Inpatient mental health treatment and subsequent child welfare outcomes

Despite a high prevalence of mental disorders among children involved with public child welfare system, little information is available about the role of preexisting mental health conditions on outcomes in foster care. This cohort study followed children and adolescents in child welfare placements to examine whether placement and permanence outcomes differ between children with and without a history of inpatient mental health treatment.

The sample included 5,978 children and adolescents in their first child welfare placement between 1998 and 2001. Data were based on child welfare records and Medicaid files from the state of Illinois. Children with history of an inpatient mental health treatment were more likely to be white, to be placed in a residential care setting, and to run away from placement. There were significant racial and ethnic interactions with regard to placement instability and permanence. For white youth, inpatient mental health treatment prior to foster care increased the risk for placement instability. For African American youth, inpatient mental health treatment prior to foster care significantly decreased the likelihood of achieving permanence.

These findings suggest that children in foster care with history of inpatient mental health treatment may benefit from integration between mental health and child welfare systems and continued follow-up. Considerable public costs are associated with long term foster care placements. This is especially true for therapeutic and residential care settings. Collaborations between mental health and child welfare systems can reduce placement disruptions, decrease the need for secure placement settings, and increase the likelihood of achieving permanence.