While the gap between need for and access to mental health services is well documented among children of color in foster care, little is known about why they are sustained. To illuminate barriers of service delivery, thirty-six caseworkers participated in one of five focus group meetings in a large urban Mid-Atlantic City. Ground Theory Methods revealed that there are barriers and facilitators at the macro, meso, and micro practice orientations. At the macro-level, development of effective practice strategies and proximity to effective services are likely to influence dissemination of effective practices. Secondly, at the meso-level, job support is needed to facilitate awareness, but for case managers to feel supported, they need effective training and opportunities to facilitate interagency collaboration. Finally, at the micro-level, cultural competence largely impacts implementation of effective practices. However, increased awareness around the social ills of stigma and the salience of “insider work” are needed to increase cultural competence. A “downstream” effect in which there are numerous barriers identified at the macro level has a direct negative impact on organizational capacity and readiness to deliver and engage youth and families in mental health services served by the child welfare system. Findings underscore the need for child welfare agencies to build supports at the macro, meso, and micro practice levels to ameliorate mental health service disparities.
Approximately 400,000 children in the U.S. who are placed in foster care (USDHHS, 2014) are more likely to be diagnosed with a host of externalizing and internalizing behaviors, including depression, anxiety, ADHD, conduct disorder, PTSD, substance use, and suicidal behavior than children in the general population (Del Vecchio et al., 2012, Jonson-Reid et al., 2012, McCrae, 2009, Silvern and Griese, 2012 and Trickett et al., 2011). Scholars assert that child welfare caseworkers may act as “service brokers” in that if (1) they are trained to detect negative symptomatology and (2) are aware of services that are readily available, they will play an instrumental role in ensuring that children in foster care receive effective and timely mental health services (Dorsey et al., 2012 and Stiffman et al., 2004). Previous research shows that children placed in foster care are ten times more likely to utilize mental health services than children in community samples (Garland, Landsverk, Hough, & Ellis-MacLeod, 1996). In spite of this relationship, Garcia, Palinkas, Snowden, and Landsverk (2013) highlight that a number of studies published over the past fifteen years show that children of color who are involved in the child welfare system (CWS) are significantly less likely to receive mental health services than their Caucasian counterparts, even after controlling for need and maltreatment exposure.
The question that remains unaddressed is how and under what conditions do these disparities linger. Garcia and colleagues recommend that “researchers need to analyze via multivariate pathways the direct and/or indirect individual, socio-environmental and organizational contextual factors, and the number of potential mediating factors…that may influence service-use experiences for at-risk youth and families of color in the CWS” (Garcia et al., 2013, p. 1731). Effective services will not be delivered unless we have a clear understanding of these pathways. To that end, this explorative study relied upon focus group data collected from child welfare case managers to understand, from their perspective, what factors facilitate and impede access to and use of effective services to promote positive developmental outcomes for youth of color served by the foster care system. The intent is to build an explanatory model of service delivery to later be tested in the context of relying upon quantitative methods.
