Racial/Ethnic Disparities in Children's Receipt of Mental Health Assessment

Previous studies document racial/ethnic disparities in many aspects of children’s mental health care.  Racial/ethnic minority children and youths are less likely to receive needed mental health services.  Recent studies emphasize the relationship between schools and children’s health.  They suggest that schools often play a significant role in the referral process for children’s mental health problems. 

The purpose of this study is to investigate the significance of school characteristics, including peer characteristics, in mental health help-seeking processes.   This study focuses on the determinants of professional mental health evaluation, and on how school characteristics can contribute to racial/ethnic differences in help-seeking behaviors.  The empirical work relies on the Early Childhood Longitudinal Study, Kindergarten Cohort (ECLS-K), which consists of a nationally representative cohort of kindergarteners who are followed through 8th grade. 

The empirical analysis first relates children's receipt of any mental health assessment to race/ethnicity and other background characteristics, controlling for severity of mental health problems.  School characteristics, then, are included to see how the coefficients on race/ethnicity change. 

In the model without school-related variables, children in black, Hispanic, Asian, and "other" categories are less likely to be professionally evaluated even when covariates including gender, age, SES, symptom level, cognitive ability, and other family characteristics are controlled for.  However, the magnitudes are attenuated by 10 to 20 percent by inclusion of school-related variables.  Results are robust to the use of alternative measures of severity of mental health problems.

To confirm the significance of assessment in various steps of mental health help-seeking, two additional analyses are conducted.  Firstly, it is found that school-related variables are generally unrelated to the likelihood of diagnosis conditional on assessment.  Secondly, while parents of black children are less likely to have concerns about children's mental health after controlling for symptom scores calculated from teacher-assessed behavior, school-related variables with the exception of private school status are unrelated to having concerns.  

The empirical results make a case for the concentration hypothesis, i.e. cross-school differences in school characteristics explain some portion of the racial/ethnic disparities.  That school characteristics have little impact on the probability of a diagnosis conditional on assessment implies that schools' influences on mental health diagnosis processes take place primarily in the assessment step.