Mental Health Services Research

, Volume 7, Issue 4, pp 243–259 | Cite as

The ARC Organizational and Community Intervention Strategy for Implementing Evidence-Based Children's Mental Health Treatments

Abstract

This paper reviews the implications of organizational and community intervention research for the implementation of effective mental health treatments in usual community practice settings. The paper describes an organizational and community intervention model named ARC for Availability, Responsiveness and Continuity, that was designed to support the improvement of social and mental health services for children. The ARC model incorporates intervention components from organizational development, interorganizational domain development, the diffusion of innovation, and technology transfer that target social, strategic, and technological factors in effective children's services. This paper also describes a current NIMH-funded study that is using the ARC intervention model to support the implementation of an evidence-based treatment, Multisystemic Therapy (MST), for delinquent youth in extremely rural, impoverished communities in the Appalachian Mountains of East Tennessee.

Keywords

evidence-based practices organizational change community development delinquency rural mental health 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Aldrich, H., & Herker, D. (1977, April). Boundary spanning roles and organization structure. Academy of Management Review, 2(2), 217–230.Google Scholar
  2. Backer, T. E., David, S. L., & Soucy, G. (1995). Introduction. In T. E. Backer, S. L. David, & G. Soucy (Eds.), Reviewing the behavioral science knowledge base on technology transfer (National Institute on Drug Abuse Monograph Series, 155, pp. 1–20). Rockville, MD: U.S. Department of Health and Human Services, PHS, NIH.Google Scholar
  3. Bandura, A. (1986). Social foundations of thought: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  4. Bartel, C. A. (2001). Social comparisons in boundary-spanning work: Effects of community outreach on members' organizational identity and identification. Administrative Science Quarterly, 46, 379–413.Google Scholar
  5. Beer, M. (1980). Organization change and development: A systems view. Santa Monica: Goodyear.Google Scholar
  6. Beeson, P. G., Britain, C., Howell, M. L., Kirwan, D., & Sawyer, D. A. (1998). Rural mental health at the millennium. In R. W. Manderscheid & M. J. Henderson (Eds.), Mental health, United States, 1998 (Vol. DHHS Publication No. SMA 99-3285, pp. 82–97). Center for Mental Health Services, Washington, DC: Supt. of Documents, U.S. Government Printing Office.Google Scholar
  7. Bennis, W. G. (1966). Changing organizations. New York: McGraw-Hill.Google Scholar
  8. Bergland, B. (1988). Rural mental health: Report of the National Action Commission on the Mental Health of Rural Americans. Journal of Rural Community Psychology, 9, 29–39.Google Scholar
  9. Bierman, K. L. (1997). Implementing a comprehensive program for the prevention of conduct problems in rural communities: The Fast Track experience. American Journal of Community Psychology, 25, 493–514.CrossRefPubMedGoogle Scholar
  10. Bjorklund, R. W., & Pippard, J. L. (1999). The mental health consumer movement: Implications for rural practice. Community Mental Health Journal, 35, 347–359.CrossRefPubMedGoogle Scholar
  11. Blake, R. R., Shepard, H. A., & Mouton, J. S. (1964). Managing intergroup conflict in industry. Houston, TX: Gulf.Google Scholar
  12. Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press.Google Scholar
  13. Burns, B. J., Costello, E. J., Angold, A., Tweed, D., Stangl, D., Farmer, E. M. Z., & Erkanli, A. (1995). Children's mental health service use across service sectors. Health Affairs, 14, 147–159.CrossRefPubMedGoogle Scholar
  14. Burns, B. J., Hoagwood, K., & Mrazek, P. J. (1999). Effective treatment for mental disorders in children and adolescents. Clinical Child and Family Psychology Review, 2, 199–254.CrossRefPubMedGoogle Scholar
  15. Burke, W. W. (1974). Managing conflict between groups. In J. D Adams (Ed.), Theory and method in organization development: An evolutionary process. Arlington, VA: NTL Institute for Applied Behavioral Sciences.Google Scholar
  16. Burke, W. W. (1993). Organization development (2nd ed.). Reading, MA: Addison-Wesley.Google Scholar
  17. Caldwell, D. F., & O'Reilly, C. A. (1982). Boundary spanning and individual performance: The impact of self-monitoring. Journal of Applied Psychology, 67, 124–127.Google Scholar
  18. Callister, R. R., & Wall, J. A. (2001). Conflict across organizational boundaries: Managed care organizations versus health care providers. Journal of Applied Psychology, 86, 754–763.CrossRefPubMedGoogle Scholar
  19. Children's Mental Health Services Research Center. (1998). The ARC initiative. Knoxville, TN: Author.Google Scholar
  20. Chorpita, B. F., Yim, L. M., Donkervoet, J. C., Arensdorf, A., Amundsen, M. J., et al. (2002). Toward large-scale implementation of empirically supported treatments for children: A review and observations by the Hawaii empirical basis to services task force. Clinical Psychology Science and Practice, 9, 165–230.Google Scholar
  21. Conger, R. D., Ge, X., Elder, G. H., Lorenz, F. O., & Simons, R. L. (1994). Economic stress, coercive family process, and developmental problems of adolescents. Child Development, 65, 541–561.PubMedGoogle Scholar
  22. Costello, E. J., Angold, A., Burns, B. J., Erkanli, A., Stangl, D. K., & Tweed, D. L. (1996). The Great Smoky Mountains Study of Youth: Functional impairment and serious emotional disturbance. Archives of General Psychiatry, 53, 1137–1143.PubMedGoogle Scholar
  23. Costello, E. J., Angold, A., Burns, B. J., Stangl, D. K., Tweed, D. L., & Erkanli, A. (1996). The Great Smoky Mountains Study of Youth: Goals, design, methods, and the prevalence of DSM-III-R disorders. Archives of General Psychiatry, 53, 1129–1136.PubMedGoogle Scholar
  24. Costello, E. J., Farmer, E. M. Z., Angold, A., Burns, B. J., & Erkanli, A. (1997). Psychiatric disorders among American Indian and White youth in Appalachia: The Great Smoky Mountains Study. American Journal of Public Health, 87, 827–832.PubMedCrossRefGoogle Scholar
  25. Dazal, I., & Thomas, J. (1968). Developing a new organization. Journal of Applied Behavioral Science, 4, 473–506.Google Scholar
  26. Dyer, W. G. (1977). Team building: Issues and alternatives. Reading, MA: Addison-Wesley.Google Scholar
  27. Edwards, D. L., Schoenwald, S. K., Henggeler, S. W., & Strother, K. B. (2001). A multi-level perspective on the implementation of Multisystemic Therapy (MST): Attempting dissemination with fidelity. In G. A. Bernfeld, D. P. Farrington, & A. W. Leschied (Eds.), Offender rehabilitation in practice: Implementing and evaluating effective programs (pp. 97–120). London: Wiley.Google Scholar
  28. Farias, G., & Johnson, H. (2000). Organizational development and change management: Setting the record straight. Journal of Applied Behavioral Science, 36, 376–379.Google Scholar
  29. Fox, J. C., Berman, J., Blank, M., & Rovnyak, V. G. (1999). Mental disorders and help seeking in a rural impoverished population. International Journal of Psychiatry in Medicine, 29, 181–195.PubMedGoogle Scholar
  30. Fox, J. C., Blank, M., Rovnyak, V. G., & Barnett, R. Y. (2001). Barriers to help seeking for mental disorders in a rural impoverished population. Community Mental Health Journal, 37, 421–436.CrossRefPubMedGoogle Scholar
  31. Fox, J., Merwin, E., & Blank, M. (1995). Defacto mental health services in the rural south. Journal of Health Care for the Poor and Underserved, 6, 434–468.PubMedGoogle Scholar
  32. French, W. L., & Bell, C. H. (1984). Organization development: Behavioral science interventions for organization improvement (3rd ed.). Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  33. Fried, B. J., Johnsen, M. C., Starrett, B. E., Calloway, M. O., & Morrissey, J. P. (1998). An empirical assessment of rural community support networks for individuals with severe mental disorders. Community Mental Health Journal, 34, 39–56.CrossRefPubMedGoogle Scholar
  34. Glisson, C. (1978). Dependence of technological routinization on structural variables in human service organizations. Administrative Science Quarterly, 23, 383–395.PubMedGoogle Scholar
  35. Glisson, C. (1992). Structure and technology in human service organizations. In Y. Hasenfeld (Ed.), Human services as complex organizations. Beverly Hills, CA: Sage.Google Scholar
  36. Glisson, C. (1994). The effect of services coordination teams on outcomes for children in state custody. Administration in Social Work, 18, 1–23.PubMedGoogle Scholar
  37. Glisson, C. (1996). Judicial and service decisions for children entering state custody: The limited role of mental health. Social Service Review, 70, 257–281.CrossRefGoogle Scholar
  38. Glisson, C. (2002). The organizational context of children's mental health services. Clinical Child and Family Psychology Review, 5, 233–252.CrossRefPubMedGoogle Scholar
  39. Glisson, C., Bailey, J., & Post, J. A. (2000). Predicting the time children spend in state custody. Social Service Review, 74, 253–280.CrossRefGoogle Scholar
  40. Glisson, C., Dukes, D., & Green, P. (in press). The effects of the ARC organizational intervention on caseworker turnover, climate, and culture in children's service systems. Child Abuse and Neglect.Google Scholar
  41. Glisson, C., & Durick, M. (1988). Predictors of job satisfaction and organizational commitment in human service organizations. Administrative Science Quarterly, 33, 61–81.Google Scholar
  42. Glisson, C., & Hemmelgarn, A. L. (1998). The effects of organizational climate and interorganizational coordination on the quality and outcomes of children's service systems. Child Abuse & Neglect, 22, 401–421.CrossRefGoogle Scholar
  43. Glisson, C., & James, L. R. (2002). The cross-level effects of culture and climate in human service teams. Journal of Organizational Behavior, 23, 767–794.CrossRefGoogle Scholar
  44. Gray, B. (1985). Conditions facilitating interorganizational collaboration. Human Relations, 38, 911–936.Google Scholar
  45. Gray, B. (1990). Building interorganizational alliances: Planned change in a global environment. Research in Organizational Change and Development, 4, 101–140.Google Scholar
  46. Guzzo, R. A., Jette, R. D., & Katzell, R. A. (1985). The effects of psychologically based intervention programs on worker productivity: A meta-analysis. Personnel Psychology, 38, 275–291.Google Scholar
  47. Hackman, J. R., & Oldham, G. R. (1980). Work redesign. Reading, MA: Addison-Wesley.Google Scholar
  48. Haley, J. (1976). Problem solving therapy. San Francisco: Jossey-Bass.Google Scholar
  49. Halliday-Boykins, C. A., & Henggler, S. W. (2001). Multisystemic Therapy: Theory, research, and practice. In E. Walton, P. A. Sandau-Beckler, & M. Mannes (Eds.), Balancing family-centered services and child well-being (pp. 320–335). New York: Columbia University Press.Google Scholar
  50. Hemmelgarn, A. L., Glisson, C., & Dukes, D. (2001). Emergency room culture and the emotional support component of Family-Centered Care. Children's Health Care, 30, 93–110.CrossRefGoogle Scholar
  51. Henggeler, S. W., Melton, G. B., Brondino, M. J., Scherer, D. G., & Hanley, J. H. (1997). Multisystemic therapy with violent and chronic juvenile offenders and their families: The role of treatment fidelity in successful dissemination. Journal of Consulting and Clinical Psychology, 65, 821–833.CrossRefPubMedGoogle Scholar
  52. Henggeler, S. W., Pickrel, S. G., & Brondino, M. J. (1999). Multisystemic treatment of substance abusing and dependent delinquents: Outcomes, treatment fidelity, and transportability. Mental Health Services Research, 1, 171–184.CrossRefPubMedGoogle Scholar
  53. Henggeler, S. W., & Schoenwald, S. K. (1998). The MST supervisory manual: Promoting quality assurance at the clinical level. Charleston, SC: MST Institute.Google Scholar
  54. Henggeler, S. W., & Schoenwald, S. K. (1999). The role of quality assurance in achieving outcomes in MST programs. Journal of Juvenile Justice and Detention Services, 14, 1–17.Google Scholar
  55. Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (1998). Multisystemic treatment of antisocial behavior in children and adults. New York: Guilford.Google Scholar
  56. Henggeler, S. W., Schoenwald, S. K., Liao, J. G., Letourneau, E. J., & Edwards, D. L. (2002). Transporting efficacious treatment to field settings: The link between supervisory practices and therapist fidelity in MST programs. Journal of Child and Adolescent Psychology, 31, 155–167.Google Scholar
  57. Hill, C. E., & Fraser, G. J. (1995). Local knowledge and rural mental health reform. Community Mental Health Journal, 31, 553–568.CrossRefPubMedGoogle Scholar
  58. Hohmann, A. A., & Shear, M. K. (2002). Community-based intervention research: Coping with the noise of real life in study design. American Journal of Psychiatry, 159, 201–207.CrossRefPubMedGoogle Scholar
  59. Hoyt, D. R., Conger, R. D., Valde, J. G., & Weihs, K. (1997). Psychological distress and help seeking in rural America. American Journal of Community Psychology, 25, 449–470.CrossRefPubMedGoogle Scholar
  60. Huey, S. J., Henggeler, S. W., Brondino, M. J., & Pickrel, S. G. (2000). Mechanisms of change in multisystemic therapy: Reducing delinquent behavior through therapist adherence and improved family and peer functioning. Journal of Consulting and Clinical Psychology, 68, 451–467.CrossRefPubMedGoogle Scholar
  61. Human, J., & Wasem, C. (1991). Rural mental health in America. American Psychologist, 46, 232–239.CrossRefPubMedGoogle Scholar
  62. Institute of Medicine. (1998). Bridging the gap between practice and research: Forging partnerships with community-based drug and alcohol treatment. Washington, DC: National Academy Press.Google Scholar
  63. Isserman, A. M. (1996). Socio-economic review of Appalachia: Appalachia then and now: An update of “The Realities of Deprivation” reported to the President in 1964. Washington, DC: Appalachian Regional Commission.Google Scholar
  64. Jones, L. R., McDanal, C. E., & Parlour, R. R. (1985). Children. In L. R. Jones & R. R. Parlour (Eds.), Psychiatric services for underserved rural populations (pp. 241–265). New York: Brunner/Mazel.Google Scholar
  65. Kane, C. F., & Ennis, J. M. (1996). Health care reform and rural mental health: Severe mental illness. Community Mental Health Journal, 32, 445–462.CrossRefPubMedGoogle Scholar
  66. Katz, D., & Kahn, R. L. (1978). The social psychology organizations (2nd ed.). New York: Wiley.Google Scholar
  67. Kazdin, A. E., & Weisz, J. R. (1998). Identifying and developing empirically supported child and adolescent treatments. Journal of Consulting and Clinical Psychology, 66, 19–36.CrossRefPubMedGoogle Scholar
  68. Kendall, P. C., & Braswell, L. (1993). Cognitive-behavioral therapy for impulsive children (2nd ed.). New York: Guilford.Google Scholar
  69. Loeber, R., & Farrington, D. P. (1998). Serious and violent juvenile offenders: Risk factors and successful interventions. Thousand Oaks, CA: Sage.Google Scholar
  70. Lynch, J. W., Kaplan, G. A., & Salonen, J. T. (1997). Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse. Social Science and Medicine, 44, 809–819.PubMedGoogle Scholar
  71. Lynch, J. W., Kaplan, G. A., & Shema, S. J. (1997). Cumulative impact of sustained economic hardship on physical, cognitive, psychological, and social functioning. New England Journal of Medicine, 337, 1889–1895.CrossRefPubMedGoogle Scholar
  72. Martin, P. Y., & Glisson, C. (1989). Perceived structure: Welfare organizations in three societal cultures. Organization Studies, 10, 353–380.Google Scholar
  73. McGregor, D. M. (1960). The human side of enterprise. New York: McGraw-Hill.Google Scholar
  74. Melton, G. (1983). Ruralness as a psychological construct. In A. W. Childs & G. B. Melton (Eds.), Rural psychology. New York: Plenum Press.Google Scholar
  75. Michela, J. L., & Burke, W. W. (2000). Organizational culture and climate in transformations for quality and innovation. In N. M. Ashkanasy, C. P. M. Wilderom, & M. F. Peterson (Eds.), Handbook of organizational culture and climate (pp. 225–244). Thousand Oaks, CA: Sage.Google Scholar
  76. Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press.Google Scholar
  77. Molgaard, V. K. (1997). The extension service as key mechanism for research and services delivery for prevention of mental health disorders in rural areas. American Journal of Community Psychology, 25, 515–544.CrossRefPubMedGoogle Scholar
  78. Munger, R. L. (1993). Changing children's behavior quickly. Lanham, MD: Madison.Google Scholar
  79. Nadler, D. A., & Tushman, M. L. (1977). A diagnostic model for organizational behavior. In J. R. Hackman, E. E. Lawler, III, & L. W. Porter (Eds.), Perspectives on behavior in organizations (pp. 85–98). New York: McGraw-Hill.Google Scholar
  80. National Institutes of Health. (1999). Bridging science and service: A report by the National Advisory Mental Health Council's Clinical Treatment and Services Research Workgroup (NIH No. 99-4353). Rockville, MD: National Institutes of Health, National Institute of Mental Health.Google Scholar
  81. Neuman, G. A., Edwards, J. E., & Raju, N. S. (1989). Organizational development interventions: A meta-analysis of their effects on satisfaction and other attitudes. Personnel Psychology, 42, 461–489.Google Scholar
  82. Pasmore, W., Francis, C., Haldeman, J., & Shani, A. (1982). Sociotechnical systems: A North American reflection on empirical studies of the seventies. Human Relations, 35, 1179–1204.CrossRefGoogle Scholar
  83. Patton, R. D., & Cissell, W. B. (1990). Community organization: Traditional principles and modern applications. Johnson City, TN: Latchpins Press.Google Scholar
  84. Peterson, B. D., West, J., Tanielian, T. L., Pincus, H. A., Kohut, J., et al. (2001). Mental health practitioners and trainees. In R. W. Manderscheid & M. J. Henderson (Eds.), Mental health, United States, 2000 (DHHS Publication No. SMA 01-3537).Google Scholar
  85. Patten, T. (1981). Organizational development through team building. New York: Wiley.Google Scholar
  86. Porras, J. I. (1986). Organization development. In G. E. Germane (Ed.), The executive course: What every manager needs to know about the essentials of business. Reading, MA: Addison-Wesley.Google Scholar
  87. Porras, J. I., & Robertson, P. J. (1992). Organizational development: Theory, practice, and research. In M. D. Dunnette & L. M. Hough (Eds.), Handbook of industrial and organizational psychology (2nd ed., Vol. 3, pp. 719–822). Palo Alto, CA: Consulting Psychologists Press, Inc.Google Scholar
  88. Robertson, P. J., Roberts, D. R., & Porras, J. I. (1993). Dynamics of planned organizational changes: Assessing empirical support for a theoretical model. Academy of Management Journal, 36, 619–634.Google Scholar
  89. Robey, D., & Altman, S. (1982). Organization development: Progress and perspectives. New York: Macmillan.Google Scholar
  90. Rogers, E. M. (1995). Diffusion of innovations. New York: Free Press.Google Scholar
  91. Rosenheck, R. A. (2001). Organizational process: A missing link between research and practice. Psychiatric Services, 52, 1607–1612.PubMedGoogle Scholar
  92. Rousseau, D. M. (1977). Technological differences in job characteristics, employee satisfaction, and motivation: A synthesis of job design research and sociotechnical systems theory. Organizational Behavior and Human Performance, 19, 18–42.CrossRefGoogle Scholar
  93. Schoenwald, S. K. (1998). Multisystemic therapy consultation guidelines. Charleston, SC: MST Institute.Google Scholar
  94. Schoenwald, S. K., & Henggeler, S. W. (2004). A public health perspective on the transport of evidence-based practices. Clinical Psychology: Science and Practice, 11, 360–363.CrossRefGoogle Scholar
  95. Schoenwald, S. K., & Henggeler, S. W. (2003). Current strategies for moving evidence-based interventions into clinical practice: Introductory comments. Cognitive and Behavioral Practice, 10, 275–277.Google Scholar
  96. Schoenwald, S. K., Henggeler, S. W., Brondino, M. J., & Rowland, M. D. (2000). Multisystemic therapy: Monitoring treatment fidelity. Family Process, 39, 83–103.CrossRefPubMedGoogle Scholar
  97. Schoenwald, S. K., & Hoagwood, K. (2001). Effectiveness, transportability, and dissemination of interventions: What matters when? Psychiatric Services, 52, 1190–1197.CrossRefPubMedGoogle Scholar
  98. Schoenwald, S. K., Sheidow, A. J., & Letourneau, E. J. (2004). Toward effective quality assurance in evidence-based practice: Links between expert consultation, therapist fidelity, and child outcomes. Journal of Clinical Child and Adolescent Psychology.Google Scholar
  99. Schoenwald, S. K., Sheidow, A. J., Letourneau, E. J., & Liao, J. G. (2003). Transportability of Multisystemic Therapy: Evidence for multi-level influences. Mental Health Services Research, 5, 223–239.CrossRefPubMedGoogle Scholar
  100. Sherman, A. (1992). Falling by the wayside: Children in rural America. Washington, DC: Children's Defense Fund.Google Scholar
  101. Shortell, S. M., O'Brien, J. L., Carman, J. M., Foster, R. W., Hughes, E. F. X., Boerstler, H., et al. (1995). Assessing the impact of continuous quality improvement/total quality management: Concept versus implementation. Health Services Research, 30, 377–401.PubMedGoogle Scholar
  102. Spoth, R. (1997). Challenges in defining and developing the field of rural mental disorder preventive intervention research. American Journal of Community Psychology, 25, 425–448.CrossRefPubMedGoogle Scholar
  103. St. Lawrence, J. S., & Ndiaye, S. M. (1997). Prevention research in rural communities: Overview and concluding comments. American Journal of Community Psychology, 25, 545–562.CrossRefPubMedGoogle Scholar
  104. Steel, R. P., & Shane, G. S. (1986). Evaluation research on quality circles: Technical and analytical implications. Human Relations, 39, 449–468.CrossRefGoogle Scholar
  105. Tennessee Commission on Children and Youth. (2001). The state of the child in Tennessee 2000. Nashville, TN: Author.Google Scholar
  106. Tichy, N. M. (1983). Managing strategic change: Technical, political, and cultural dynamics. New York: Wiley.Google Scholar
  107. Torrey, W. C., Drake, R. E., Dixon, L., Burns, B. J., Flynn, L., et al. (2001). Implementing evidence-based practices for persons with severe mental illness. Psychiatric Services, 52, 45–50.PubMedGoogle Scholar
  108. Trist, E. (1985). Intervention strategies for interorganizational domains. In R. Tannenbaum, N. Margulies, & F. Massarik (Eds.), Human systems development. San Francisco: Jossey-Bass.Google Scholar
  109. U.S. Department of Health and Human Services. (1999). Mental health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health.Google Scholar
  110. U.S. General Accounting Office. (2003). Child welfare: HHS could play a greater role in helping child welfare agencies recruit and retain staff (GAO-03-357). Washington, DC: Author.Google Scholar
  111. Walton, R. E. (1987). Managing conflict: Interpersonal dialogue and third-party roles. Reading, MA: Addison-Wesley.Google Scholar
  112. Weisz, J. R., & Jensen, P. S. (1999). Efficacy and effectiveness of child and adolescent psychotherapy and pharmacotherapy. Mental Health Services Research, 1, 125–157.CrossRefPubMedGoogle Scholar
  113. Woodman, R. W. (1989). Organizational change and development: New arenas for inquiry and action. Journal of Management, 15, 205–228.Google Scholar
  114. Worren, N. A. M., Ruddle, K., & Moore, K. (1999). From organizational development to change management. Journal of Applied Behavioral Science, 35, 273–286.Google Scholar
  115. Yager, E. G. (1981). The quality control circle explosion. Training and Development, 35, 98–105.Google Scholar
  116. Yuen, E. J., Gerdes, J. L., & Gonzales, J. J. (1996). Patterns of rural mental health care: An exploratory study. General Hospital Psychiatry, 18, 14–21.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  1. 1.Children's Mental Health Services Research CenterUniversity of TennesseeKnoxville
  2. 2.Family Services Research CenterMedical University of South CarolinaCharleston
  3. 3.Children's Mental Health Services Research CenterThe University of Tennessee

Personalised recommendations