Mental health, adverse life events and health service use among Norwegian youth in the child welfare system: Results from a population‐based study

Ove Heradstveit,Tormod Bøe,Kristin Gärtner Askeland,Anette Christine Iversen,Sondre Aasen Nilsen,Dora Poni Joseph Loro,Karen J Skaale Havnen

doi:10.1111/cfs.12842

Abstract

AbstractYouth within the child welfare system (CWS) have often experienced adverse life events, and many need support from health services. This study aimed to compare mental health problems and health service use among adolescents receiving in‐home services (IHS), living in foster care (FC) and general population youth (GP). Data stem from the youth@hordaland survey, a population‐based study of adolescents (N = 10,257, age 16–19) conducted in 2012 in Hordaland County, Norway. The adolescents provided self‐reported data on CWS contact, health service use, adverse life events and multiple instruments assessing mental health problems. The IHS and FC groups had significantly higher symptom scores across most mental health measures than peers from the GP. Youth receiving IHS had significantly higher scores on measures of general internalizing and externalizing problems, attention deficit hyperactivity disorder (ADHD) and depression compared with peers in FC. Those receiving IHS reported the highest health service use. Adverse life events accounted for a substantial part of the differences between the groups. Mental health problems are frequent among older adolescents within the CWS, especially among youth receiving IHS. Service providers and policymakers should be aware of the present and likely continued challenges faced by many of these youth.

Highlights

Children exposed to poverty, inadequate parenting or maltreatment are at risk of mental health problems (Bøe et al, 2017; Khan et al, 2015; Maclean et al, 2019; McLeod & Shanahan, 1993).Youth receiving interventions from the child welfare system (CWS) have often experienced such adversities (Conn et al, 2015)
Youth receiving interventions from the CWS may be placed in out-of-home care or reside with their biological parents while being provided some form of in-home services (IHS)
We considered data to be missing at random (MAR), and variables entered in the imputation model were age, gender, ethnicity, parental education, parental work status, Perceived economic well-being (PEWB), family structure, service use variables, and mental health symptom and perfectionism scores

Summary

Introduction

Inadequate parenting or maltreatment are at risk of mental health problems (Bøe et al, 2017; Khan et al, 2015; Maclean et al, 2019; McLeod & Shanahan, 1993). Youth receiving interventions from the child welfare system (CWS) have often experienced such adversities (Conn et al, 2015). Former child welfare clients are at high risk for suicide attempts and severe psychiatric morbidity (Brännström et al, 2020; Vinnerljung et al, 2006), highlighting the potentially severe consequences of adverse childhood conditions experienced by many CWS clients. Youth receiving interventions from the CWS may be placed in out-of-home care (i.e., residential, kinship or foster care [FC]) or reside with their biological parents while being provided some form of in-home services (IHS). In Norway, as in other Western countries, most children and youth receive IHS with the aim of preventing the need for out-of-home placements such as FC (see Kojan & Lonne, 2012; Mennen et al, 2010; Tonheim & Iversen, 2019)

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