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Mental health service utilization by children in foster care in California
N Halfon1, G Berkowitz, L Klee
1Center for the Vulnerable Child, Children's Hospital, Oakland, CA.
Insights
Children in foster care disproportionately use mental health services in California. Despite being less than 4% of eligible children, they represent 41% of users, highlighting a significant disparity in care access.
Area of Science:
- Child Welfare
- Mental Health Services
- Healthcare Utilization
Background:
- California's foster care system serves a vulnerable population.
- Medi-Cal (California's Medicaid program) funds healthcare for eligible children.
- Understanding mental health service use is critical for this population.
Purpose of the Study:
- To examine the utilization of mental health services by children in California's foster care system.
- To compare service use and diagnoses between foster care and non-foster care Medi-Cal-eligible children.
- To identify the most common mental health diagnoses among children in foster care.
Main Methods:
- Analysis of Medi-Cal-paid claims data.
- Used unduplicated counts of service use and diagnoses.
- Compared utilization rates between foster care and non-foster care children.
Main Results:
- Children in foster care comprise 41% of all mental health service users, despite being <4% of eligible children.
- Foster care children account for high percentages of specific services: 53% psychologist, 47% psychiatry, 43% Short Doyle/Medi-Cal inpatient.
- Utilization rates for foster care children are 10-20 times higher than non-foster care peers for selected services.
Conclusions:
- Children in foster care exhibit significantly higher utilization of mental health services compared to their non-foster care counterparts.
- Adjustment, conduct, anxiety, and emotional disorders are the most prevalent diagnoses.
- Age-related differences in diagnosis distribution warrant further investigation.
Abstract:
An examination of Medi-Cal-paid claims was undertaken to assess the utilization of mental health services by children in California's foster care system. Using unduplicate counts of service use and diagnoses, it was determined that children in foster care account for 41% of all users of mental health services even though they represent less than 4% of Medi-Cal-eligible children. When partitioned into specific service categories, children in foster care account for 53% of all psychologist visits, 47% of psychiatry visits, 43% of Short Doyle/Medi-Cal inpatient hospitalization in public hospitals, and 27% of inpatient psychiatric hospitals. Expenditure for services paralleled utilization frequency. When compared to the non-foster care Medi-Cal-eligible child population, children in foster care have 10 to 20 times the rate of utilization per eligible child for selected services. For children in foster care, 75% of all diagnoses for billed service were accounted for by four diagnoses: adjustment disorders (28.6%), conduct disorders (20.5%), anxiety disorders (13.8%), and emotional disorders (11.9%), with clear age-related differences in the distribution of diagnoses.