Does caregiver participation in decision making within child welfare agencies influence children's primary and mental health care service use?
M P Jolles, R Wells
PMID 27470153WHAT IT FOUND
In families involved with US child welfare, caregiver participation in decision making was linked to higher primary health care use for children aged 10 and younger.
It did not show a difference in mental health service use.
Key findings
01In matched samples, children aged 10 and younger whose families were served through a participatory decision making practice had higher primary health care service use in the past 12 months than children not served through this practice (p<0.01).
02Differences in mental health service use between groups were not significant.
03Among children who remained in the home, 208 (13%) were served through a participatory decision making practice, and more of these children were lower risk before matching.
STILL TO COME
How it was doneWhat they found
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What it does not show
Families were not randomly assigned to participatory decision making; caseworkers selected them, so the finding is an association, not proof of effect. The groups differed before matching on observed risk factors, and the matching could only balance factors that were measured. The study used public child welfare agencies and children who remained in the home, so it may not apply to private agencies or children placed out of home. The study measured service use, not health outcomes, so it cannot show whether children got healthier. Only 208 (13%) children were served through a participatory decision making practice, and the mental health model used a separate sample of 882 children aged 1.5 to 17.
Declared interests
The National Survey of Child Adolescent Well-being was sponsored by the US Department of Health and Human Services. The authors reported no known conflicts of interest.
The easy way to misread this
Do not read the higher primary health care use as proof that caregiver participation in decision making caused it. Families were not randomly assigned, caseworkers selected lower-risk families, and the study could not rule out unmeasured factors.