همکاری میان سازمانی و شناسایی نیازهای بهداشت روانی در رفاه کودکان: یافته های حاصل از لس آنجلس

Research has indicated that disparities between the need for and receipt of mental health services are in part due to challenges in identifying mental health problems in this population. Interagency collaboration between the child welfare system (CWS) and mental health organizations shows promise in circumventing these challenges. To this end, Los Angeles County's Department of Children and Family Services (DCFS) and Department of Mental Health (DMH) engaged in interagency collaborative efforts that included the development of a collaborative model detailing steps for systematic screening, assessment, referral, and continuum of care for mental health needs of DCFS-involved children. DCFS and DMH also developed a uniform agency mental health screening tool to be used by the DCFS staff to enhance identification of needs and expedite services for CWS-involved children at risk of mental health problems. This article describes the processes of interagency collaboration between DCFS and DMH, development of a uniform agency mental health screening tool, and demographic descriptors of an ethnically diverse cohort of CWS-involved children who received the mental health screening protocol (N = 4694) between 2011 and 2012. Findings indicate that collaborative efforts between DCFS and DMH facilitated the mental health screening of a large cohort of CWS-involved children, which resulted in the detection of need and referral for services.

The prevalence of mental health needs is high among children served by the child welfare system (CWS; Burns et al., 2004 and Hurlburt et al., 2004). Research has indicated that children in the United States who come into contact with the CWS are at greater risk of poor mental health outcomes than those in the general population (Burns et al., 2004). Risk factors that often coincide with child maltreatment, such as prenatal drug and alcohol exposure and exposure to interpersonal violence and other trauma (Raviv et al., 2010), place many stressors on children's mental health (Kaplow & Widom, 2007). The CWS hence faces increasing organizational pressure (e.g., via lawsuits or federal mandates) to collaborate with specialized mental health service providers to provide timely and appropriate screening and assessment of mental health needs among CWS-involved children (Bonta, 2006 and Petersen et al., 2013). For example, as part of a settlement agreement from a class-action lawsuit (Bonta, 2006) to enhance identification of needs and expedite referral to mental health services for CWS-involved children, the Los Angeles County Department of Children and Family Services (DCFS) and Los Angeles County Department of Mental Health (DMH) adopted a model of interagency collaboration with the goal of providing streamlined services to CWS-involved children. This interagency collaboration (henceforth referred to as collaboration) is a significant landmark given the legal implications and the fact that DCFS and DMH provide services in Los Angeles County, one of the most populated and ethnically diverse locations in the United States. This descriptive study highlights key collaborative practices and policies between these two large service systems in their efforts to meet client needs and address legal and organizational mandates to provide appropriate mental health services to CWS-involved children. First, we present an overview of the impetus for and strategies of the collaboration between DCFS and DMH. Next, we describe the uniform agency mental health screening tool (MHST) developed through this collaboration; this tool was intended for use by DCFS staff members (non-mental-health specialists) to help capture the mental health needs of children in the CWS. We also depict the establishment of a dual-agency referral and linkage team intended to coordinate mental health services for CWS-involved youths. Finally, we provide a description of demographics and child welfare characteristics of children who received this mental health screening in the context of collaboration.

This study illustrates the role of collaboration between child welfare and mental health agencies in enhancing identification of CWS-involved children at elevated risk of mental health problems, which subsequently led to referrals for mental health assessments commensurate with the level of need. Without the implementation of policies and practices to promote collaboration between DCFS and DMH, whether through strategies that included co-location of staff members or development of a uniform agency mental health screening tool, it is arguable that much of the mental health needs of this population could have remained undetected. Given the need for optimal mental health screening and the gaps between mental health needs and service use among CWS-involved children in Los Angeles County, findings from this study not only inform policy and practices for DCFS and DMH but could also have wider implications for other large metropolitan CWS organizations. It should also be noted that although Los Angeles is widely considered to be a metropolitan area, Los Angeles County consists of urban, suburban, and rural areas. Therefore, we maintain that collaborative practices that are feasible in Los Angeles County may also be feasible in both urban and rural communities. It is our hope that this descriptive paper will provide policy and practice insights for existing and future interagency collaboration between the CWS and mental health service providers and support the development of models of collaboration between child welfare and specialized service providers. For example, following DCFS and DMH's lead, child welfare agencies and policy makers should consider the burden to workers of implementing new practices and encourage the adoption of screening tools (e.g., for mental health or substance use disorders) that fit the skill set, expertise, and workload of child welfare workers. CWS agencies that are dealing with legal or federal mandates involving mental health service delivery could also benefit from exploring the model of collaboration adopted by DCFS and DMH. Finally, the vulnerability toward and potential for revictimization or trauma among children in CWS warrant policies and research that encourage ongoing collaboration between CWS and mental health service providers, particularly to ensure continued child safety and well-being.