Abstract
We studied 9,220 children referred to a comprehensive mental health crisis stabilization program to examine the impact of caregiver capacity on crisis worker decisions to refer children for intensive community-based treatment as opposed to inpatient psychiatric hospitalization. Due to the different role of caregivers in the child welfare system, analyses were stratified by state custody status. Among both groups, there was a significant inverse association between child mental health need and referral to intensive community-based treatment. For children not in state custody with low mental health need, there was no difference in the likelihood of referral to intensive community-based treatment across levels of caregiver capacity. However, for children not in state custody with medium and high mental health needs, those whose caregivers were deficient or severely deficient were significantly more likely to be referred for intensive community-based treatment than were those who had capable caregivers. Multivariate analyses demonstrated similar results after controlling for potential confounding variables and confirmed that caregiver capacity contributes significantly to the logistic model’s classification accuracy. Results suggest further investigation of the impact of caregiver capacity on mental health crisis worker referral decisions is needed.
Similar content being viewed by others
References
Andersen, R., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. The Milbank Memorial Fund Quarterly, 51, 95–124. doi:10.2307/3349613.
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(3), 1–10. doi:10.2307/2137284.
Andersen, R. M., Rice, T. H., & Kominski, G. F. (Eds.). (1996). Changing the US health care system. San Fransisco: Jossey-Bass Publishers.
Anderson, R. L., Lyons, J. S., Giles, D. M., Price, J. A., & Estle, G. (2003). Reliability of the child and adolescent needs and strengths-mental health (CANS-MH) scale. Journal of Child and Family Studies, 12, 279–289. doi:10.1023/A:1023935726541.
Chernoff, R., Combs-Orme, T., Risley-Curtiss, C., & Heisler, A. (1994). Assessing the health status of children entering foster care. Pediatrics, 93, 594–601.
Glied, S., & Cuellar, A. E. (2003). Trends and issues in child and adolescent mental health. Health Affairs, 22(5), 39–50. doi:10.1377/hlthaff.22.5.39.
Harman, J. S., Childs, G. E., & Kelleher, K. J. (2000). Mental health care utilization and expenditures by children in foster care. Archives of Pediatrics and Adolescent Medicine, 154, 1114–1117.
He, X. Z., Lyons, J. S., & Heinemann, A. W. (2004). Modeling crisis decision-making for children in state custody. General Hospital Psychiatry, 26, 378–383. doi:10.1016/j.genhosppsych.2004.01.006.
Henggler, S. W., Rowland, M. D., Halliday-Boykins, C., Sheidow, A. J., Ward, D. M. J. R., et al. (2003). One-year follow-up of multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 543–551. doi:10.1097/01.CHI.0000046834.09750.5F.
Illinois Department of Healthcare and Family Services. (2005). Handbook for providers of screening, assessment and support services. Springfield, IL: Illinois Department of Healthcare and Family Services. Available at: http://www.hfs.illinois.gov/handbook/chapter200.html.
Leon, S. C., Uziel-Miller, N. D., Lyons, J. S., & Tracy, P. (1999). Psychiatric hospital service utilization of children and adolescents in state custody. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 305–310. doi:10.1097/00004583-199903000-00018.
Lyons, J. S. (1998). The severity and acuity of psychiatric illness: Child and adolescent version. San Antonio, TX: Psychological Corporation.
Lyons, J. S. (2004). Redressing the emperor: Improving our children’s public mental health system. Westport, CT: Praeger.
Lyons, J. S., Baerger, D., Quigley, P., Erlich, J., & Griffin, E. (2001). Mental health service needs of juvenile offenders: A comparison of detention, incarceration, and treatment settings. Children’s Services (Mahwah, N.J.), 4, 69–85. doi:10.1207/S15326918CS0402_2.
Lyons, J. S., GMacIntyre, J. C., Lee, M. E., Carpinello, S., Zuber, M. P., & Fazio, M. L. (2004). Psychotropic medication prescription patterns for children and adolescents in New York’s public mental health system. Community Mental Health, 40, 101–118. doi:10.1023/B:COMH.0000022731.65054.3e.
Lyons, J. S., Rawal, P., Yeh, I., Leon, S. C., & Tracy, P. (2002). Use of measurement audit in outcomes management. The Journal of Behavioral Health Services & Research, 29(1), 75–80. doi:10.1007/BF02287834.
Lyons, J. S., Stutesman, J., Neme, J., Vessey, J. T., O’Mahoney, M. T., & Camper, J. (1997). Predicting psychiatric emergency admission and hospital outcome. Medical Care, 35, 792–800.
Lyons, J. S., Uziel-Miller, N. D., Reyes, F., & Sokol, P. T. (2000). Strengths of children and adolescents in residential settings: Prevalence and associations with psychopathology and discharge placement. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 176–181. doi:10.1097/00004583-200002000-00017.
Romansky, J. B., Lyons, J. S., Lehner, R. K., & West, C. M. (2003). Factors related to psychiatric hospital readmission among children and adolescents in state custody. Psychiatric Services (Washington, D.C.), 54, 356–362. doi:10.1176/appi.ps.54.3.356.
Sourander, A., & Leijala, H. (2002). The clinical course of children treated in a short-term inpatient programme. Child Psychiatry and Human Development, 33(1), 75–88. doi:10.1023/A:1016520406736.
Stroul, B. A. (1993). Systems of care for children and adolescents with severe emotional disturbances: What are the results?. Washington, D C: Georgetown University Child Development Center.
Takayama, J. I., Bergman, A. B., & Connell, F. A. (1994). Children in foster care in the state of Washington: Health care utilization and expenditures. Journal of the American Medical Association, 271, 1850–1855. doi:10.1001/jama.271.23.1850.
Acknowledgements
The authors wish to thank Lynn Steiner, M. S. W., for her contribution to this work.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Epstein, R.A., Jordan, N., Rhee, Y.J. et al. The Relationship Between Caregiver Capacity and Intensive Community Treatment for Children with a Mental Health Crisis. J Child Fam Stud 18, 303–311 (2009). https://doi.org/10.1007/s10826-008-9231-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10826-008-9231-0