Petrenko, C. L., Culhane, S. E., Garrido, E. F., & Taussig, H. N. (2011). Do youth in out-of-home care receive recommended mental health and educational services following screening evaluations? Children and Youth Services Review, 33(10), 1911-1918.
Youth in out-of-home care are at high risk for mental health and educational problems. Yet, many do not receive services and the lack of universal screening complicates the detection of problems, leaving many youths with undiagnosed needs. This study aimed to establish whether mental health and educational screening recommendations were associated with service provision for pre-adolescents in out-of-home care, and whether having an assigned mentor increased the odds of receiving such services. Differences by ethnic/racial status, placement type, and maltreatment type were also examined for possible disparities in pre-existing mental health services utilization at baseline, and in recommended new service implementation at follow-up.
Participants included a final sample of 147 youths aged 9-11. Data was collected in 5 cohorts between 2002-2007 from the Fostering Healthy Futures program. Youths were randomly assigned to one of the two conditions: (1) the intervention group (n = 70), where youth participated in a 30-week preventive intervention with individual therapeutic mentoring, and (2) a screening-only control group (n = 77), who received services as usual. Interviews were conducted at baseline (T1) with youths, their caregivers, and teachers. Instruments of cognitive, academic, social, and mental health functioning were administered to youths, and caregivers completed a measure on youth behaviors. For all youths in the study, reports with recommendations were provided to caseworkers, who were encouraged to share with caregivers, therapists and teachers. For youths in the intervention group, reports were provided to their mentors, who were encouraged to advocate for recommended services. Time 2 (T2) interviews were conducted one year later. For all youths in the sample at T1, 22% had unmet mental health needs and 36% had unmet educational needs. At T2, youths who had been recommended for new services were 2.5 times more likely to receive mental health services and 3.5 times more likely to receive educational services. However, by T2, nearly 50% of youth with unmet mental health needs and 84% with unmet educational needs did not receive services. Youths of racial/ethnic minority status, in kinship care, and not physically/sexually abused had lower rates of pre-existing service utilization at T1. Finally, contrary to expectations, being a part of the intervention group (having a mentor) did not increase the odds of receiving recommended services. Screenings may be effective in identifying youths with unmet mental health and educational needs that may have otherwise gone undetected, but greater inter-agency coordination and communication is necessary to improve service implementation, such as improving families and individuals’ knowledge of how to access services, reducing stigma, providing adequate funding, training and support to caseworkers, and improving systematic or needs-based referrals and collaborations.
A series of logistic regressions were conducted for mental health and educational services. The authors were unable to conclude that report recommendations directly led to service implementation, as services may have been implemented without reading the screening evaluation reports. In addition, the small sample size for logistic regression is indeed concerning. Replications with larger sample sizes are needed in future studies.