Predictors of Service Referral and Dosage in an Early Childhood System of Care

Introduction: Systems of care (SOC) provide comprehensive, individualized wraparound services to children and families with serious emotional and behavioral problems (Cook & Kilmer, 2012; Stroul et al., 2008; Suter & Bruns, 2009). Within SOC, families and service providers collaborate to develop service plans (Coldiron et al., 2017), relying in part on provider expertise to identify areas of risk. Child and family risk factors may serve as both facilitators of and barriers to service access and participation (e.g., Attride-Stirling et al., 2004; Brannan et al., 2003; Walrath et al., 2006). The current study sought to identify the extent to which child and family risk factors impact service referral and receipt in an early childhood SOC.

Method: The sample included 183 families enrolled in an early childhood SOC. Children ranged in age from 1.38 to 5.89 (M = 3.90, SD = 1.08). Most children were male (74.9%). Risk factors measured included child externalizing behaviors (CBCL; Achenbach & Rescorla, 2001), child trauma exposure (TESI; Ghosh-Ippen et al., 2002), caregiver depression (CES-D; Radloff, 1977), parenting stress (PSI; Abidin, 2012), and household substance use. Service dosage ranged from 1.42 to 480.90 hours (M = 70.65, SD = 64.09). Multiple regression analysis was conducted with square root of dosage as the outcome and risk factors as predictors. Service referrals were collapsed into mental health, child welfare, early intervention, social services, and family support. Logistic regression analyses were conducted with each service referral category as the outcome.

Results: Results of the multiple regression for service dosage indicated that externalizing behaviors was a significant factor (β = .068, p = .022). Child trauma exposure was a marginally significant predictor of child welfare referral (OR = 1.355, p = .056). For the model predicting mental health referral, both child trauma exposure (OR = 1.533, p = .018) and household substance use (OR = .162, p = .007) contributed significantly. A trend was observed for parenting stress (OR = 1.037, p = .078) predicting early intervention referral.

Conclusions: Findings suggest that child and family risk factors are differentially associated with dosage and service referral. Specifically, children with externalizing symptoms received more services than children without this risk factor. Further, children with trauma exposure were more likely to be referred to child welfare and mental health services, while families with substance use and parenting stress were more likely to be referred to mental health services and early intervention, respectively. Results highlight the importance of identifying individualized family needs and referring to targeted services as a prevention strategy.