Skip to main content
PMC home page
American Journal of Public Health logoLink to American Journal of Public Health
. 2001 Jul;91(7):1094–1099. doi: 10.2105/ajph.91.7.1094

Mental health services for youths in foster care and disabled youths.

S dosReis 1, J M Zito 1, D J Safer 1, K L Soeken 1
PMCID: PMC1446701  PMID: 11441737

Abstract

OBJECTIVES: This study assessed whether mental health services for youths differ with respect to medical assistance aid category. METHODS: Computerized claims for 15,507 youths with Medicaid insurance in a populous county of a mid-Atlantic state were used to establish population-based prevalence estimates of mental disorders and psychotherapeutic treatments during 1996. RESULTS: An analysis of service claims revealed that the prevalence of mental disorders among youths enrolled in foster care (57%) was twice that of youths receiving Supplemental Security Income (SSI; 26%) and nearly 15 times that of other youths receiving other types of aid (4%). Rates of mental health service use were pronounced among foster care youths aged 6 to 14 years. Attention deficit/hyperactivity disorder, depression, and developmental disorders were the most prevalent disorders. Stimulants, antidepressants, and anticonvulsants were the most prevalent medications. CONCLUSIONS: Youths enrolled in foster care and youths receiving SSI use far more mental health services than do youths in other aid categories. Additional research should evaluate the complexity and outcomes of mental health services for youths in foster care.

Full Text

The Full Text of this article is available as a PDF (86.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Achenbach T. M., Howell C. T. Are American children's problems getting worse? A 13-year comparison. J Am Acad Child Adolesc Psychiatry. 1993 Nov;32(6):1145–1154. doi: 10.1097/00004583-199311000-00006. [DOI] [PubMed] [Google Scholar]
  2. Bird H. R., Canino G., Rubio-Stipec M., Gould M. S., Ribera J., Sesman M., Woodbury M., Huertas-Goldman S., Pagan A., Sanchez-Lacay A. Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico. The use of combined measures. Arch Gen Psychiatry. 1988 Dec;45(12):1120–1126. doi: 10.1001/archpsyc.1988.01800360068010. [DOI] [PubMed] [Google Scholar]
  3. Blendon R. J., Aiken L. H., Freeman H. E., Corey C. R. Access to medical care for black and white Americans. A matter of continuing concern. JAMA. 1989 Jan 13;261(2):278–281. [PubMed] [Google Scholar]
  4. Bright R. A., Avorn J., Everitt D. E. Medicaid data as a resource for epidemiologic studies: strengths and limitations. J Clin Epidemiol. 1989;42(10):937–945. doi: 10.1016/0895-4356(89)90158-3. [DOI] [PubMed] [Google Scholar]
  5. Burns B. J., Costello E. J., Angold A., Tweed D., Stangl D., Farmer E. M., Erkanli A. Children's mental health service use across service sectors. Health Aff (Millwood) 1995 Fall;14(3):147–159. doi: 10.1377/hlthaff.14.3.147. [DOI] [PubMed] [Google Scholar]
  6. Cadman D., Boyle M., Szatmari P., Offord D. R. Chronic illness, disability, and mental and social well-being: findings of the Ontario Child Health Study. Pediatrics. 1987 May;79(5):805–813. [PubMed] [Google Scholar]
  7. Costello E. J., Angold A., Burns B. J., Stangl D. K., Tweed D. L., Erkanli A., Worthman C. M. The Great Smoky Mountains Study of Youth. Goals, design, methods, and the prevalence of DSM-III-R disorders. Arch Gen Psychiatry. 1996 Dec;53(12):1129–1136. doi: 10.1001/archpsyc.1996.01830120067012. [DOI] [PubMed] [Google Scholar]
  8. Fossett J. W., Perloff J. D., Kletke P. R., Peterson J. A. Medicaid and access to child health care in Chicago. J Health Polit Policy Law. 1992 Summer;17(2):273–298. doi: 10.1215/03616878-17-2-273. [DOI] [PubMed] [Google Scholar]
  9. Frank G. Treatment needs of children in foster care. Am J Orthopsychiatry. 1980 Apr;50(2):256–263. doi: 10.1111/j.1939-0025.1980.tb03288.x. [DOI] [PubMed] [Google Scholar]
  10. Geiger H. J. Race and health care--an American dilemma? N Engl J Med. 1996 Sep 12;335(11):815–816. doi: 10.1056/NEJM199609123351110. [DOI] [PubMed] [Google Scholar]
  11. Halfon N., Berkowitz G., Klee L. Children in foster care in California: an examination of Medicaid reimbursed health services utilization. Pediatrics. 1992 Jun;89(6 Pt 2):1230–1237. [PubMed] [Google Scholar]
  12. Halfon N., Berkowitz G., Klee L. Mental health service utilization by children in foster care in California. Pediatrics. 1992 Jun;89(6 Pt 2):1238–1244. [PubMed] [Google Scholar]
  13. Halfon N., Klee L. Health services for California's foster children: current practices and policy recommendations. Pediatrics. 1987 Aug;80(2):183–191. [PubMed] [Google Scholar]
  14. Hochstadt N. J., Jaudes P. K., Zimo D. A., Schachter J. The medical and psychosocial needs of children entering foster care. Child Abuse Negl. 1987;11(1):53–62. doi: 10.1016/0145-2134(87)90033-0. [DOI] [PubMed] [Google Scholar]
  15. Hughes D. C., Newacheck P. W., Stoddard J. J., Halfon N. Medicaid managed care: can it work for children? Pediatrics. 1995 Apr;95(4):591–594. [PubMed] [Google Scholar]
  16. Klee L., Halfon N. Mental health care for foster children in California. Child Abuse Negl. 1987;11(1):63–74. doi: 10.1016/0145-2134(87)90034-2. [DOI] [PubMed] [Google Scholar]
  17. Lawson W. B. Clinical issues in the pharmacotherapy of African-Americans. Psychopharmacol Bull. 1996;32(2):275–281. [PubMed] [Google Scholar]
  18. Leaf P. J., Alegria M., Cohen P., Goodman S. H., Horwitz S. M., Hoven C. W., Narrow W. E., Vaden-Kiernan M., Regier D. A. Mental health service use in the community and schools: results from the four-community MECA Study. Methods for the Epidemiology of Child and Adolescent Mental Disorders Study. J Am Acad Child Adolesc Psychiatry. 1996 Jul;35(7):889–897. doi: 10.1097/00004583-199607000-00014. [DOI] [PubMed] [Google Scholar]
  19. Newacheck P. W., Hughes D. C., Stoddard J. J. Children's access to primary care: differences by race, income, and insurance status. Pediatrics. 1996 Jan;97(1):26–32. [PubMed] [Google Scholar]
  20. Offord D. R., Boyle M. H., Szatmari P., Rae-Grant N. I., Links P. S., Cadman D. T., Byles J. A., Crawford J. W., Blum H. M., Byrne C. Ontario Child Health Study. II. Six-month prevalence of disorder and rates of service utilization. Arch Gen Psychiatry. 1987 Sep;44(9):832–836. doi: 10.1001/archpsyc.1987.01800210084013. [DOI] [PubMed] [Google Scholar]
  21. Parker S., Greer S., Zuckerman B. Double jeopardy: the impact of poverty on early child development. Pediatr Clin North Am. 1988 Dec;35(6):1227–1240. doi: 10.1016/s0031-3955(16)36580-4. [DOI] [PubMed] [Google Scholar]
  22. Perkins R. E., Moodley P. Perception of problems in psychiatric inpatients: denial, race and service usage. Soc Psychiatry Psychiatr Epidemiol. 1993 Aug;28(4):189–193. doi: 10.1007/BF00797322. [DOI] [PubMed] [Google Scholar]
  23. Perrin J. M., Kuhlthau K., McLaughlin T. J., Ettner S. L., Gortmaker S. L. Changing patterns of conditions among children receiving Supplemental Security Income disability benefits. Arch Pediatr Adolesc Med. 1999 Jan;153(1):80–84. doi: 10.1001/archpedi.153.1.80. [DOI] [PubMed] [Google Scholar]
  24. Prince J. B., Wilens T. E., Biederman J., Spencer T. J., Wozniak J. R. Clonidine for sleep disturbances associated with attention-deficit hyperactivity disorder: a systematic chart review of 62 cases. J Am Acad Child Adolesc Psychiatry. 1996 May;35(5):599–605. doi: 10.1097/00004583-199605000-00014. [DOI] [PubMed] [Google Scholar]
  25. Rabin D. L., Bush P. J., Fuller N. A. Drug prescription rates before and after enrollment of a Medicaid population in an HMO. Public Health Rep. 1978 Jan-Feb;93(1):16–23. [PMC free article] [PubMed] [Google Scholar]
  26. Rappley M. D., Gardiner J. C., Jetton J. R., Houang R. T. The use of methylphenidate in Michigan. Arch Pediatr Adolesc Med. 1995 Jun;149(6):675–679. doi: 10.1001/archpedi.1995.02170190085015. [DOI] [PubMed] [Google Scholar]
  27. Rosenbach M. L. The impact of Medicaid on physician use by low-income children. Am J Public Health. 1989 Sep;79(9):1220–1226. doi: 10.2105/ajph.79.9.1220. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Schor E. L. Foster care. Pediatr Clin North Am. 1988 Dec;35(6):1241–1252. doi: 10.1016/s0031-3955(16)36581-6. [DOI] [PubMed] [Google Scholar]
  29. Schor E. L. The foster care system and health status of foster children. Pediatrics. 1982 May;69(5):521–528. [PubMed] [Google Scholar]
  30. Simms M. D. The foster care clinic: a community program to identify treatment needs of children in foster care. J Dev Behav Pediatr. 1989 Jun;10(3):121–128. [PubMed] [Google Scholar]
  31. Smyth-Staruch K., Breslau N., Weitzman M., Gortmaker S. Use of health services by chronically ill and disabled children. Med Care. 1984 Apr;22(4):310–328. doi: 10.1097/00005650-198404000-00003. [DOI] [PubMed] [Google Scholar]
  32. Starfield B. Family income, ill health, and medical care of U.S. children. J Public Health Policy. 1982 Sep;3(3):244–259. [PubMed] [Google Scholar]
  33. Starfield B., Gross E., Wood M., Pantell R., Allen C., Gordon I. B., Moffatt P., Drachman R., Katz H. Psychosocial and psychosomatic diagnoses in primary care of children. Pediatrics. 1980 Aug;66(2):159–167. [PubMed] [Google Scholar]
  34. Stein E., Rae-Grant N., Ackland S., Avison W. Psychiatric disorders of children "in care": methodology and demographic correlates. Can J Psychiatry. 1994 Aug;39(6):341–347. doi: 10.1177/070674379403900605. [DOI] [PubMed] [Google Scholar]
  35. Swire M. R., Kavaler F. The health status of foster children. Child Welfare. 1977 Dec;56(10):635–653. [PubMed] [Google Scholar]
  36. Takayama J. I., Bergman A. B., Connell F. A. Children in foster care in the state of Washington. Health care utilization and expenditures. JAMA. 1994 Jun 15;271(23):1850–1855. [PubMed] [Google Scholar]
  37. Takayama J. I., Wolfe E., Coulter K. P. Relationship between reason for placement and medical findings among children in foster care. Pediatrics. 1998 Feb;101(2):201–207. doi: 10.1542/peds.101.2.201. [DOI] [PubMed] [Google Scholar]
  38. Wise P. H., Meyers A. Poverty and child health. Pediatr Clin North Am. 1988 Dec;35(6):1169–1186. doi: 10.1016/s0031-3955(16)36577-4. [DOI] [PubMed] [Google Scholar]
  39. Zito J. M., Safer D. J., Riddle M. A., Johnson R. E., Speedie S. M., Fox M. Prevalence variations in psychotropic treatment of children. J Child Adolesc Psychopharmacol. 1998;8(2):99–105. doi: 10.1089/cap.1998.8.99. [DOI] [PubMed] [Google Scholar]
  40. Zito J. M., Safer D. J., dosReis S., Gardner J. F., Boles M., Lynch F. Trends in the prescribing of psychotropic medications to preschoolers. JAMA. 2000 Feb 23;283(8):1025–1030. doi: 10.1001/jama.283.8.1025. [DOI] [PubMed] [Google Scholar]
  41. Zito J. M., Safer D. J., dosReis S., Magder L. S., Gardner J. F., Zarin D. A. Psychotherapeutic medication patterns for youths with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med. 1999 Dec;153(12):1257–1263. doi: 10.1001/archpedi.153.12.1257. [DOI] [PubMed] [Google Scholar]
  42. Zito J. M., Safer D. J., dosReis S., Magder L. S., Riddle M. A. Methylphenidate patterns among Medicaid youths. Psychopharmacol Bull. 1997;33(1):143–147. [PubMed] [Google Scholar]
  43. Zito J. M., Safer D. J., dosReis S., Riddle M. A. Racial disparity in psychotropic medications prescribed for youths with Medicaid insurance in Maryland. J Am Acad Child Adolesc Psychiatry. 1998 Feb;37(2):179–184. doi: 10.1097/00004583-199802000-00010. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES