The journal of mental health administration

, Volume 23, Issue 4, pp 389–405

Use of the public mental health system by children in foster care: Client characteristics and service use patterns

  • Elaine Blumberg
  • John Landsverk
  • Elissa Ellis-MacLeod
  • William Ganger
  • Shirley Culver


This study examined client crossover from the social services (DSS) to the mental health (SDMHS) system in San Diego County. Public mental health service use was examined in 1,352 subjects participating in a longitudinal study of children in foster care. Overall, 17.4% (n=235) of the children in DSS were also served in SDMHS. Children in DSS who also received services from SDMHS (multiple-system youth) were compared with children only served in DSS (single-system youth). Multiple-system youth were significantly older and had different removal and placement histories than single-system youth. Within multiple-system youth, analyses compared demographic and diagnostic data of subgroups defined by the number of episodes and/or the levels of mental health care received. These analyses revealed that a small group of multiple-system youth (16.6%) were the most severely disturbed and received the most services. Methodological issues related to tracking clients across service sectors are discussed.


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  1. 1.
    Schuh RG, Leviton L: Evaluating referral and agency coordination with a computerized client-tracking system.Evaluation Review 1991; 15(5):533–554.Google Scholar
  2. 2.
    Stroul B, Friedman RM:A System of Care for Severely Emotionally Disturbed Children & Youth. Washington, DC: CASSP Technical Assistance Center, Georgetown University Child Development Center, 1986.Google Scholar
  3. 3.
    Behar LB: A model for child mental health services: The North Carolina experience.Children Today 1986; 15(3):16–22.PubMedGoogle Scholar
  4. 4.
    Behar LB, Kayye PT: The Public Sector's Responsibility in Serving Chronically Disturbed Children and Adolescents. Paper presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry, Washington, DC, October, 1987.Google Scholar
  5. 5.
    Behar LB, Macbeth G, Holland JM: Distribution and costs of mental health services within a system of care for children and adolescents.Administration and Policy in Mental Health 1993; 20(4):283–294.CrossRefGoogle Scholar
  6. 6.
    Burchard JD, Clarke RT: The role of individualized care in a service delivery system for children and adolescents with severely maladjusted behavior.The Journal of Mental Health Administration 1990; 17(1):48–60.CrossRefGoogle Scholar
  7. 7.
    Dill AEP, Rochefort DA: Coordination, continuity, and centralized control: A policy perspective on service strategies for the chronic mentally ill.Journal of Social Issues 1989; 45(3):145–159.CrossRefGoogle Scholar
  8. 8.
    Lourie IS, Katz-Leavy J: New directions for mental health services for families and children.Families in Society 1991; 72(5):277–285.Google Scholar
  9. 9.
    Schmitz CL, Gilchrist L: Developing a community-based care system for seriously emotionally disabled children and youth.Child and Adolescent Social Work 1991; 8(5):417–430.CrossRefGoogle Scholar
  10. 10.
    Soler M, Shauffer C: Fighting fragmentation: Coordination of services for children and families.Education and Urban Society 1993; 25(2):129–140.Google Scholar
  11. 11.
    Rae-Grant NI: Roadblocks and stopgaps: A review of factors obstructing the development of comprehensive child mental health services.Canadian Psychiatric Association 1976; 21:433–441.Google Scholar
  12. 12.
    Tuma JM: Mental health services for children: The state of the art.American Psychologist 1989; 44(2):188–199.CrossRefPubMedGoogle Scholar
  13. 13.
    Wells K, Whittington D: Prior services used by youths referred to mental health facilities: A closer look.Children and Youth Services Review 1990; 12:243–256.CrossRefGoogle Scholar
  14. 14.
    Silver SE, Duchnowski AJ, Kutash K, et al.: A comparison of children with serious emotional disturbance served in residential and school settings.Journal of Child and Family Studies 1992; 1(1):43–59.CrossRefGoogle Scholar
  15. 15.
    Polivka BJ, Clark JA: A collaborative system of care for youth with severe emotional disturbances: An evaluation of client characteristics and services.The Journal of Mental Health Administration 1994; 21(2):170–184.CrossRefGoogle Scholar
  16. 16.
    Clark HB, Prange ME, Lee B, et al.: Improving adjustment outcomes for foster children with emotional and behavioral disorders: Early findings from a controlled study on individualized services.Journal of Emotional and Behavioral Disorders 1994; 2(4):207–218.Google Scholar
  17. 17.
    Epstein MH, Cullinan D, Quinn K, et al.: Personal, family, and services use characteristics of young people served by an interagency community-based system of care.Journal of Emotional and Behavioral Disorders 1995; 3(1):55–64.CrossRefGoogle Scholar
  18. 18.
    Rosenblatt A, Attkisson CC: Integrating systems of care in California for youth with severe emotional disturbance III: Answers to questions about out-of-home placements and the AB377 evaluation project.Journal of Child and Family Studies 1993; 2(2):119–141.CrossRefGoogle Scholar
  19. 19.
    Rosenblatt A, Attkisson CC, Fernandez A: Integrating systems of care in California for youth with severe emotional disturbance II: Initial group home expenditure and utilization findings from the California AB377 evaluation project.Journal of Child and Family Studies 1992; 1(3):263–286.CrossRefGoogle Scholar
  20. 20.
    Behar L: Changing patterns of state responsibility: A case study of North Carolina.Journal of Clinical Child Psychology 1985; 14(3):188–195.CrossRefGoogle Scholar
  21. 21.
    Jordan DD, Hernandez M: The Ventura planning model: A proposal for mental health reform.The Journal of Mental Health Administration 1990; 17(1):26–47.CrossRefGoogle Scholar
  22. 22.
    Hochstadt NJ, Jaudes PK, Zimo DA, et al.: The medical and psychosocial needs of children entering foster care.Child Abuse and Neglect 1987; 11:53–62.CrossRefPubMedGoogle Scholar
  23. 23.
    Moffatt MEK, Peddie M, Stulginskas JL, et al.: Health care delivery to foster children: A study.Health and Social Work 1985; 10:129–137.CrossRefPubMedGoogle Scholar
  24. 24.
    National Advisory Mental Health Council (NAMHC):National Plan for Research on Child and Adolescent Mental Disorders. Rockville, MD: National Institute of Mental Health, 1990.Google Scholar
  25. 25.
    Halfon N, Berkowitz G, Klee L: Mental health service utilization by children in foster care in California.Pediatrics 1992; 89(6):1238–1244.PubMedGoogle Scholar
  26. 26.
    County Welfare Directors Association of California, Chief Probation Officers Association of California, and California Mental Health Directors Association:Ten Reasons to Invest in the Families of California: Reasons to Invest in Services Which Prevent Out-of-Home Placement and Preserve Families. 1990.Google Scholar
  27. 27.
    George C, Main M: Social interactions of young abused children: Approach, avoidance, and aggression.Child Development 1979; 50:306–318.CrossRefPubMedGoogle Scholar
  28. 28.
    Howing P, Wodarski HS, Durtz PD, et al.: Child abuse and delinquency: The empirical and theoretical links.Social Work 1990; 35(3):244–249.PubMedGoogle Scholar
  29. 29.
    American Psychiatric Association:Diagnostic and Statistical Manual of Mental Disorders. Third ed. revised. Washington, DC: American Psychiatric Association, 1987.Google Scholar

Copyright information

© Association of Mental Health Administrators 1996

Authors and Affiliations

  • Elaine Blumberg
    • 1
  • John Landsverk
    • 2
    • 3
  • Elissa Ellis-MacLeod
    • 1
    • 2
    • 3
  • William Ganger
    • 4
  • Shirley Culver
    • 5
    • 6
  1. 1.Center for Behavioral Epidemiology and Community Health, Graduate School of Public HealthSan Diego State UniversitySan Diego
  2. 2.Center for Child Protection, Children's HospitalSan Diego
  3. 3.School of Social WorkSan Diego State UniversitySan Diego
  4. 4.Child and Family Research GroupSan Diego
  5. 5.Children, Youth, and FamiliesSan Diego Mental Health ServicesSan Diego
  6. 6.Center for Research on Child and Adolescent Mental Health ServicesChildren's HospitalSan Diego

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