title: Use of mental health services among older youths in foster care.
abstract: OBJECTIVE
  This study examined lifetime, 12-month, and current mental health service use among older youths in the foster care system and examined variations in mental health care by race, gender, maltreatment history, living situation, and geographic region.
  
  
  METHODS
  The Service Assessment for Children and Adolescents, the Child Trauma Questionnaire, and the Diagnostic Interview Schedule were used in interviews with 406 youths in Missouri's foster care system who were aged 17 years.
  
  
  RESULTS
  Ninety-four percent of the youths had used a mental health service in their lifetime, 83 percent used a mental health service in the past year, and 66 percent were currently receiving a mental health service. Lifetime rates for inpatient psychiatric care (42 percent) and other residential programs (77 percent) were exceptionally high. A quarter of the youths received mental health services before they entered the foster care system. Among youths who received residential services, half did not receive community-based services before receiving residential services. After the analyses controlled for need, predisposing characteristics, and enabling characteristics, youths of color were less likely to receive outpatient therapy, psychotherapeutic medications, and inpatient services, and they were more likely to receive residential services. Youths who had been neglected and youths in kinship care were less likely to receive some types of services. Geographic differences in service use were common and sometimes mediated the effect of race on service use.
  
  
  CONCLUSIONS
  The child welfare system was actively engaged in arranging mental health services for youths in the foster care system, but the system was unable to maintain many youths in less restrictive living situations. The variations by race and geography indirectly indicate quality concerns.
authors.affiliation: Department of Social Work at Washington University, Campus Box 1196, Saint Louis, MO 63130, USA. cmcmille@wustl.edu
authors.forename: J Curtis
authors.initials: JC
authors.lastname: McMillen
authors.forename: Lionel D
authors.initials: LD
authors.lastname: Scott
authors.forename: Bonnie T
authors.initials: BT
authors.lastname: Zima
authors.forename: Marcia T
authors.initials: MT
authors.lastname: Ollie
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Munson
authors.forename: Edward
authors.initials: E
authors.lastname: Spitznagel
mesh_terms: D000293:Adolescent; D000328:Adult; D019090:Case Management; D002648:Child; D003156:Community Mental Health Services / Q000592:standards / Q000706:statistics & numerical data*; D003710:Demography; D005260:Female; D005581:Foster Home Care / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires