Context matters: The state of racial disparities in mental health services among youth reported to child welfare in 1999 and 2009

Upwards of 50% of youth reported to the child welfare system (CWS) do not receive mental health services, despite need. While children of color are less likely to receive services than Caucasians, the mechanisms through which disparities are sustained remain largely unknown. Data come from two nationally representative cohorts of youth who were referred to the CWS in 1999 and 2009. Results showed that while need for mental health services decreased, significant differences in the number of children who received services was not detected between cohorts. African American youth were less likely to receive services compared to their Caucasian counterparts, even after controlling for age, gender, type of maltreatment, and placement instability. However, after taking into account urbanicity, poverty, and the organizational-social context, the disparity between African American and Caucasian youth dissipated. Service disparities between Latino and Caucasian youth were not detected. The odds of service receipt were lower among youth nested within stressful organizational climates and urban (versus rural) counties, and the organizational-social context did not moderate the relationship between race and service receipt. Findings underscore the need to develop and implement strategies to increase access to services in urban counties and to promote an organizational climate conducive to reducing racial disparities.     

Racial/Ethnic Disparities in Mental Health Service Use for Older Foster Youth and Foster Care Alumni

Studies have shown that foster care alumni have disproportionally high rates of poor mental health outcomes compared to the general population. The purpose of this study was to examine differences in mental health service use for Latino, African American, and White youth while in foster care and upon exit from the foster care system. Secondary data were used to identify youth 1 year prior to exiting the foster care system (N?=?934) and 1 year after exit from the foster care system (N?=?433). Racial/ethnic disparities in mental health service use upon exit from the foster care system were found, with Latino youth using the least amount of services after foster care exit. Racial/ethnic service disparities in type of services used were also found. Findings suggest that a lack of support (e.g., mandatory or voluntary) may be significant in overcoming challenges in the continuation or disruption of services.     

Racial/ethnic disparities in prior mental health service use among incarcerated adolescents

Research on racial and ethnic disparities in mental health and substance abuse service use among incarcerated youth in the U.S. is inconclusive. This cross-sectional study adds to our understanding of racial and ethnic disparities by examining the prior use of mental health and substance abuse services among incarcerated juveniles. Guided by Andersen's behavioral model of health service utilization, a series of logistic regression analyses were conducted on a non-probability sample of 13–19 year-old youth in two residential facilities for juvenile offenders in Western Pennsylvania (N = 181). Black and Hispanic youth were less likely than White youth to have used mental health and substance abuse services, even when controlling for predisposing, enabling, and need factors. Additional analyses revealed that these differences did not hold across all service types, specifically with regards to outpatient service use. Significant differences did exist, however, in the prior use of inpatient mental health and substance abuse services. This suggests that White youth are often funneled into the mental health system, while youth of color enter the justice system. Implications for racial/ethnic disproportionality in service use and justice system involvement are discussed.     

Racial/ethnic disparity in child welfare systems: A longitudinal study utilizing the Disparity Index (DI)

The purpose of the study is to examine racial/ethnic disparity among children and families that are involved with the child welfare system. Specifically, the authors explore whether or not disparity levels and long-term changes in disparity in California child welfare systems are significant. In addition, the study investigates how county characteristics such as child poverty rates, unemployment rates, and rurality are associated with levels of disparity and changes in racial/ethnic disparity over time. Using a Latent Growth Curve (LGC) modeling approach, the study estimated the trajectories of county-level Disparity Index (DI) scores (Shaw, Putnam-Hornstein, Magruder, & Needell, 2008). African American and Hispanic/Latino children were compared to Caucasian children for two phases of the child welfare process: substantiated allegations and entries, between 2005 and 2008. The results demonstrate that racial/ethnic disparity between African American and Caucasian children was significant at both phases of the child welfare process in 2008. However, disparity between Hispanic/Latino and White children was not significant. Levels of disparity between African American and Caucasian children remained constant over time. Regarding the effects of county characteristics, higher child poverty rates, higher unemployment rates and rurality were related to lower levels of disparity. In addition, unemployment rates were associated with increasing rates of change in entries disparity between African American and Caucasian children. And urbanicity was associated with increasing rates of change in substantiated allegations disparity between Hispanic/Latino and Caucasian children. The study's implications for future research are discussed.     

Ethnic Variations in the Two-Year Living Arrangements of Prenatally Drug-Exposed and Comparison Children Placed at Birth

ABSTRACT

This study reports on the outcomes of foster home placements of 1,038 African American, Latino, and White infants, prenatally exposed to drugs, removed from their mothers' custody at birth and placed in foster care and the outcomes of a comparison group of 203 infants similarly removed, but not known to have been drug-exposed. Twenty-four months after placement, slightly more than half of the White drug-exposed infants were still under court supervision, and two thirds of the African American and Hispanic infants. A similar situation existed for the comparison group, but the ethnic distributions were reversed. Although African American children predominated in the proportion that were in kinship care, the largest proportion of both Latino and White children were in kinship care. Policy and practice implications are discussed in terms of enhancing placement outcomes for prenatally drug-exposed infants in general and in terms of encouraging placement options that may vary depending upon the ethnicity of the child and the child's kinship ties.     

Who am I? Who do you think I am? Stability of racial/ethnic self-identification among youth in foster care and concordance with agency categorization

While it has been well documented that racial and ethnic disparities exist for children of color in child welfare, the accuracy of the race and ethnicity information collected by agencies has not been examined, nor has the concordance of this information with youth self-report. This article addresses a major gap in the literature by examining 1) the racial and ethnic self-identification of youth in foster care, and the rate of agreement with child welfare and school categorizations; 2) the level of concordance between different agencies (school and child welfare); and 3) the stability of racial and ethnic self-identification among youth in foster care over time. Results reveal that almost 1 in 5 youth change their racial identification over a one-year period, high rates of discordance exist between the youth self-report of Native American, Hispanic and multiracial youth and how agencies categorize them, and a greater tendency for the child welfare system to classify a youth as White, as compared to school and youth themselves. Information from the study could be used to guide agencies towards a more youth-centered and flexible approach in regard to identifying, reporting and affirming youth's evolving racial and ethnic identity.     

Health outcomes for adults in family foster care as children: An analysis by ethnicity

Studies have linked the experience of child abuse or adversity to health problems in adulthood, and researchers have long documented health problems affecting children in foster care. Yet, the adult health outcomes of maltreated children placed in foster care have not been sufficiently isolated. Although information on transitioning youth and young adults is now beginning to emerge, the impact of ethnicity on adult health outcomes has been largely ignored. Given the overrepresentation of ethnic minority children in foster care and the national disparities in the health of ethnic minorities, this study examined the relationship between ethnicity and physical health outcomes for African American, Hispanic, and White adults who experienced family foster care as children. Logistic regression models indicated that ethnicity was not a significant predictor of physical health (p > .05). However, gender and age were associated significantly with their physical health outcomes.     

Perceived self-stigma in the utilization of mental health services in foster care and post foster care among foster care alumni

Foster youth experience higher rates of mental health disorders and receive higher rates of mental health services in comparison to the general population. Yet, upon foster care exit, mental health service use drastically declines. Little is known as to the reasons for mental health service decline after foster care exit. However, research studies in the mental health literature have consistently shown that self-stigma and public stigma are significant in mental health service receipt. Studies have also shown that self-stigma affects an adolescent's self-identity, self-efficacy, and interpersonal relationships, which impact self-sufficiency once youth leave foster care. This study explores self-stigma in the utilization of mental health services while in foster care, and whether the stigma developed while in foster care impacts mental health service use upon foster care exit. The role of public stigma in the utilization of mental health services post foster care is also examined. Thirteen former foster youth with a mental health treatment history while in foster care were interviewed. Results show that foster youth experienced self-stigma, which increased the negative impact of mental health service receipt while in foster care. After foster care exit, youth who identified experiencing self-stigma while in foster care tended to discontinue mental health services after foster care exit. In contrast, foster youth who did not identify self-stigma in the receipt of mental health services while in foster care continued accessing services upon foster care exit. Public stigma was not identified as influencing mental health service use post foster care, but was coupled with negative labels, stereotypes, and negative perceptions. Implications for preventive and intervention measures are also discussed/proposed.     

Receipt of independent living services among older youth in foster care: An analysis of national data from the U.S.

Fifteen years has passed since the Chafee Foster Care Independence Program was created under the Social Security Act, which marked an increased role of the U.S. federal government in supporting foster care youth to independence. It was not until the National Youth in Transition Database (NYTD) was launched in 2010 that all 50 states reported standard data on receipt of the 13 types of Chafee independent living services. This paper, which draws on the first two years of NYTD data, analyzes Chafee service receipt across the U.S. among youth in foster care (ages 16–21). About half of the 131,204 youth included in this analysis received at least one type of Chafee service, and considerable variation existed in the proportion of youth that received each of the 13 specific types of services. Females were more likely than males to receive all but one type of service, and African Americans were less likely to receive most of the services. An interaction effect indicated that Black youth were significantly less likely to receive services in large urban areas than other racial/ethnic groups. Young people with disabilities or medical/psychological conditions were generally more likely to receive services than youth without disabilities. Youth in large urban regions receive fewer services than youth residing in other areas, and substantial variation exists between states in proportions of service recipients. Recommendations are made for targeting services, future data collection, and research, including suggestions on ways to improve measurement of Chafee services.     

Making MEPA-IEP work: tools for professionals

The Multiethnic Placement Act of 1994 and the Interethnic Adoption Provisions of 1996 (MEPA-IEP) require states to develop plans that "provide for the diligent recruitment of potential foster and adoptive families that reflect the ethnic and racial diversity of children in the state for whom foster and adoptive homes are needed." This paper explores the background of MEPA-IEP, describes the disparate outcomes for minority children in the child welfare system, and identifies agency challenges in finding permanent families for African American children. Tools are provided for successfully recruiting families while following MEPA-IEP and avoiding potentially discriminatory practices in placement decisionmaking.     

Pathways to Mental Health Services for Children and Youth in the Child Welfare System: A Focus on Social Workers’ Referral

Case abstraction was used to collect data from court reports to examine characteristics that predict referral to mental health services by court and child welfare social workers and whether referral to mental health services was a significant determinant of service utilization. Home placement and multiple types of abuse were significant predictors of a referral to mental health services by the court social worker and age and reported sexual abuse were significant in the utilization of services. Practice and policy implications are discussed.     

Ethnic and Marital Differences in Family Structure,Risk Behaviors,and Service Requests Among Young Minority Fathers

The purpose of this study was to examine ethnic and marital status differences in family structure, risk behaviors and service requests among African American and Hispanic adolescent fathers participating in a community-based fatherhood program. Demographic factors, risk behaviors, and service requests were gathered at program entry. The results indicated that each group demonstrated distinct patterns associated with family structure, sexual risk behaviors, substance use, and criminal behavior. In comparison to African American fathers, Hispanic fathers were younger and were more likely to be married and present at the delivery of their child. African American fathers reported having more children than Hispanic fathers. Disparities in school-related measures were also found, with African American fathers having higher high school graduation rates than Hispanic fathers. The impact of marriage on risk behaviors had mixed results. Services requests were similar for both groups. The finding that different ethnic groups have specific patterns of risk behaviors highlights the importance of considering the ethnic composition of a population when developing future research and interventions.     

Behavioral health service use and costs among children in foster care

This article compares behavioral health service use and cost for foster care versus nonfoster care children; children before, during, and after foster care placement; and successfully reunified versus nonsuccessfully reunified foster care children. Behavioral health service costs for children in foster care were higher than for children not in foster care. Children in foster care used more services during their foster care placement than before placement and after discharge. Nonsuccessfully reunified children received a significantly larger quantity of services than those successfully reunified.     

Ethnic differences in symptom presentation of sexually abused girls

Although researchers have begun to examine the issue of ethnic and cultural factors in childhood sexual abuse (CSA), relatively little has been done to look at possible ethnic and cultural differences in psychological symptoms related to CSA. This study investigated the relationship between ethnicity and symptom presentation among Hispanic, African American, and Caucasian sexually abused girls. The study examined the relationship between ethnicity and depression, ethnicity and post-trauma intrusive symptoms, and ethnicity and post-trauma avoidance symptoms. Results indicated that African American girls had significantly higher levels of post-trauma avoidance symptoms than Hispanic girls, but not Caucasian girls. No significant differences were found between ethnic groups for depression or intrusive symptoms.     

Ethnic Identity Development Among Adolescents in Foster Care

Because past research indicates that stronger ethnic identity is related to better outcomes in areas such as academic achievement and mental health, it is important to provide youth in foster care with opportunities to develop their ethnic identity. Using data from in-person interviews with 188 youth aged 14–17 in foster care (88.7% response rate), this paper explores two areas related to ethnic identity: (1) youth perceptions about their own ethnic identity, and (2) attitudes about ethnic identity development specific to the experience of being in foster care. Results suggest that black youth and Hispanic/Latino youth have a stronger sense of ethnic identity than white youth. Most youth are interested in learning more about their ethnic background. Understanding how youth in foster care identify ethnically and understanding their beliefs related to ethnic identity may lead to the enhancement of services provided to youth across child welfare, education, and mental health systems.

A Three-Pronged Approach to Addressing Racial Disproportionality and Disparities in Child Welfare: The Santa Clara County Example of Leadership, Collaboration and Data-Driven Decisions

Disproportionality and disparities in the treatment of children of color has been a growing concern in the child welfare system. System stakeholders have begun to recognize the problem through data, which help identify discrepancies within their jurisdictions. Nationally, the primary concern is the overrepresentation of African American children within the child welfare system, where African Americans represent proportions of the foster population at a level more than twice as high as they are represented in the community at large. In some jurisdictions, however, this is only one piece of the disproportionality concern. San Jose, for example, has both an overrepresentation of African American and an overrepresentation of Hispanic children in the child welfare system. Because San Jose’s child welfare population is unique, they have had to take a unique approach to addressing these concerns. This article outlines strategies and tools used to begin reducing disproportionality within the child welfare and juvenile dependency court system, using San Jose’s experience as an example. Some of the key approaches to addressing disproportionality include ensuring a systems approach (creating a Cross Agency Systems Team that prioritizes services for parents and children in various systems, e.g., mental health, substance abuse, etc.); addressing disproportionality from multiple perspectives and examining the roles’ of caseworkers, supervisors, service providers, judges, and attorneys; gaining community and system stakeholder buy-in by maintaining momentum and providing opportunities for dialogue about the complex issues facing families of color; using a data-driven approach to inform ongoing initiatives and changes in policy and practice (e.g., closely examining policies and practices such as the frequency of recommendations to by-pass reunification services); and implementing changes in practice at multiple levels including child welfare and on the bench. The examination of San Jose’s approach reveals challenges, successes, and lessons learned.     

Ethnic Differences in Symptom Presentation of Sexually Abused Girls

ABSTRACT

Although researchers have begun to examine the issue of ethnic and cultural factors in childhood sexual abuse (CSA), relatively little has been done to look at possible ethnic and cultural differences in psychological symptoms related to CSA. This study investigated the relationship between ethnicity and symptom presentation among Hispanic, African American, and Caucasian sexually abused girls. The study examined the relationship between ethnicity and depression, ethnicity and post-trauma intrusive symptoms, and ethnicity and post-trauma avoidance symptoms. Results indicated that African American girls had significantly higher levels of post-trauma avoidance symptoms than Hispanic girls, but not Caucasian girls. No significant differences were found between ethnic groups for depression or intrusive symptoms.     

Racial and ethnic differences in patterns of adolescent tobacco users: A latent class analysis

BackgroundLittle is known about how tobacco use varies among youth of different racial and ethnic groups and how these patterns are related to levels of nicotine dependence.ObjectivesThis study investigated the tobacco use patterns of White, African American, and Hispanic high school students. We further explored whether tobacco use patterns were associated with levels of nicotine dependence and gender.MethodsData were analyzed from the 2014 National Youth Tobacco Survey (NYTS) of high school students who endorsed at least one form of tobacco use in their lifetime (n = 4691). Three separate latent class analysis (LCA) models were estimated using seven different types of tobacco products as indicators. Also, the level of nicotine dependence was compared with one class to another class in three racial/ethnicity groups.ResultsFour classes of White youth were identified: (1) “Non-user” (67%), (2) “Polytobacco” (6%), (3) “Chewing Tobacco” (8%), and (4) “(E-)Cigarettes” (19%) classes. The “Polytobacco” class had the highest nicotine dependence followed by “Chewing Tobacco,” “(E-)cigarettes,” and “Non-user.” Among African American youth, two tobacco patterns were identified: “Non-user” (91%) and “Cigarette/Cigar” (9%). The “Cigarette/Cigar” class had greater nicotine dependence than the “Non-user” class. Among Hispanic youth, three subgroups were identified: “Non-user” (78%), “(E-)Cigarette/Cigar” (14%), and “Hookah” (18%). “(E)Cigarette/cigar” had the highest nicotine dependence in Hispanic youth followed by the “Hookah” and “Non-users” classes.ConclusionWe found distinct classes of youth tobacco use by race/ethnicity. Although poly-tobacco use was common, White, African American, and Latino youth used different tobacco types, suggesting that racially and ethnically targeted prevention strategies may be indicated.     

Connective complexity: African American adolescents and the relational context of kinship foster care

Attempts to address racial disproportionality in child welfare must include a focus on the benefits and challenges facing children in kinship care. African American children not only are overrepresented in the child welfare system, but also are placed disproportionately in kinship foster care. Using a sample of 18 African American adolescents ages 11 to 14, this article explores how the relational context of care experienced by adolescents in kinship foster care differs from that of adolescents in nonkinship foster family placements. Findings are presented regarding the stability of relationships as well as complex role dilemmas experienced by kinship youth as they relate to caregivers and birthparents in the child welfare context. Implications are given for practice with kinship families.