Mental health service use by children and youth in the child welfare system: A focus on need and predisposing factors and caregiver type

Studies have documented that children in foster care are in need of mental health intervention, but not all foster care children receive the mental health services they need. One area that lacks attention and may help explain the underutilization of mental health services is the influence that the caregiver has on a child's utilization of services. Caregivers serve as gatekeepers for children while in the child welfare system, but few studies have focused on the factors that influence a caregiver's use of mental health services for the children under their care. This study represents a step toward addressing this gap in the literature by examining the influence that caregivers have on the utilization of mental health services for children and youth in the child welfare system. This study examined whether the caregivers' perceptions and knowledge of mental health services mediate need and predisposing factors and the utilization of mental health services for children under their care. This study also examined caregiver type as a moderator to understand whether type of caregiver was significant.;Hierarchal logistic regression and structural equation modeling with a mediating-moderating effect were used to test the hypotheses proposed. Results indicate that older caregivers were more likely to use mental health services for their children. Caregivers' with children with high externalizing behaviors and a high level of stress were more likely to use mental health services for their children. No mediation effect was found. However, statistically significant associations between need and predisposing factors and perceptions and knowledge of mental health services were found with the higher the need factor the more negative the perceptions and knowledge of mental health services and the higher the predisposing factor the more negative the perceptions and knowledge of mental health services were by the caregiver.;In addition, a moderating effect was found with the higher the need factor the more negative the perceptions and knowledge of mental health services among birth parents and relative caregivers. Furthermore, the higher the need factor the less likely that relative caregivers and foster parents were to use mental health services for the children under their care.