schmidt
Summary

Mental health concerns, in the form of emotional or behavioral disorders, are increasingly common among children. However, there are indications that only half of children who need mental health services will receive them, and this unmet need may be even greater for children served by the child welfare system. Using U.S. data from the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN) and Structural Equation Modeling, this study found that family environments characterized by low family functioning, high caregiver distress, and low social support had higher than average child mental health needs yet used fewer mental health services.

These findings were independent of socio-economic status and were valid for all ethnic groups studied but more pronounced for African American children. Different family compositions (intact family, single/cohabitating parent, and foster/substitute family) were similar to one another, but the findings were weaker for foster/substitute families; these families appear to be more sensitive to children’s needs. .
Families with disrupted environments (i.e., low family functioning, high caregiver distress and low social support) experienced greater child mental health issues, yet were less likely to receive less mental health services. Caregivers who were isolated, distressed and caught up in maladaptive patterns of family functioning often accessed fewer needed mental health services for their children —they appeared to have fewer financial resources to use, less ability to reflect on their children’s needs, and difficulty evaluating their children’s behavioural and mental health.

Methodological notes

The research focused on children considered at risk of maltreatment in urban and suburban U.S.A., so results should not be generalized past this demographic. Data were from 1,075 participating child-caregiver dyads who completed interviews at target time points (child ages of 6 and 8; 79.4% of the overall sample). The LONGSCAN is a consortium of studies at five research sites around the United States studying children (aged 4 years old or younger) identified as at risk of maltreatment. Almost 65% of dyads had been reported to child protection agencies for allegations of maltreatment. Measurement of family environment consisted of measures with demonstrated reliability and validity assessing family social support (emotional and practical support), family functioning (conflict, cohesion, expressiveness, leadership and competence), and caregiver psychological distress; child mental health need was measured by the Child Behavior Checklist Internalizing and Externalizing Problem Scales which have established psychometric properties.