Predictors of Service Dosage, Recommendation, and Usage in an Early Childhood System of Care
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Objective: Children and families enrolled in early childhood systems of care (SOC) present with various psychological and behavioral risk factors that may inhibit healthy development. Within a SOC, wraparound services are designed to increase families’ access to numerous child-serving sectors in order to target those risk factors. This study examined whether child and family risk factors at enrollment in an early childhood SOC predicted dosage, service recommendation, and usage of recommended services. Method: Participants were 144 children ranging in age from 1.38 to 5.89 years and their caregivers. Families completed measures of child and caregiver functioning prior to participation in the SOC. Service recommendation and usage were measured at intake and three months, respectively. We used multiple regression analysis to examine the relationship between risk factors and dosage of services received. Logistic regression analyses identified the relationships between risk factors and service recommendation and usage according to specific service types within the SOC. Results: Children with greater behavior problems received more services overall (R2 = .103, β = .243, p = .033). Child risk factors predicted recommendation for child welfare (trauma exposure: OR = 1.352, p = .052) and mental health services (behavior problems: OR = 1.061, p = .034; trauma exposure: OR = 1.316, p = .046), whereas families with substance use issues were less likely to be recommended for mental health services (OR = .229, p = .017). Conclusions: Findings highlight opportunities for improved service provision and service-level decision making in early childhood SOCs.
KeywordsEarly childhood System of care Service recommendation Service usage Family risk factors
A. S. designed and executed the study, analyzed the data, and wrote the paper. R. B. C collaborated in the writing and editing of the final manuscript. J. S. K designed and executed the study, and collaborated in the writing and editing of the manuscript.
The preparation of this paper was supported, in part, by the first author’s National Institutes of Health T32-funded postdoctoral training fellowship (T32DA019426-13) and by a grant from the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Yale University Human Research Protection Program and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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