Addressing System Challenges in Mental Health Services Research for Youth in the Child Welfare System: Insights From the Foster Care Family Navigator Trial

Child welfare-involved (CWI) youth have high rates of unaddressed mental health needs, and system-level barriers (e.g., inadequate coordination between child welfare agencies and other systems designed to serve CWI youth) are one major reason why disparities in mental health services' access continue to persist for CWI youth. This Research Note aims to inform the mental health services field about system-level challenges to conducting real-world, health services research with CWI youth and their families. We present challenges experienced in conducting our NIMH-funded Foster Care Family Navigator (FCFN) trial focused on development and preliminary testing of a clinic-embedded navigation intervention designed to improve detection of foster care youth services need, linkage to and engagement in community-based mental health services. Systems-level challenges that impacted proposed research trial design and data collection included: (1) Limited system staff time and compensation processes; (2) Staff training and knowledge; and (3) System disruptions. Health services research geared toward increasing access to mental health services to CWI youth must incorporate multiple complex design considerations prior to intervention development and delivery including longer (than 12 months) intervention development phases, detailed contingency plans for intervention delivery and integrated tailored, ongoing support and training for staff with existing clinic workflows. In this way, structural challenges to access to care that researchers are trying to ameliorate for CWI and other underserved, minoritized populations are not being inadvertently perpetuated through research study designs.