Skip to main content

Advertisement

SpringerLink
Log in

Admission to Psychiatric Residential Treatment Facilities among Youth from Families Investigated for Maltreatment

  • Original Paper
  • Published:
Journal of Child and Family Studies Aims and scope Submit manuscript

Abstract

This study uses large, longitudinal, multisector administrative datasets of families investigated by child welfare services for maltreatment to explore which children are more likely to later enter psychiatric residential treatment facilities. This question is grounded in a pressing interest to understand these costly, highly restrictive mental health treatment settings. We use statewide data from one Southeastern state linked from multiple systems (child welfare services, income maintenance, and Medicaid). We use Cox regression analyses to develop models predicting psychiatric residential treatment facilities entry among children 5–17 years, whose families were investigated for maltreatment between 2003 and 2012 (n = 182,676). Findings show children from these families who enter foster care have a heightened risk for psychiatric residential treatment facilities entry (hazard ratio = 11.63), after controlling for other factors. Study findings build on a body of research underscoring the importance of the overlap of child welfare and mental health systems to child well-being.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Akin, B. A., Brook, J., & Lloyd, M. H. (2015). Co-occurrence of parental substance abuse and child serious emotional disturbance: understanding multiple pathways to improve child and family outcomes. Child Welfare, 94(3), 71–96.

    Google Scholar 

  • Akin, B. A., Bryson, S. A., McDonald, T. P., & Walker, S. (2012). Defining a target population at high risk of long-term foster care: Barriers to permanency for families of children with serious emotional disturbances. Child Welfare, 91(6), 79–101.

    PubMed  Google Scholar 

  • Americans with Disabilities Act of 1990 (1991). Pub. L. No. 101-336, 771 § 2, 104 Stat. 328.

  • Brauner, C. B., & Stephens, C. B. (2006). Estimating the prevalence of early childhood serious emotional/behavioral disorders: challenges and recommendations. Public Health Reports, 121(3), 303–310.

    PubMed  PubMed Central  Google Scholar 

  • Brown, J., Natzke, B., Ireys, H., Gillingham, M., & Hamilton, M. (2010). State variation in out-of-home medicaid mental health services for children and children: an examination of residential treatment and inpatient hospital services. Administration and Policy in Mental Health and Mental Health Services Research, 37, 318–326. doi:10.1007/s10488-009-0235-x.

    Article  PubMed  Google Scholar 

  • Bruton, J., Blackmon, A., Wiford, C., Burns, B., & Maultsby, L. (2012). Evaluation of psychiatric residential treatment facility use by North Carolina children for fiscal years 2009–2011. Retrieved from the Services Effectiveness Research Program. http://serp.mc.duke.edu/PDF/PRTF_Evaluation_Report.pdf. Accessed 17 Feb 2016.

  • Burns, B. J., Phillips, S. D., Wagner, H. R., Barth, R. P., Kolko, D. J., Campbell, Y., & Landsverk, J. (2004). Mental health need and access to mental health services by children involved with child welfare: a national survey. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 960–970. doi:10.1097/01.chi.0000127590.95585.65.

    Article  Google Scholar 

  • Coalition for Evidence-Based Policy. (2012). Rigorous program evaluations on a budget: How low-cost randomized controlled trials are possible in many areas of social policy. Washington, DC: Coalition for Evidence-Based Policy.

    Google Scholar 

  • Coulton, C. J., Goerge, R., Putnam-Hornstein, E., & de Haan, B. (2015). Harnessing big data for social good: A grand challenge for social work (Working Paper No. 11). American Academy of Social Work and Social Welfare. http://aaswsw.org/wp-content/uploads/2015/07/Big-Data-GC-edited-and-formatted-for-committee-review-7-17-20151.pdf. Accessed 17 Feb 2016.

  • Cox, D. R. (1972). Regression models and life tables (with discussion). Journal of the Royal Statistical Society, 34(2), 187–220.

    Google Scholar 

  • DeBellis, M. (2001). Developmental traumatology: The psychobiological development of maltreated children and its implications for research, treatment, and policy. Development and Psychopathology, 13, 539–564. doi:10.1017/S0954579401003078.

    Article  Google Scholar 

  • dosReis, S., Zito, J. M., Safer, D. J., & Soeken, K. (2001). Mental health services for youths in foster care and disabled youths. American Journal of Public Health, 91, 1094–1099. doi:10.2105/AJPH.91.7.1094.

    Article  PubMed  PubMed Central  Google Scholar 

  • Drake, B., Jonson-Reid, M., & Sapokaite, L. (2006). Re-reporting of child maltreatment: Does participation in other public sector services moderate the likelihood of a second maltreatment report?. Child Abuse & Neglect, 30, 1201–1226. doi:10.1016/j.chiabu.2006.05.008.

    Article  Google Scholar 

  • Farmer, E. M. Z., Wagner, H. R., Burns, B. J., & Richards, J. T. (2003). Treatment foster care in a system of care: Sequences and correlates of residential placements. Journal of Child and Family Studies, 12, 11–25. doi:10.1023/A:1021349907744.

    Article  Google Scholar 

  • Fraser, M. E., & Lanier, P. (2016). Child mental health policy: Promise without fulfillment? In J. Jenson & M. W. Fraser (Eds.), Social policy for children and families (3rd edn., pp. 125–166). Thousand Oaks, CA: Sage.

  • Garland, A. F., Hough, R. L., McCabe, K. M., Yeh, M. A. Y., Wood, P. A., & Aarons, G. A. (2001). Prevalence of psychiatric disorders in youths across five sectors of care. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 409–418. doi:10.1097/00004583-200104000-00009.

    Article  Google Scholar 

  • Guo, S. (2009). Survival analysis. New York; Oxford: Oxford University Press. doi:10.1093/acprof:oso/9780195337518.001.0001.

  • Halfon, N., Berkowitz, G., & Klee, L. (1992). Mental health service utilization by children in foster care in California. Pediatrics, 89, 1238–1244.

    PubMed  Google Scholar 

  • Harman, J. S., Childs, G. E., & Kelleher, K. J. (2000). Mental health care utilization and expenditures by children in foster care. Archives of Pediatrics & Adolescent Medicine, 154, 1114–1117. doi:10.1001/archpedi.154.11.1114.

    Article  Google Scholar 

  • Heneghan, A., Stein, R. E., Hurlburt, M. S., Zhang, J., Rolls-Reutz, J., Fisher, E., & Horwitz, S. M. (2013). Mental health problems in teens investigated by US child welfare agencies. Journal of Adolescent Health, 52(5), 634–640. doi:10.1016/j.jadohealth.2012.10.269.

    Article  PubMed  Google Scholar 

  • Hook, J. L., Romich, J. L., Lee, J. S., Marcenko, M. O., & Kang, J. Y. (2016). Trajectories of economic disconnection among families in the child welfare system. Social Problems, 63, 161–179. doi:10.1093/socpro/spw006.

  • Horwitz, S. M., Hurlburt, M. S., Goldhaber-Fiebert, J. D., Heneghan, A. M., Zhang, J., Rolls-Reutz, J., & Stein, R. E. (2012a). Mental health services use by children investigated by child welfare agencies. Pediatrics, 130, 861–869. doi:10.1542/peds.2012-1330.

    Article  PubMed  PubMed Central  Google Scholar 

  • Horwitz, S. M., Hurlburt, M. S., Heneghan, A., Zhang, J., Rolls-Reutz, J., Fisher, E., & Stein, R. E. (2012b). Mental health problems in young children investigated by U.S.child welfare agencies. Journal of the American Academy of Child & Adolescent Psychiatry, 51, 572–581. doi:10.1016/j.jaac.2012.03.006.

    Article  Google Scholar 

  • Hurlburt, M. S., Leslie, L. K., Landsverk, J., Barth, R. P., Burns, B. J., Gibbons, R. D., & Zhang, J. (2004). Contextual predictors of mental health service use among children open to child welfare. Archives of General Psychiatry, 61, 1217–1224. doi:10.1001/archpsyc.61.12.1217.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hussey, D. L., & Guo, S. (2005). Forecasting length of stay in child residential treatment. Child Psychiatry and Human Development, 36(1), 95–111. doi:10.1007/s10578-004-3490-9.

    Article  PubMed  Google Scholar 

  • James, S., Landsverk, J., Leslie, L., Slymen, D., & Zhang, J. (2008). Entry into restrictive care settings: Placements of last resort? Families in Society, 89, 348–359. doi:10.1606/1044-3894.3760.

    Article  Google Scholar 

  • James, S., Roesch, S., & Zhang, J. J. (2012). Characteristics and behavioral outcomes for children in group care and family-based care: a propensity score matching approach using national data. Journal of Emotional and Behavioral Disorders, 20, 144–156. doi:10.1177/1063426611409041.

    Article  Google Scholar 

  • Kerker, B. D., & Dore, M. M. (2006). Mental health needs and treatment of foster youth: Barriers and opportunities. American Journal of Orthopsychiatry, 76, 138–147. doi:10.1037/0002-9432.76.1.138.

    Article  PubMed  Google Scholar 

  • Ko, S. J., Ford, J. D., Kassam-Adams, N., Berkowitz, S. J., Wilson, C., Wong, M., & Layne, C. M. (2008). Creating trauma-informed systems: child welfare, education, first responders, health care, juvenile justice. Professional Psychology: Research and Practice, 39, 396–404. doi:10.1037/0735-7028.39.4.396.

    Article  Google Scholar 

  • Kohl, P. L., Jonson-Reid, M., & Drake, B. (2009). Time to leave substantiation behind findings from a national probability study. Child Maltreatment, 14(1), 17–26. doi:10.1177/1077559508326030.

    Article  PubMed  Google Scholar 

  • Leslie, L. K., Hurlburt, M. S., James, S., Landsverk, J., Slymen, D. J., & Zhang, J. (2014). Relationship between entry into child welfare and mental health service use. Psychiatric Services, 56, 981–987. doi:10.1176/appi.ps.56.8.981.

    Article  Google Scholar 

  • Li, F., Green, J. G., Kessler, R. C., & Zaslavsky, A. M. (2010). Estimating prevalence of serious emotional disturbance in schools using a brief screening scale. International Journal of Methods in Psychiatric Research, 19(S1), 88–98. doi:10.1002/mpr.315.

    Article  PubMed  PubMed Central  Google Scholar 

  • Merikangas, K. R., He, J., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Study-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49, 980–989. doi:10.1016/j.jaac.2010.05.017.

    Article  PubMed  PubMed Central  Google Scholar 

  • Olmstead vs. L. C. (1999) (98-536) 527 U.S. 581.

  • Oswald, S. H., Heil, K., & Goldbeck, L. (2010). History of maltreatment and mental health problems in foster children: A review of the literature. Journal of Pediatric Psychology, 35, 462–472. doi:10.1093/jpepsy/jsp114.

    Article  PubMed  Google Scholar 

  • Park, J. M., Jordan, N., Epstein, R., Mandell, D. S., & Lyons, J. S. (2009). Predictors of residential placement following a psychiatric crisis episode among children and children in state custody. American Journal of Orthopsychiatry, 79, 228–235. doi:10.1037/a0015939.

    Article  PubMed  Google Scholar 

  • Pecora, P., & English, D. (2016). Elements of effective practice for children and youth served by therapeutic residential care (Casey Family Programs Research Brief). http://www.casey.org/media/Group-Care-complete.pdf. Accessed 17 Feb 2016.

  • President’s New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health in America. Final report (Pub. No. SMA03-3831). Retrieved from http://store.samhsa.gov/shin/content//SMA03-3831/SMA03-3831.pdf. Accessed 17 Feb 2016.

  • Pumariega, A. J. (2007). Residential treatment for children and youth: time for reconsideration and reform. American Journal of Orthopsychiatry, 77, 343–345. doi:10.1037/0002-9432.77.3.343.

    Article  PubMed  Google Scholar 

  • Raghavan, R., Brown, D. S., Allaire, B. T., Garfield, L. D., & Ross, R. E. (2014). Medicaid expenditures on psychotropic medications for maltreated children: a study of 36 states. Psychiatric Services, 65, 1445–1451. doi:10.1176/appi.ps.201400028.

    Article  PubMed  PubMed Central  Google Scholar 

  • Robst, J., Armstrong, M., Dollard, N., Rohrer, L., Sharrock, P., Batsche, C., & Reader, S. (2013). Characteristics related to family involvement in youth residential mental health treatment. Children and Youth Services Review, 35(1), 40–46. doi:10.1016/j.childyouth.2012.10.004.

    Article  Google Scholar 

  • Rubin, D. M., O’Reilly, A. L., Luan, X., & Localio, A. R. (2007). The impact of placement stability on behavioral well-being for children in foster care. Pediatrics, 119, 336–344. doi:10.1542/peds.2006-1995.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shonkoff, J. P., Garner, A. S., Siegel, B. S., Dobbins, M. I., Earls, M. F., McGuinn, L., & Wood, D. L. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246.

    Article  PubMed  Google Scholar 

  • Szilagyi, M. A., Rosen, D. S., Rubin, D., Zlotnik, S., Harmon, D., Jaudes, P., & Sagor, L. (2015). Health care issues for children and adolescents in foster care and kinship care. Pediatrics, 136(4), e1142–e1166.

    Article  PubMed  Google Scholar 

  • Takayama, J. I., Bergman, A. B., & Connell, F. A. (1994). Children in foster care in the State of Washington: health care utilization and expenditures. Journal of the American Medical Association, 271, 1850–1855. doi:10.1001/jama.1994.03510470054034.

    Article  PubMed  Google Scholar 

  • Urdapilleta, O., Kim, G., Wang, Y., Howard, J., Varghese, R., Waterman, G., … Palmisano, C. (2012). National evaluation of the Medicaid demonstration waiver home- and community-based alternatives to psychiatric residential treatment facilities: Final report. Columbia, MD: IMPAQ International.

  • U.S. Department of Health & Human Services, Office of the Secretary. (2013). Report to the President and Congress, Medicaid home and community-based alternatives to psychiatric residential treatment facilities demonstration. https://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/institutional-care/downloads/prtf-demo-report.pdf. Accessed 17 Feb 2016.

  • U.S. Department of Health & Human Services, Children’s Bureau. (2015). The AFCARS Report, Preliminary FY 2014 estimates as of July 2015, No. 22. http://www.acf.hhs.gov/sites/default/files/cb/afcarsreport22.pdf. Accessed 17 Feb 2016.

  • U.S. Department of Health & Human Services, Children’s Bureau. (2016). Child maltreatment 2014. http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment. Accessed 17 Feb 2016.

  • U.S. General Accounting Office. (2003). Federal agencies could play a stronger role in helping states reduce the number of children placed solely to obtain mental health services (Publication No. GAO-03-397). http://www.gao.gov/new.items/d03397.pdf. Accessed 17 Feb 2016.

  • Whitted, K. S., Delavega, E., & Lennon-Dearing, R. (2013). The youngest victims of violence: Examining the mental health needs of young children who are involved in the child welfare and juvenile justice systems. Child and Adolescent Social Work Journal, 30(3), 181–195.

    Article  Google Scholar 

  • Yang, M. Y. (2015). The effect of material hardship on child protective service involvement. Child Abuse & Neglect, 41, 113–125. doi:10.1016/j.chiabu.2014.05.009.

    Article  Google Scholar 

  • Zelechoski, A. D., Sharma, R., Beserra, K., Miguel, J. L., DeMarco, M., & Spinazzola, J. (2013). Traumatized youth in residential treatment settings: Prevalence, clinical presentation, treatment, and policy implications. Journal of Family Violence, 28, 639–665. doi:10.1007/s10896-013-9534-9.

    Article  Google Scholar 

Download references

Acknowledgments

The authors wish to acknowledge The Duke Endowment for their generous funding and our partners at the Jordan Institute for Families who supported this work.

Author information

Authors and Affiliations

  1. School of Social Work, University of North Carolina at Chapel Hill, UNC-Chapel Hill, 325 Pittsboro Street, Chapel Hill, NC, 27599-3550, USA

    Paul Lanier & Roderick A. Rose

Authors
  1. Paul Lanier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roderick A. Rose
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Lanier.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lanier, P., Rose, R.A. Admission to Psychiatric Residential Treatment Facilities among Youth from Families Investigated for Maltreatment. J Child Fam Stud 26, 306–316 (2017). https://doi.org/10.1007/s10826-016-0541-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10826-016-0541-3

Keywords

Search

Navigation