Barriers and facilitators to mental health care experienced by youth involved in child welfare and their caregivers.

Introduction: Child welfare involved youth have high rates of behavioral health needs; however, many never receive needed mental health services. The specific barriers children and their caregivers face are not well described. The objective of this study was to describe the process and experience of initiating mental health care for youth entering out-of-home care. Methods: Youth-caregiver dyads were enrolled in a 12-month longitudinal study, after entering protective custody for the first time, during which dyads completed surveys every 3 months. Electronic health records data linked with administrative child welfare data were extracted. Subgroups of dyads were identified based on reported mental health needs and whether needs were met over time. Descriptive analyses of these subgroups were completed to compare sociodemographic and child welfare characteristics and mental health screening scores. Youth or caregivers of youth with reported unmet mental health needs were recruited to participate in semi-structured interviews regarding experiences seeking mental health services. Timeline recall was used to support enhanced reporting. Timelines created during interviews were analyzed to uncover additional patterns in the events described. Thematic content analysis was applied to all interviews using Dedoose. Results: Conclusion: Most youth access mental health services while in out-of-home placement; however, mental health needs are often not consistently met over time. Caregivers play an important role in both reporting mental health concerns and accessing mental health services. Integrated mental health services are an important resource for child welfare involved youth seeking mental health treatment.