P3.068: Barriers and facilitators to mental health care experienced by youth involved with child welfare and their caregivers

Background: Child welfare involved youth have high rates of behavioral health needs; however, many children never receive needed mental health services. The specific mental health care barriers children and their caregivers face are not well described. The objective of this study is to describe the process and experience of initiating mental health care among individuals with child welfare involvement as they enter out-of-home care.

Methods: As part of an ongoing study (R01HS028589; Beal, PI), N = 200 youth-caregiver dyads were enrolled in a 2-year longitudinal study, after entering protective custody for the first time, during which dyads complete surveys every 3 months. Youth or caregivers who indicated that they did not get all needed mental health care were recruited to participate in semi-structured interviews as part of the current study. Timeline recall was used to support enhanced reporting about mental health care experiences, supported using electronic medical record and Medicaid data to indicate when mental health care was accessed over time. Thematic content analysis was applied to all transcribed interviews using Dedoose. Timelines created during the interviews were analyzed to uncover additional patterns in the events described by adolescents and/or caregivers as they sought mental health treatment.

Results: 43 unique child-caregiver dyads were eligible for this study and asked to participate in the interview. 19 dyads completed the interview. Participants described both barriers and facilitators to accessing mental healthcare services. Barriers were categorized into 5 major themes: 1) Caregiver and/or youth specific barriers; 2) Difficulty communicating and coordinating services; 3) Barriers within mental health services; 4) Disruptions related to change of custody or placement; 4) Insurance related barriers. Facilitators were categorized into 3 major themes: 1) Support from non-mental health services; 2) Characteristics or actions of the caregiver and adolescent; 3) Mental health care specific interventions. Most interviewees reported accessing mental health services during their most recent placement; however, they also reported a delay in accessing those services. Timeline analysis revealed that adolescents rarely access mental health services prior to child welfare involvement. Furthermore, caregivers who recognized a need for services and requested services from their caseworker prior to any other outreach accessed mental health resources earlier than those who did not proactively reach out to their caseworker.

Conclusion: The experiences described by child welfare involved youth and their caregivers as they access mental health services are diverse. However, the consistent themes across interviews reveal modifiable factors, such as providing referrals to specific services, that affect overall access to care and can inform future interventions. Furthermore, this analysis revealed the important role caregivers and caseworkers play in accessing mental health services, with actions or characteristics of the caregiver emerging as a common theme in both barriers and facilitators to mental health services.