Author ORCID Identifier

https://orcid.org/0000-0002-3640-9946

Date Available

5-12-2025

Year of Publication

2023

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Public Health

Department/School/Program

Epidemiology and Biostatistics

First Advisor

Erin Haynes

Abstract

Children’s traumatic experiences have lifelong impacts on their mental health and quality of life, therefore mental health services are a critical part of necessary community resources. The increased frequency and severity of natural disasters such as hurricanes, tornadoes, and pandemics reinforces the need to examine and understand the importance of mental health and child services in response to disaster events. This research assesses the relationship between disasters and subsequent health service utilization amongst children and adolescents. We investigated current research on the relationship between children’s mental health and community mental health resource efficacy and accessibility after a major disaster by conducting a systematic search of the epidemiologic and health service utilization literature. The research resulted in 1682 potentially relevant studies and 31 articles were selected based on identified criteria from pre-selected databases. Children’s traumatic experiences can have lifelong impacts on their mental health and quality of life; therefore, mental health services are critical community resources. COVID-19 caused significant health and infrastructure interruptions. Therefore, understanding the impact disparities have on service access and experience is essential for a resilient mental health system. Our research objective was to identify the characteristics of children entering the Wisconsin Child Welfare Services system for the first time from 2015 to 2020 and investigate disparities by gender, race, age, and mental health assessments. We further explored differences in years before Covid-19 and during the initial year of the pandemic by examining a composite dataset (N= 9979) of all Wisconsin child welfare placement and Child and Adolescent Strengths and Needs assessments (CANS) from 2015 to 2020. Descriptive analyses were conducted on demographic variables, child placement, and assessments, including frequencies and prevalence ratios. In 2020, 1,314 new children entered the welfare system for the first time, a 24.2% decrease in children compared to the average of 1,733 from 2015 to 2019. Race, age, mental health needs, and welfare placement remained relatively stable. The most significant difference from 2020 to the prior years was the total drop in children entering the welfare system for the first time. Our final objective was to investigate the characteristics of children who entered the welfare system in 2020 and identify relationships that explain how some children still entered the welfare system and other children did not. We investigated spatial relationships and used causal inferential methods to identify the expected versus actual new children entering the system in 2020. Overall, we conclude that there is a critical need for more research assessing the relationship between children’s mental health services and disaster trauma and recovery. The studies conclude a gender and age-based disparity in access and efficiency of children’s mental health services. The studies also identify the need for greater resource distribution and organizational structure. Our findings suggest that children had relatively stable needs in 2020 and found a significant decrease in children entering the system for the first-time coinciding with lockdowns but post-lockdown the number of children entering the system remained low. Our research suggests a need for household level research investigating child removal, household status, and post-2020 welfare system evaluations.

Digital Object Identifier (DOI)

https://doi.org/10.13023/etd.2023.234

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Available for download on Monday, May 12, 2025

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