title: For Better or Worse? Change in Service Use by Children Investigated by Child Welfare Over a Decade.
abstract: BACKGROUND
  Children, particularly minority children, referred to child welfare because of suspected maltreatment are vulnerable and need many services. We sought to assess whether service use has improved over the past decade and whether racial-ethnic disparities in service use have decreased.
  
  
  METHODS
  We used 2 national data sets (the National Survey of Child and Adolescent Well-Being [NSCAW] I and II) collected a decade apart to assess changes over time in health, education, mental health (MH), and dental services and overall service use.
  
  
  RESULTS
  In NSCAW II more children were young, had lower Child Behavior Checklist (CBCL) scores, and were Hispanic. We found significant increases in dental services, a decrease in special education services, and a decrease in MH services on the bivariate level (all P < .01). A large proportion of the change in MH services occurred in school settings, but the pattern continued when examining only those services delivered outside of school. The greatest decrease occurred for children with CBCL scores <64. However, in multivariate analyses, older children, white non-Hispanic children, and children placed out of the home were significantly more likely to receive MH services. Rates of MH services controlling for CBCL scores showed no improvement over the decade, nor was there a decrease in racial and ethnic disparities.
  
  
  CONCLUSIONS
  These data showed no change in MH services over time for children referred for child welfare evaluation, but improvement in dental services was noted. Racial and ethnic disparities persist. Decrease in MH services occurred predominantly among children whose MH symptoms were below the clinical range.
authors: Albert Einstein College of Medicine/Children's Hospital at Montefiore, New York, NY. Electronic address: ruth.stein@einstein.yu.edu.
authors: Ruth E K
authors: RE
authors: Stein
authors: School of Social Work, University of Southern California, Los Angeles, Calif; Child and Adolescent Services Research Center, Rady Children's Hospital, San Diego, Calif.
authors: Michael S
authors: MS
authors: Hurlburt
authors: Palo Alto Medical Foundation, Palo Alto, Calif; Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors: Amy M
authors: AM
authors: Heneghan
authors: Child and Adolescent Services Research Center, Rady Children's Hospital, San Diego, Calif.
authors: Jinjin
authors: J
authors: Zhang
authors: Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY.
authors: Bonnie
authors: B
authors: Kerker
authors: Child and Adolescent Services Research Center, Rady Children's Hospital, San Diego, Calif.
authors: John
authors: J
authors: Landsverk
authors: Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY.
authors: Sarah McCue
authors: SM
authors: Horwitz
mesh_terms: D000293:Adolescent; D001741:Black or African American; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data*; D002662:Child Health Services / Q000706:statistics & numerical data*; D000068216:Child Protective Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D016208:Databases, Factual; D003752:Dental Health Services / Q000706:statistics & numerical data*; D004519:Education, Special / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D014481:United States; D044465:White People
keywords: NSCAW; child welfare; dental services; disparities; health; mental health; special education