A California Health Interview Survey (CHIS) study of children's mental health services

BACKGROUND: There are a limited number of population-based studies of mental health treatment among children. OBJECTIVE: To conduct an epidemiological study of factors associated with children's receipt of mental health services in the prior year (yes/no), using the largest state-level survey in the United States. METHOD: A Behavioral Model approach examining a number of predisposing, enabling, and need measures was used with 2007 Children's California Health Interview Survey data. RESULTS: An estimated 252,399 (6.8%) of 3,729,786 California children ages 5 to 11 received at least one mental health service in the prior year. Bivariate analysis revealed significant associations with age, race (Asian), household size, birthplace of child and parents, age of parents, usual source of care, insurance, doing poorly in school, and mental health variables. In the multivariable logistic regression analysis, of predisposing and enabling variables, only age (odds ratio [OR] = 1.1) and Asian race (OR = 0.4) were associated with a visit. More important were a diagnosis of attention deficit disorder / attention deficit hyperactivity disorder (OR = 3.0), mental health development categories of borderline or abnormal (ORs = 2.0 and 3.7, respectively), and emotional difficulties labeled minor, definite, or severe (ORs = 3.4, 5.8, and 4.4, respectively). DISCUSSION: 2007 population-based data in California suggests that physician diagnosis and parental evaluation of mental and emotional health largely explain which children receive mental health service. After adjusting for need, traditional predisposing and enabling measures are not statistically significant. Asian children, however, are at risk of not receiving such services.