Identifying and meeting the needs of maltreated children with mental health problems Public Deposited

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  • March 21, 2019
  • McCrae, Julie S.
    • Affiliation: School of Social Work
  • This research addresses three topics related to improving child welfare and mental health services for children involved with child welfare: need, identification, and service-symptom relationships. Each study in this series uses data from the National Survey of Child and Adolescent Well-being (NSCAW), the first nationally-representative sample of children investigated for maltreatment. Results show that 62% of children experience clinical-level emotional-behavioral problems at some point over three years following a maltreatment investigation. One-fifth of children report clinical-level depression and 19% report clinical-level post-traumatic stress. Thought and attention problems are among the most prevalent and persistent types of problems reported by children's caregivers, as are externalizing behavior problems. Children appear to experience heightened symptoms at the time of the investigation, but also experience symptom discontinuity over time, suggesting the need for services that target multiple symptom-areas. At least 470,000 children nationally may not be recognized by child welfare workers as having mental health symptoms at the conclusion of a maltreatment investigation, according to this research. Using risk assessment and investigative information to identify children with symptoms correctly classifies 75 to 80% of children and therefore could serve as a first-level screen. This would reduce the number of children who are provided a standardized psychological measure, having the potential for benefit and cost-avoidance. Analysis of the relationship between mental health services and changes in children's symptoms over time failed to demonstrate a positive service-symptom relationship. That is, children who receive mental health services have significantly higher levels of symptoms compared with children who do not receive services. Children typically receive school-based counseling services and less often receive in-home counseling, suggesting the need for more family-focused approaches to their mental health. Children may receive services prompted by their "acting-out" behaviors, at the same time that their family is experiencing substantial problems. This may give children the message that their behavior is the primary problem rather than the family circumstances that led to their child welfare involvement. Clearly, maltreatment is associated with mental health problems, and our current state of knowledge and practice appears insufficient to make measurable differences in children's level of risk for such problems.
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  • In Copyright
  • Barth, Richard P.
Degree granting institution
  • University of North Carolina at Chapel Hill
  • Open access

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