Homelessness, foster care entry, and mental health services use for children

This study examined whether children who become homeless differ from other low-income children in their mental health service use before and after their first homeless episode, and to what extent homelessness is associated with the likelihood of mental health service use.

This longitudinal study followed 162,810 Medicaid-enrolled children with and without history of homelessness to observe their mental health service use. Logistic regression was conducted to assess the association of homelessness, foster care placement, and other covariates with inpatient and outpatient mental health services use.

Overall, 4.7% of the homeless group received inpatient mental health services during the observation period, compared with 3.0% of the non-homeless group. Approximately 25% of homeless children used outpatient services, compared with 18% of non-homeless children. There were substantial independent associations of mental health use with homelessness (OR=1.9 for inpatient; OR=1.4 for ambulatory) and with foster care (OR=5.6 for inpatient; OR=7.4 for ambulatory).

Sheltered homelessness can function as a gateway to mental health services for children who present the need for such. Foster care placement appeared to be a primary conduit to mental health services for children in shelters. Foster care history played a substantial role in increasing the likelihood of both inpatient and ambulatory mental health service use, independent of homeless experiences. Findings underscore the importance of collaborations between homeless assistance, foster care, and mental healthcare to mitigate family homelessness and collateral needs among homeless children.