The applicants propose to examine the impact of placement types and changes in the Child Welfare system (CWS) on children's receipt of mental health services within the context of state and regional variation of mental health care policies, structure and fiscal support. Systems level data about organization and financing of mental health care, related to CWS populations and placement types, will be collected under NIMH funding, and then linked to child and family specific data being collected in the National Study of Child and Adolescent Wellbeing (NSCAW) which is funded by ACYF. The 6,000 children and families in the NSCAW will be randomly selected to represent a national one year entry cohort into the CWS. The proposed study will accomplish the following aims. 1) Estimate the need for mental health services among youth, ages 2-14 years in the CWS and compare the levels of need by initial type of placement setting (own home, non-relative foster family home, kinship care, or residential care). 2) Determine placement sequences or pathways for children, ages 0-14 years of age at baseline, and identify their determinants. Predictors of placement pathways are hypothesized to include child characteristics such as age, gender, race/ethnicity, maltreatment history, the presence of behavioral problems, and parental background and functioning. 3) Characterize the sequences or pathways of mental health service use for children, ages 2-14 years at baseline in the NSCAW study, and examine the impact of placement type and placement changes on access to and use of mental health services. 4) Classify the policies, structures and functions of CWS services and public sector-funded mental health services between regions of the country at the PSU level and determine the impact of this geographic variation on use of mental health services for children in the CWS. The applicants hypothesize that these differences profoundly influence access to and use of services and are mediated through placement type. The proposal represents a cost efficient method to expand the knowledge base regarding need for mental health services in the CWS by merging and analyzing detailed child level data provided through NSCAW with the systems level data collected in the proposed applicant work.
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