Maltreated children with mental health needs: does coordination between child welfare agencies and mental health providers improve their outcomes?
Open Access
- Author:
- Bai, Yu
- Graduate Program:
- Health Policy and Administration
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- February 23, 2007
- Committee Members:
- Marianne Messersmith Hillemeier, Committee Chair/Co-Chair
Rebecca Wells, Committee Chair/Co-Chair
Rhonda Belue, Committee Member
D Wayne Osgood, Committee Member
E Michael Foster, Committee Member - Keywords:
- safety
permanency
mental health
child
child welfare
interorganizational relationship
organizational - Abstract:
- The high prevalence of mental health problems among children in child welfare and the inadequate provision of mental health services for this subpopulation have been well documented. Calls for strengthening cooperation between child welfare and mental health agencies are derived from two pervasive assumptions. First, children without mental health problems had better experiences and outcomes than those with mental health problems. Second, more cooperation between child welfare and mental health agencies is needed to better serve vulnerable families. The body of evidence to support two assumptions, however, is sparse and even contradictory. In addition, few studies highlight what factors support more of such interagency coordination. This dissertation addresses these questions through a longitudinal analysis of a national sample. This dissertation is composed of three studies. The first study examines whether mental health needs affect safety and permanency for children in child welfare. The second study investigates the role of the intensity of interorganizational relationships (IORs) between child welfare agencies and mental health providers in increasing mental health services use and improving psychological functioning. The third one explores organizational determinants of the intensity of IORs for child welfare agencies. The first study evaluated the safety and permanency among children in the child welfare system with mental health needs and compared these outcomes with those of children without mental health needs. Longitudinal analyses drew on data from the National Survey of Child and Adolescent Well-Being (NSCAW). Proportional hazard models and Generalized Linear Models with sampling weights were used to identify the predictors of safety and permanency. Results indicated that having mental health needs increased the risk of a new maltreatment report and decreased the likelihood of reaching permanency. Externalizing and internalizing patterns had different associations with safety and permanency. Policy implications include the need to assess mental health straight after intake of children and that coordination between child welfare agency and mental health providers should be strengthened. The second study investigated whether IORs increase the use of mental health services and improve the mental health status for children served by child welfare system.This analysis was longitudinal involving 36 months follow-up data from the NSCAW. The sample consisted of 1,613 children within 75 child welfare agencies, who were 2 year old or above and had mental health problems at baseline. IOR intensity was measured as the number of coordination approaches between child welfare agencies and mental health providers. Weighted multilevel logistic regression model showed that agency level factors accounted for 14% of the variance in probability of service use and mental health improvement. Greater intensity of IORs was associated with higher likelihood of service use and mental health improvement. It was concluded that IORs were an effective means to improve children¡¯s well-being. The third study sought to identify organizational and contextual factors associated with higher numbers of inter-agency ties. This study was cross-sectional with 86 child welfare agencies whose directors were interviewed through the NSCAW. Five organizational factors were investigated: the child welfare agency¡¯s scope of services, agency size, organizational affiliation, fiscal resources, and IORs with other types of child-serving agencies. IOR intensity was measured as the number of coordination approaches between child welfare agencies and mental health providers. Poisson regression model revealed that greater number of IORs with the judicial system and schools significantly predicted high intensity of connections between child welfare agencies and mental health providers. Neither agency size, scope of child welfare agency services, expenditures, nor agency affiliation was associated with the number of ties with mental health providers. Child welfare agencies appear to cooperate more extensively with mental health agencies when they have a general affinity for cooperation. Agencies with more ties to other child-serving organizations might share strategies with their peers that encourage them to cooperate more actively as well. In general, this dissertation extends previous research through the use of a nationally representative sample, a rich array of measures from multiple sources, appropriately sophisticated quantitative methodologies, and a systematic approach to very complex issues .