Lost in Transition: Illicit Substance Use and Services Receipt Among At-Risk Youth in the Child Welfare System

This study examined the use of mental health and substance abuse services among adolescents followed from 1999 to 2007 as part of the National Survey of Child and Adolescent Well-Being (NSCAW). NSCAW is a nationally representative, longitudinal study of the well-being of children who have had contact with the child welfare system (CWS). 1,004 adolescents age 11-15 years at baseline were followed for 5-7 years, over five waves of data collection. After the investigation for maltreatment (baseline), 69.1% of youths using illicit substances received mental health and/or substance abuse outpatient s services. By the last follow-up, during the transition to adulthood, only 21.5% of young adults using illicit substances received outpatient specialty services. Youth who used illicit substances were more likely to receive outpatient and inpatient specialty services than non-users at the time of contact with the CWS (mostly baseline), but this difference faded over the follow-up period. By 5-7 years follow-up, there was no significant difference in specialty services receipt for illicit substances users versus non-users. Predictors of outpatient service use were having Medicaid, mental health needs, and having recently seen a school counselor or primary care physician. Among illicit substance users transitioning to adulthood, African American youths were less likely to receive outpatient services than White youths. These findings reveal a need for more attention to illicit substances use among youth in the CWS, better cross agency integration, and special attention to the needs of transition-age youth to better connect them with services.