Research Watch

Study finds that specialty mental health services reduce the risk of out-of-home-placements for children in juvenile justice and child welfare systems

Year of Publication
Reviewed By
Jonathan D. Schmidt

Glisson, C., & Green, P. (2006). The role of specialty mental health care in predicting child welfare and juvenile justice out-of-home placements. Research on Social Work Practice, 16, 480-490.


Many children and adolescents in the child welfare and juvenile justice systems require mental health services, yet fail to receive it. This study of Tennessee's Department of Children's Services (DCS, an integrated child welfare and juvenile justice systems) sought to identify the proportion of children in Tennessee who needed specialty mental health services, how many received it, and the relationship between the receipt of services and subsequent out-of-home placements within an 18 month follow-up.

Children seen by DCS are at risk of out-of-home placements because of "dependency and neglect" (ranging from neglect to sexual abuse), "unruly behavior", and delinquency" (p. 481). Approximately 1250 participants between the ages of 4 and 18 were recruited from DCS courts in 19 different counties in Tennessee and followed up again after 1.5 years. The majority of caregivers appeared to be in need of specialty mental health services and had substance abuse problems.

As well, approximately 65% of children were found to have significant mental health, behavior and psychosocial problems (according to both the Shortform Assessment for Children and the Columbia Impairment Scale). Despite this need, only 23% received specialty mental health treatment during the follow-up. Logistic regression was used to model the odds of experiencing an out-of-home placement during the 18 month follow-up. Controlling for a host of other factors, failure to receive needed mental health services was one of the strongest predictors of out-of-home placement. The authors calculated that a child having access to specialty mental health services following the court lowered the probability of an out-of-home placement by 36%.

Methodological Notes

The melding of juvenile justice and child welfare systems is problematic; it is difficult to discern unique effects for each system of mental health needs on out-of-home placements. In this sample, maltreated children (rather than delinquent youth) were far less likely to be placed in out-of-home care. The sample was limited to only those who consented to participate, though the response rate was fairly high. Additionally, the study was cross sectional (investigated those involved in courts at a given moment, not all cases referred for maltreatment). Including refusals at court and attrition, it is estimated that the final sample was about 40% and that only 10% of the sample included child protection cases. The analysis was difficult to interpret since they oversampled urban areas but did not appear to weight their analysis accordingly. More research needs to be done to more fully explain organizational and client factors that predict out-of-home placements for certain groups (e.g., maltreated children). Overall, this study is a reminder to pay attention to the mental health needs of those in child welfare and juvenile justice systems. This study also provides social workers the opportunity to reflect on what factors should increase or decrease the likelihood of out-of-home placements.