“If We’re Going to Change Things, It Has to Be Systemic:” Systems Change in Children’s Mental Health (original) (raw)
Related papers
Evaluating systems of care: Missing links in children's mental health research
Journal of Community Psychology, 2004
Systems of care (SOCs) have been developed throughout the country to meet the needs of children with severe emotional disturbances (SED) and their families. In these SOCs, multiple agencies and disciplines are expected to work together with informal community supports to address families' needs . A review of the literature on the impact of SOCs suggests: (a) communities' service delivery systems change; and (b) children experience modest improvements in symptomatology and functioning. At the same time, little is known about (a) which components of the SOC approach, at what levels, are necessary to impact child and family outcomes; (b) the degree to which SOCs affect other family members, beyond the target child; and (c) the impact of community contexts and supports in SOCs. Future research should improve measurement of key SOC constructs, examine the relation between specific levels of implementation and outcomes for the entire family, and investigate the impact of broader community systems and supports on families within SOCs.
2001
This document is part of a series designed to provide. guidance for communities and caregivers interested in building exemplary systems of care and to give systems builders the latest available information about how .best to help and serve and support children who live with serious emotional disturbances at home and in their communities. The monographs show that the Comprehensive Community Mental Health Services for Children and Their Families Program has evaluated and developed promising practices that directly improve the health and lives of children and families throughout the country. This volume explores the ever-burgeoning conviction in a growing community of providers, advocates, and families that wraparound services are simply better, cheaper, and more humane than conventional service delivery processes for families with children with serious emotional disturbance. Through the stories of six families who have received individualized services and supports, the wraparound process is shown to support their strengths and meet their needs. Following the six case studies, the final chapter presents a qualitative, cross-site analysis that integrates and summarizes the observations and lessons learned from the six wraparound stories. Appendices include a conceptual framework for this volume.
The Sustainability of Systems of Care for Children’s Mental Health: Lessons Learned
The Journal of Behavioral Health Services & Research, 2007
The federal Comprehensive Community Mental Health Services for Children and Their Families Program was initiated in 1992 to provide grants to states, communities, territories, and Indian tribes to develop systems of care to serve children and adolescents with or at risk for emotional disorders and their families. As part of the national evaluation of this program, a study was undertaken to assess the ability of funded sites to sustain their systems of care beyond the federal grant period. The study involved a web survey and telephone interviews with local and state respondents to examine the extent to which key components of systems of care were maintained during the period in which federal funds were phasing out and during the postgrant period. Study results demonstrate positive and negative changes that occurred in the communities which are included in the sample, with respect to maintaining the availability of each service included in the broad service array, the implementation of system of care principles, the system of care infrastructure, and the achievement of system of care goals. In addition, results identify factors that contribute to or impede the ability to sustain systems of care, and the effectiveness of various strategies for sustainability. Study findings offer guidance not only to federally funded system of care communities but also to nonfunded communities engaged in system of care development to enhance their ability to sustain systems of care for this population over time. Findings will also assist federal, state, and local policymakers, technical assistance providers, family members, advocates, and other key stakeholders to more effectively support the development of viable, sustainable systems of care.
Children & Schools, 2013
This study explored the relationship between the level of systems collaboration with schools and outcomes for children diagnosed with serious emotional disorder and their families involved in integrative family and systems treatment, a home-based treatment program. Using data collected from 38 clients and their families, this study used a structural equation model to explore how systems collaboration with schools influenced children's behavioral outcomes, parental competence, and family functioning. The squared multiple correlations from endogenous variables of the final model accounted for 31 percent of the variance in problem severity in children, 38 percent of the variance in level of functioning in children, 30 percent of the variance in parental competence with children, and 41 percent of the variance in family functioning. The final model indicated the following: Systems collaboration with schools positively influenced parental competence with children, which positively predicted level of functioning in children and negatively predicted problem severity in children. Although the limited sample size of the study precludes any definitive conclusions, implications of the study on the potential role of systems collaboration with schools in treating families with at-risk children or adolescents are explored and discussed.
Applied and Preventive Psychology, 1997
This article examines research on systems of care, which are acknowledged as the current dominant paradigm in the delivery of children's mental health services. The authors conclude that systems of care produce important systemlevel changes. Early results suggest that these systems changes do not impact clinical outcomes, however. One plausible explanation for this finding is that system interventions are too far removed from the actual delivered services, thereby limiting their potential impact. Moreover, numerous assumptions underlying the purported effectiveness of systems of care remain unvalidated. The authors propose that the primary direction to improving children's mental health services should be through effectiveness research, in contrast to continued large-scale investments in systems research and development. Recommendations are made for addressing methodological problems that researchers will confront and for developing policies encouraging future research on the effectiveness of children's mental health services.
Psychiatric services (Washington, D.C.), 1997
This study compared six-month functional and symptom outcomes of children and adolescents with serious emotional disturbance who received services in an exemplary system of care with outcomes of children who received traditional care. The system of care offers a comprehensive and coordinated network of mental health and other necessary services. The study used a randomized longitudinal experimental design. Baseline data on symptoms, functioning, and family characteristics were collected from 350 families selected from among those who sought services for children from community agencies in Stark County, Ohio. The families were randomly assigned to either the experimental group, which received services from the system of care, or the control group, which received usual care in the community. Six-month outcome measures of children's symptoms and functioning were compared for the two groups. Although access to care and the amount of care received increased under the system of care, ...
1991
Children with serious emotional disorders receive inadequate and inappropriate services, rather than the comprehensive and coordinated system of care needed. To develop the knowledge needed to provide adequate and appropriate services, an alliance is needed among advocates, practitioners, and researchers. The Mental Health Services Program for Youth, supported by the Robert Wood Johnson Foundation, is a demonstration program intended to develop comprehensive and coordinated systems of mental health care. The community-level projects supported by the program develop such services as case management, emergency services, respite care, and therapeutic foster care. Each project incorporates a plan for integrating services and financial resources for children served by multiple agencies and service systems. A quasi-experimental design is being used to evaluate the program, by context, process, and outcome and by organizational, financial, and client characteristics. The evaluation design involves an interview-based organizational assessment, use of a management information system to assess client data, and a case conference involving input from all members of the clinical team. The importance of bridging the gap between theoretical and empirical knowledge to improve the current delivery system is stressed.