Mental Health Referrals From Child Protective Services: Understanding the Routes to Safety and Support
Adverse childhood experiences are linked to higher rates of depression, anxiety, post-traumatic stress disorder (PTSD), substance use, and disruptive behavior disorders.
The main duty of Child Protective Services (CPS) is to protect children from immediate harm. However, a child can be physically safe yet remain in psychological freefall if trauma and emotional distress go untreated.
Therefore, CPS caseworkers are also expected to recognize the need for a mental health referral. They set in motion a structured process to connect children and families with professional care.
If you’d like to learn more about how mental health referrals from child protective services work, a mental health professional can guide you on this process. This page can also help, guiding you through all you need to know about mental health referrals from CPS, including:
What a mental health referral from child protective services is- The role of CPS in mental health
- Types of referrals made by child protective services
- Where to find continued care after a CPS referral
What Is a Mental Health Referral From Child Protective Services?
A mental health referral from CPS is a formal, documented step designed to protect a child’s long-term well-being. It’s when the agency identifies a child’s psychological or emotional needs as significant enough to require professional intervention. Therefore, the Family First Prevention Services Act (FFPSA) requires CPS to consider mental health, substance abuse, and parenting support as core services.3
Untreated mental health issues often sit at the core of child welfare cases. For this reason, the U.S. Department of Health and Human Services and the Child Welfare Information Gateway both emphasize that emotional and behavioral health are inseparable from child safety.
To put this information into context, a parent struggling with severe depression might be unable to meet their child’s basic needs. Or, a child with untreated trauma may exhibit aggression that a caregiver cannot manage.
The referral, then, serves two functions:
It protects the child from further harm.- It gives the family a chance at stability.
The following section takes a closer look at how the CPS referral process works to protect a child’s well-being.
The Role of Child Protective Services in Mental Health
CPS follows a structured approach to handling mental health-related cases. The following is a breakdown of what goes into the mental health referral process.
Initial Investigation and Risk Assessment
After the investigation, CPS workers conduct a systematic assessment. They use evidence-based tools like the Structured Decision Making® (SDM) model or state-mandated safety assessment tools to assess the following:4
Caregiver factors: Including a history of violence, untreated psychiatric disorders, substance misuse, or prior CPS involvement- Child factors. Such as age, developmental stage, observable distress, or presence of behavioral red flags (for example, withdrawal, aggression, self-harm, or regression)
- Environmental context: For instance, housing stability, financial strain, social support, or exposure to domestic violence
- Collateral information: Including insights from teachers, healthcare providers, and extended family members who know the child’s daily routine
Determining the Need for Mental Health Intervention
The decision-making process takes into account behavioral and psychological indicators observed during the investigation. For example, children who display persistent nightmares, hypervigilance, self-injury, sudden aggression, withdrawal, or unexplained developmental delay are flagged for deeper review.
CPS also uses mental health screening tools, such as the Child Behavior Checklist (CBCL). The results of such tools are then paired with collateral input.5
Parental mental illness or substance use disorders also warrant child mental health intervention as part of the protective response.6
Formal Referral to Services
The investigation summary- Risk assessment results
- Behavioral screenings
- Medical history
- School reports
This combination of information ensures the clinician has a comprehensive baseline before the first session. In some states, CPS is required to file this referral with the juvenile court so it becomes part of the official record.
Children are matched with the kind of service their current state of health requires. For example, a child with PTSD symptoms after abuse will likely be referred to a clinician trained in trauma-focused cognitive behavioral therapy (TF-CBT). Alternatively, a teen with escalating substance use may be connected to an integrated dual-diagnosis program.
Most CPS-involved children qualify for Medicaid. Medicaid provides health coverage to about 36% of children in the U.S., 16% of women aged 18-64, and most families living below the poverty line.7 Its benefits include a wide range of proven mental health and disorder therapies.
Additionally, the Family First Prevention Services Act of 2018 allows states to use Title IV-E child welfare funds to support mental health and substance use disorder treatments.3 It also covers in-home parenting programs that help build practical skills.
Matching With the Right Kind of Care
Matching children and families with the right kind of care is one of the most high-stakes responsibilities of CPS. The main tiers of care include:
- Outpatient therapy: This includes scheduled sessions in community clinics, schools, or private practices. Caseworkers track attendance and flag missed sessions as red alerts for deeper engagement barriers. They may also convene check-ins to resolve obstacles to therapy.
- Residential treatment: Children with psychiatric instability or repeated lack of response to treatments may be placed in residential treatment programs. For example, CPS may try to integrate trauma therapy, education, and life skills into a coherent plan.
- Foster care youth and therapeutic support: CPS often provides foster parents with consultation and training on trauma-informed caregiving. They also link foster homes with crisis support to stabilize placements.
Service Coordination and Follow-up
If therapy isn’t working, CPS is obligated to adjust the plan and escalate to more intensive programs.
CPS follow-up tasks often include:
Confirming appointment scheduling and attendance with providers- Coordinating transportation support (for example, Medicaid rides, transport vouchers, or caseworker drop-offs)
- Reviewing provider treatment notes and integrating them into case plans
- Holding multidisciplinary team meetings to align schools, therapists, and caregivers
- Adjusting service plans if therapy is ineffective or the child’s needs change
- Conducting direct check-ins with children and caregivers to assess real-world progress
- Documenting compliance and outcomes for federal/state oversight reviews
Types of Referrals Made by Child Protective Services
A mental health referral from CPS may be individual for the child or their parents. In some cases, a combined approach involving the family may be used. The following sections provide a breakdown of the services that can be received through these referrals.
Child-Specific Services
Child-specific services are the most direct and immediate category of referrals CPS makes. A classic example is referral to outpatient cognitive behavioral therapy.
For children who show developmental delay, CPS may trigger an early intervention referral under the Individuals with Disabilities Education Act (IDEA Part C).9 This can connect the child to speech therapy, occupational therapy, or specialized developmental programs.
A CPS referral can also push a school district to expedite an Individualized Education Program (IEP) evaluation if the child’s trauma-related behavior is interfering with academic achievement.10
Parent/Caregiver Services
Even the most suitable form of therapy for a child can be undermined if the caregiving environment remains unsafe. CPS referrals acknowledge that you can’t heal children in isolation from the adults raising them.
CPS directs parents to interventions that tackle both skill-building and underlying psychosocial barriers. Parent-child interaction therapy (PCIT) or the Positive Parenting Program are some evidence-based therapy examples for parents. They involve coaching, modeling, and feedback during real-time parent-child interactions.11,12
CPS referrals can also include individual psychotherapy for parents. This can give them a structured outlet for processing stress, depression, trauma, or anger. Unfortunately, each of these issues is disproportionately common in families involved with child welfare.
States can also use Title IV-E funds for evidence-based mental health treatment programs that allow parents to receive care without losing custody prematurely.13
Family-Focused Services
Some CPS mental health referrals target the family unit. Family therapy is delivered through clinically established models, like functional family therapy (FFT) or multisystemic therapy (MST).
Unlike individual counseling, these sessions pull parents and children into the room together to hash out dysfunctional communication patterns.
CPS in some states also provides wraparound services. This model brings together a team of caseworkers, therapists, school staff, and community providers to develop an individualized plan that aims to address the whole family’s needs.
The intent of these services is to prevent unnecessary out-of-home placements by surrounding the family with coordinated resources. For instance, wraparound services have been shown to reduce behavioral health crises and keep children safely in their homes.
Trauma-Informed Services
Children in the child welfare system have higher rates of PTSD and complex trauma. Unlike an adult who can sometimes distance themselves from a harmful environment, children are often trapped in such situations during their most formative years.
Trauma therapy for children involved with CPS includes evidence-based approaches that aim to recalibrate the child’s nervous system, such as:
- Trauma-focused cognitive behavioral therapy (TF-CBT): One of the most rigorously studied treatments for traumatized youth, it combines cognitive restructuring with relaxation skills and gradual exposure to traumatic memories.
- Attachment therapy post-CPS intervention: When a child has been removed from their home, their ability to trust is often compromised. Attachment-based interventions help to rebuild secure bonds with foster, adoptive, or reunified caregivers.
- Eye movement desensitization and reprocessing (EMDR): EMDR targets how trauma is stored in the nervous system. It does so by pairing bilateral stimulation (eye movements or tapping) with trauma recall.
- Play therapy: For younger children who can’t verbalize their trauma, play therapy can act as an outlet to externalize fears and rehearse new solutions. Research notes strong outcomes of child-centered play therapy in reducing anxiety, aggression, and trauma symptoms.14
Partner With Mission Connection Healthcare for Therapy After a CPS Referral
Mission Connection specializes in explaining treatment options, preparing for therapy sessions, and advocating for the right level of care.
We offer online consultations, outpatient counseling, partial hospitalization programs, and full inpatient treatment when safety and stability demand round-the-clock care.
All our treatment programs are delivered in safe, supportive settings and led by experienced mental health professionals. Across every program, our services are grounded in evidence-based, trauma-informed approaches.
To learn more about therapy options at Mission Connection, call us or get in touch online.
References
- Meng, J. F., & Wiznitzer, E. (2024). Factors associated with not receiving mental health services among children with a mental disorder in early childhood in the United States, 2021–2022. Preventing Chronic Disease, 21, E126. https://doi.org/10.5888/pcd21.240126
- ChildCare.gov. (2025). Child protective services. https://childcare.gov/consumer-education/other-support-and-resources/child-protective-services
- Child Welfare Information Gateway. (2018, February). Family First Prevention Services Act – P.L. 115-123. https://www.childwelfare.gov/resources/family-first-prevention-services-act-pl-115-123/
- Evident Change. (2025, March 17). SDM® model in child protection. https://evidentchange.org/child-welfare/
- American Psychological Association. (2001). Child behavior checklist (CBCL). https://www.apa.org/depression-guideline/child-behavior-checklist.pdf
- Reedtz, C., van Doesum, K., Signorini, G., et al. (2019). Promotion of wellbeing for children of parents with mental illness: A model protocol for research and intervention. Frontiers in Psychiatry, 10, 606. https://doi.org/10.3389/fpsyt.2019.00606
- Mark, T. L., Dolan, M., Allaire, B., et al. (2024). Untreated psychiatric and substance use disorders among caregivers with children reported to child protective services. JAMA Health Forum, 5(4), e240637. https://doi.org/10.1001/jamahealthforum.2024.0637
- Administration for Children and Families. (2022, September 22). Child & Family Services Reviews (CFSRs). https://acf.gov/cb/monitoring/child-family-services-reviews
- Dragoo, K. (2025). The Individuals with Disabilities Education Act (IDEA), Part C: Early intervention for infants and toddlers with disabilities. Congress.gov. https://www.congress.gov/crs-product/R43631
- Chicago Public Schools. (2025). Special education process. https://www.cps.edu/services-and-supports/special-education/process/
- Lieneman, C., Brabson, L., Highlander, A., Wallace, N., & McNeil, C. (2017). Parent–child interaction therapy: Current perspectives. Psychology Research and Behavior Management, 10, 239–256. https://doi.org/10.2147/prbm.s91200
- Sanders, M. R. (2023). The Triple P system of evidence-based parenting support: Past, present, and future directions. Clinical Child and Family Psychology Review, 26(4), 707–722. https://doi.org/10.1007/s10567-023-00441-8
- Weiser, R. (2020). Planning Title IV-E prevention services: A toolkit for states, introduction to the toolkit. Mathematica Policy Research Reports. https://ideas.repec.org/p/mpr/mprres/37482a3d370241f1bfa86a4bb7e2e223.html
- Humble, J. J., Summers, N. L., Villarreal, V., et al. (2018). Child-centered play therapy for youths who have experienced trauma: A systematic literature review. Journal of Child & Adolescent Trauma, 12(3), 365–375. https://doi.org/10.1007/s40653-018-0235-7
