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Implementing Mental Health Screenings for Children and Youth in Family Shelters

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Young teens talking with a counselor.

Feasibility of Shelter-Based Mental Health Screening for Homeless Children” (abstract). Sean Lynch, Julia Wood, William Livingood, Carmen Smotherman, Jeffrey Goldhagen, and David Wood. Public Health Reports, Vol. 130, No. 1 (2015).

What it’s about: Researcher Sean Lynch and his colleagues wanted to investigate whether family shelters could implement an in-house mental health screening and referral program for children and youth up to age 17. The study used information from a pilot program hosted as part of the Medical Home for Homeless Children Project, an initiative spanning nine family shelters in Jacksonville, Florida.

For the pilot, staff referred children who were expected to stay in a shelter for three or more days to a nurse care coordinator, who administered an age-appropriate mental health screening. If the screening indicated risk for mental health challenges, or if a parent expressed concern about a child’s well-being, the nurse referred the participant to mental health services. As part of the broader project, nurses also provided children with comprehensive care related to their physical health and development, including outreach, screening, referrals, and follow-up. In total, 118 of the 326 children and youth seen during the pilot received a mental health screening.

Why read it: Previous research has shown that children and youth who experience family homelessness are more at-risk for mental health, behavioral, and academic problems than children who are stably housed, the authors write. Although families experiencing homelessness may have difficulty accessing mental health services for their children, there is a lack of research about what can be done to reduce those barriers. This study explores how increased coordination of screening and referrals can impact homeless children’s access to mental health services, and considers other factors that can help families complete screening tools and attend referral appointments.

Biggest takeaways from the research: The researchers found that participating family shelters successfully implemented mental health screenings and referrals for children and youth, despite having limited resources and serving a highly transient population. The need for mental health services was evident in the screening results. Among the 118 participants screened, 23% of young children (ages 0 to 5) and 33% of older children (ages 6 to 17) had scores indicating they may be at-risk for behavioral and mental health challenges.

Lynch et al. also shared their observations in the following areas:

Barriers to mental health screenings. Many eligible children and youth did not complete mental health screenings. This result may stem from a number of factors, the authors write, such as competing family priorities, a lack of health literacy, and a fear of disclosing mental health information they worried could be reported to child protective services. Additionally, pilot participants who had short shelter stays (i.e., less than a week) were less likely to be screened than those who stayed longer.

Factors that support screenings and successful referrals. Nurses who coordinated children's care often developed strong relationships with families in the shelters, which helped them recruit parents to participate in screenings and to attend their initial referral appointments. Among the 50 children referred to mental health services, 25 completed their first appointment—a number the authors estimate would be even lower without nurse involvement.

More structure is needed to ensure that children continue receiving treatment after their first appointment, they add, such as case management services provided by the mental health provider.

Additional references: Learn more about homeless families and mental health in the NCFY library.

We've also reviewed a past study that explores how school districts can create a multi-tiered system of support to address the mental health needs of homeless students.

Browse a list of mental health screening and assessment tools.

Publications discussed here do not necessarily reflect the views of the National Clearinghouse on Families and Youth, the Family and Youth Services Bureau, or the Administration for Children and Families.

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