Date of Award




Document Type


Degree Name

Doctor of Philosophy (PhD)


School of Social Welfare

Content Description

1 online resource (xii, 168 pages) : illustrations (some color)

Dissertation/Thesis Chair

Carolyn Smith

Committee Members

Katharine Briar-Lawson, Lynn Videka, Glenn Deane


child welfare, mental health, service access, system factors, Poor children, Poor teenagers, Child mental health services, Child welfare

Subject Categories

Social Work


Most research on children's access to mental health has focused on child and family factors (e.g. child's age and ethnicity), with little attention being paid to service system factors such as service referrals and insurance. Furthermore, most research conducted to date on mental health service access has been cross-sectional without considering how service access and needs change over time. This dissertation study aims to address these oversights by examining over time service system change and the impact of service system factors on the relationship between service needs and access. The study employs multilevel and longitudinal regression analyses (STATA) using five waves of data from the National Survey of Child and Adolescent Well-being (n=3152). Statistical techniques included the use of multiple imputation to replace missing data and the inclusion of study design variables in regression analysis to adjust for the impact of sampling weights on analysis. Results indicate that both service access and service need exhibit a curvilinear decreasing trend over time. The results also highlighted the importance of system factors on the change of service access over time. Specifically, findings indicate that needs assessment results in a significant increase in service access over time, referral efforts result in a decrease in service access across time, community environment results in a decrease in service access with time, public insurance has a large main effect on the probability of gaining access to services, and increased referral efforts tend to increase service access for African American children to a greater extent than for white children. Practice and policy implications of the findings are then discussed as they relate to how often children's mental health service needs should be assessed and to what degree community and school based mental health services should be made available to children and families in order to reduce the possible gate keeper effect of child welfare systems on children's access to mental health services. Public policy investment in providing a safe and stable community environment and the provision of adequate insurance to uninsured children are proposed ways to increase children's access to mental health services.

Included in

Social Work Commons