Tracing the pathway from mental health screening to services for children and youth in foster care

Purpose: Children and youth in out-of-home care have high rates of behavioral health need, and states are increasingly adopting screening protocols to identify and intervene with these youth. This study presents longitudinal analyses of the case flow of youth aged 3-17 in Washington State's foster care system, tracking rates of screening, scoring above or below clinical criteria cutoff scores, and service receipt. This study describes what variables are associated with these three decision points. Results: Eighty-nine percent of eligible youth were screened for behavioral health need soon after entry in to out of-home care; most of those who were not screened were already receiving behavioral health services. Sixty-one percent scored above criteria on at least one screening measure by at least one respondent. Sixty percent of those who scored above criteria and 33% of those who scored below criteria received at least one behavioral health service within 4 months of entry to care. After controlling for all variables, screening above criteria was related to age, race/ethnicity, county rurality, abuse type, reason for out-of-home placement, past behavioral health service receipt, and type of past diagnosis. Service receipt for those scoring above criteria was related to age, race/ethnicity, county rurality, abuse type, and type of prior behavioral health diagnosis. Conclusions: The role of screening in child welfare is dynamic and influenced by multiple factors. In the current study, youth screening above criteria was related to increased rates of service receipt. However, many children with behavioral health service needs did not receive services. The relatively high rates of youth scoring below criteria but receiving services may indicate a need for ongoing systematic screening in order to identify emergent needs, or additional screening measures at intake. States considering or employing the use of screening tools should weigh a variety of approaches to screening, assessment, and referral to services in order to ensure maximal benefit.