Mental health service use during the transition to adulthood for adolescents reported to the child welfare system.

OBJECTIVE: This study analyzed patterns of outpatient mental health service use from adolescence into early adulthood among young adults who were reported as victims of maltreatment in adolescence. METHODS: Data were from the National Survey of Child and Adolescent Well-Being, a national probability study of children for whom maltreatment was investigated by the child welfare system. The sample consisted of 616 young adults aged 12 to 15 at baseline. Analysis used descriptive statistics to determine need for and use of outpatient mental health services across time. Logistic regression was used to examine predictors of use of outpatient mental health services in young adulthood. RESULTS: Almost half of the young adults in this sample had one or more indicators of mental health problems. There was a significant decrease in use of specialty mental health services from adolescence to young adulthood, declining from 47.6% at baseline, to 14.3% at the five- to six- year follow-up. Among young adults with mental health problems, less than a quarter used outpatient mental health services. Logistic regression results indicated that having mental health problems, having Medicaid, and being white were positively associated with use of outpatient mental health services in young adulthood. CONCLUSIONS: Mental health problems were prevalent among young adults who were suspected of being maltreated when they were adolescents, but only about a quarter of those in need used outpatient mental health services. Interventions to improve access to outpatient mental health services for this vulnerable population should particularly support outreach and engagement of young adults who are uninsured and from racial or ethnic minority groups with a history of involvement with the child welfare system in order to meet their unique developmental needs.

Developmental needs and individualized family service plans among infants and toddlers in the child welfare system.

This study examines levels of developmental need in young children investigated by child protective services, estimates early intervention service use, and examines need and service use variations during the 5-6 years after investigation on the basis of maltreatment substantiation status. Data were from the National Survey of Child and Adolescent Well-Being, the first nationally representative study of children investigated for maltreatment. The sample comprised 1,845 children aged 0 to 36 months at baseline. Logistic regression with covariate adjustment was used to examine the relationship between having an Individualized Family Service Plan (IFSP; a proxy and marker of early intervention services through Part C of the Individuals With Disabilities Education Act) and substantiation status. A high prevalence of developmental problems was found among children with substantiated cases and children with unsubstantiated cases. Few children with developmental needs had an IFSP. Substantiation status and level of child welfare system involvement were significantly associated with having an IFSP.

Intimate partner violence during pregnancy and mothers' child abuse potential.

This research examines whether women who have experienced intimate partner violence (IPV) during pregnancy have a higher child abuse potential than women who have not experienced IPV. Data were analyzed from a longitudinal investigation of IPV during pregnancy. This study recruited 88 pregnant women during prenatal care and followed them for 1(1/2) years. IPV was assessed using the Conflict Tactics Scale 2 (CTS2). The woman's potential for child abuse was assessed using the Child Abuse Potential Inventory (CAPI). There was a significant positive association between IPV and child abuse potential scores (p = .003), even after controlling for sociodemographics. The odds of having a high level of child abuse potential were 3 times greater for women who were victims of IPV compared to nonvictims. Higher child abuse potential scores of the victimized women resulted mainly from the Distress and Problems with Others CAPI scales.

Depression among female family planning patients: prevalence, risk factors, and use of mental health services.

BACKGROUND: Depression is a common, yet underdiagnosed mental health problem among women of reproductive age. Whereas risk factors and treatment of depression have been well studied among women of all ages, little attention has been paid to the prevalence of depression and clinical outcomes of clinical depressive symptoms among women who visit public family planning clinics. METHODS: A total of 588 female patients of three North Carolina health department family planning clinics were screened for their depressive symptoms. Women who screened positive for depressive symptoms during the initial assessment were referred for further mental health evaluation and treatment. Multivariate logistic regression was performed to examine risk factors of depressive symptoms, and a flow chart was used to demonstrate referral process and outcomes. RESULTS: Approximately half of the women in the study evidenced high levels of depressive symptoms that were consistent with having a clinically relevant mental health problem. Results from multivariate analysis found that being classified as currently depressed was significantly associated with previous treatment for depression (OR = 5.43), no social support (OR = 3.57), and unemployment (OR = 3.21). Caucasians were significantly more likely than African Americans to be depressed (OR = 2.63), and teenagers and women with low levels of education were more likely to evidence depression (OR = 1.99 and OR = 1.78, respectively). Few of the patients who were classified as depressed and were referred for further mental health evaluation followed through with the referrals. CONCLUSIONS: These findings underscore the importance of providing routine screening of women for depression within the context of family planning services and providing referrals, follow-up, and mental health treatment to those women in need.