The University of Texas at Arlington, School of Social Work, 211 S. Cooper Street, Box 19129, Arlington, TX, 76019, U.S.A.
Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON,M5S 1V4, Canada.
Child Abuse Negl. 2018 May;79:115-124. doi: 10.1016/j.chiabu.2018.01.027. Epub 2018 Feb 20.
Although various studies have investigated factors associated with mental health service utilization, few studies have examined factors associated with referral for mental health services among maltreated children. The objective of this study was to examine the association between suicidal thoughts and self-harming behavior and referral for mental health services among children involved in the Child Welfare System in Ontario, Canada. Data for this study were obtained from the Ontario Incidence Study of Reported Child Abuse and Neglect 2013. An estimate 57,798 child maltreatment investigations was analyzed using binary logistic regression with referral for mental health service as the outcome variable. Of the 57,798 cases, 4709 (8.1%), were referred for mental health services. More than seven out of ten maltreated children who engaged in self-harming behavior and two out of three maltreated children who expressed suicidal thoughts were not referred for mental health services. In the multivariate logistic regression model, children who expressed suicidal thoughts had 2.39 times higher odds of being referred for mental health services compared to children with no suicidal thoughts (AOR = 2.39, 99% C.I. 2.05-2.77) and children who engaged in self-harming behavior had 1.44 times higher odds of being referred for mental health services compared to children who did not engage in self-harming behavior (AOR = 1.44, 99% C.I. 1.24-1.67), both after controlling for child demographic characteristics, maltreatment characteristics, and child functioning concerns. Given that referral is the initial step towards mental health service utilization, it is important that child welfare workers receive the necessary training so as to carefully assess and refer children in care who expressed suicidal thoughts or engaged in self-harming behavior for appropriate mental health services. The paper discusses the results and their implications for child welfare policy and practice.
尽管有许多研究调查了与心理健康服务利用相关的因素，但很少有研究探讨与受虐待儿童的心理健康服务转介相关的因素。本研究的目的是检验自杀意念和自残行为与加拿大安大略省儿童福利系统中受虐待儿童的心理健康服务转介之间的关联。本研究的数据来自 2013 年安大略省报告的儿童虐待和忽视发生率研究。使用二元逻辑回归分析了 57798 例儿童虐待调查数据，以心理健康服务转介为因变量。在 57798 例案例中，有 4709 例（8.1%）被转介到心理健康服务机构。超过十分之七的有自残行为的受虐待儿童和三分之二有自杀意念的受虐待儿童没有被转介到心理健康服务机构。在多变量逻辑回归模型中，表达自杀意念的儿童被转介到心理健康服务机构的可能性是没有自杀意念的儿童的 2.39 倍（调整后优势比 = 2.39，99%置信区间 2.05-2.77），有自残行为的儿童被转介到心理健康服务机构的可能性是没有自残行为的儿童的 1.44 倍（调整后优势比 = 1.44，99%置信区间 1.24-1.67），在控制了儿童人口统计学特征、虐待特征和儿童功能障碍问题后。鉴于转介是利用心理健康服务的第一步，重要的是儿童福利工作者应接受必要的培训，以便仔细评估和转介表达自杀意念或自残行为的照顾中的儿童，以便为他们提供适当的心理健康服务。本文讨论了研究结果及其对儿童福利政策和实践的意义。
