Newswise — Each year, more than 600,000 children seen in the U.S. child welfare system for alleged maltreatment do not receive mental health care for significant emotional and behavioral problems, reports a study in the August Journal of the American Academy of Child & Adolescent Psychiatry. The findings are based on NIMH-funded analyses of the National Survey of Child and Adolescent Well-Being, a nationally representative study funded by the US DHHS's Administration on Children and Families.

"Routine screening for mental health needs and increasing access to mental health professionals for further evaluation and treatment should be a priority for children early in their contact with the child welfare system," concludes a research team led by Barbara J. Burns, Ph.D., of Duke University School of Medicine, Durham, N.C.

Dr. Burns and colleagues analyzed nationwide data on children and adolescents investigated by child welfare agencies for reported abuse or neglect. A standard child behavior checklist suggested that 48 percent of the children had "clinically significant" emotional or behavioral problems.

However, only one-fourth of these children in need received specialized mental health care, such as evaluation by a child and adolescent psychiatrist or other mental health professional. Mental health services were received by just 16 percent of maltreated children overall. For those not scoring in the "significant" range on the checklist, the rate was just four percent.

Children with certain characteristics were more likely to receive mental health services: for example, preschool-aged victims of sexual abuse or children with a severely mentally ill parent.

However, other groups were less likely to receive mental health services, including African-American children. Children who were not placed in foster care were also less likely to receive services. This was a particular concern, since 90 percent of the victims of alleged maltreatment continued living in their parents' home.

Similarly, 64 percent of the children were evaluated for neglect rather than abuse. Yet these children accounted for only 13 percent of those receiving mental health services.

Based on U.S. government estimates of 1.7 million maltreated children and adolescents per year, the findings suggest that just 200,000 of 800,000 children in need actually receive mental health services. This leaves more than 600,000 children per year with "unmet mental health needs," Dr. Burns and colleagues conclude.

Abused and neglected children are at high risk of emotional and behavioral problems. Previous studies of mental health care for children served by child welfare agencies have emphasized those placed in foster care. The new study is one of the first to focus on the larger group of children who remain at home or live with relatives after reported maltreatment.

The results show that about half of youngsters in the child welfare system have significant emotional or behavior problems, and that three-fourths of these do not receive needed mental health services. Certain groups seem at especially high risk of not receiving services, including children who remain at home and those who are victims of alleged neglect.

Dr. Burns and colleagues call for further study to identify barriers to mental health care for matreated children. One likely contributor is the lack of adequate resources, including child and adolescent psychiatrists and other well-trained mental health professionals. The researchers call for a "true partnership" between child mental health and child welfare services to ensure adequate mental health assessment and intervention for maltreated children.

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Journal of the American Academy of Child & Adolescent Psychiatry, Aug-2004 (Aug-2004)