Our data most often measured prevalence
during the past 6 months (ADHD, anxiety, and suicidality), with
depression measured during the past 2 weeks and substance
use/abuse reflecting lifetime use. It is possible that teens within
the child welfare systems would have rates higher than the
general population if ascertainment periods were similar, especially
for teens who do not receive services for MH problems.
Although our rate of substance use/abuse (23%) is higher than
reported by Leslie or Kessler, it compares to a recent report that
found that 75% of all high school students have used addictive
substances including tobacco, alcohol, marijuana, or cocaine [25].
Our study confirms that adolescents who present to child
welfare agencies indicate high rates of MH problems regardless
of whether they remain in their biological homes or are placed in
out-of-home care. Prior studies do suggest that children who
remain at home have high levels of MH needs and our data
confirm this [26,27]. Data from this study reveal that over onethird
of children who remain at home without services report
at least one MH problem. It is worth noting that out-of-home
placement is often a gateway for MH services, therefore teens
who remain at home may be at particular risk for their MH
problems to go untreated.
The quality of the family environment influences a child’s
developmental trajectory and long-term health outcomes [5,28].