Mental Health Service Use by Youths in Contact With Child Welfare: Racial Disparities by Problem Type

Objective: This study examined racial disparities in mental health service use by problem type (internalizing versus externalizing) for youths in contact with the child welfare system. Methods: Participants included 1,693 non-Hispanic white, African-American, and Hispanic youths (ages four to 14) from the National Survey of Child and Adolescent Well-Being, a national probability study of youths who were the subject of investigations of maltreatment by child welfare agencies. Mental health need, assessed at baseline, was considered present if the youth had internalizing or externalizing scores in the clinical range on either the Child Behavior Checklist or the Youth Self-Report. Outpatient mental health service use in the subsequent year was assessed prospectively. Results: Children who were removed from the home and those investigated for abuse (versus neglect) were more likely to receive services in the year after the child welfare investigation. Overall, African-American youths were less likely than non-Hispanic white youths to receive mental health services. However, race-ethnicity moderated the association between externalizing need and service use such that African Americans were more likely to receive services when externalizing need was present (26% versus 4%) compared with non-Hispanic white youths (30% versus 14%). Race and ethnicity did not moderate the association between youth internalizing need and service use, but internalizing need was associated with increased probability of service use only for non-Hispanic white youths. Conclusions: Examinations of overall racial disparities in service use may obscure important problem-specific disparities. Additional research is needed to identify, factors that lead to disparities and to develop strategies for reducing them. (Psychiatric Services 63:1004-1010, 2012; doi: 10.1176/appi.ps.201100427)