PEDIATRICS Vol. 89 No. 6 June 1992, pp. 1238-1244
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Mental Health Service Utilization by Children in Foster Care in California

Neal Halfon MD, MPH1, Gale Berkowitz DPH2, and Linnea Klee PhD3

1 From the Center for the Vulnerable Child, Children's Hospital, Oakland, and the Health and Medical Sciences Program, School of Public Health, University of California, Berkeley, and The Institute for Health Policy Studies, University of California, San Francisco
2 From the Center for the Vulnerable Child, Children's Hospital, Oakland, and The Institute for Health Policy Studies, University of California, San Francisco
3 From the Center for the Vulnerable Child, Children's Hospital, Oakland

An examination of Medi-Cal-paid claims was undertaken to assess the utilization of mental health services by children in California's foster care system. Using unduplicate counts of service use and diagnoses, it was determined that children in foster care account for 41% of all users of mental health services even though they represent less than 4% of Medi-Cal-eligible children. When partitioned into specific service categories, children in foster care account for 53% of all psychologist visits, 47% of psychiatry visits, 43% of Short Doyle/Medi-Cal inpatient hospitalization in public hospitals, and 27% of inpatient psychiatric hospitals. Expenditure for services paralleled utilization frequency. When compared to the non-foster care Medi-Cal-eligible child population, children in foster care have 10 to 20 times the rate of utilization per eligible child for selected services. For children in foster care, 75% of all diagnoses for billed service were accounted for by four diagnoses: adjustment disorders (28.6%), conduct disorders (20.5%), anxiety disorders (13.8%), and emotional disorders (11.9%), with clear age-related differences in the distribution of diagnoses.

Key Words: foster care • mental health services • Medicaid

Submitted on March 18, 1991
Accepted on May 23, 1991


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