The Potential to Reduce Mental Health Disparities Through the Comprehensive Community Mental Health Services for Children and Their Families Program

  • Richard MiechEmail author
  • Melissa Azur
  • Tracy Dusablon
  • Keri Jowers
  • Amy B. Goldstein
  • Elizabeth A. Stuart
  • Christine Walrath
  • Philip J. Leaf
Regular Article


Few service systems are currently in place with the explicit purpose to reduce youth mental health disparities across socioeconomic status and race–ethnicity, despite substantial interest by the federal government and other institutions to redress health disparities. This study examines the potential for the Comprehensive Community Mental Health Services for Children and Their Families Program to address health disparities, even though this program was not explicitly designed for disparity reduction. Specifically, this study examines whether program sites disproportionately provide services within their catchment areas for youth who come from poor families, who are Black, and who are Hispanic. Data for this study come from 45 sites and 19,189 youth who were enrolled in program sites from 1997 to 2005. Meta-analysis was used to generate Forest plots and to obtain single, pooled estimates of risk ratios and their standard errors across all Children’s Mental Health Initiative communities. The results indicate that in comparison to the targeted catchment area (a) the percentage poor youth in the programs was almost three times higher, (b) the percentage Black in the programs was about twice as high, and (c) the percentage Hispanic in the programs was about the same. These results indicate that the program successfully reaches disadvantaged youth and can bring substantial infrastructure to address youth mental health disparities. In fact, to the extent that the program successfully improves mental health among enrollees it may be serving as one of the largest initiatives to redress health disparities, although its role in disparity reduction is not widely recognized.


disparities systems of care children’s mental health services 



This research was supported by National Institute of Mental Health Grant # 1R01MH075828 and carried out at the Johns Hopkins Bloomberg School of Public Health. The views expressed are the opinions of the authors and not those of the National Institute of Mental Health, the National Institute of Health, or the federal government.


  1. 1.
    Mark T, Buck JA. Characteristics of US youths with serious emotional disturbance: data from the National Health Interview Survey. Psychiatric Services. 2006;57(11):1573–1578.PubMedCrossRefGoogle Scholar
  2. 2.
    Pachter LM, Auinger P, Palmer R, et al. Do parenting and the home environment, maternal depression, neighborhood, and chronic poverty affect child behavioral problems differently in different racial–ethnic groups? Pediatrics. 2006;117(4):1329–1338.PubMedCrossRefGoogle Scholar
  3. 3.
    Costello EJ, Keeler GP, Angold A. Poverty, race/ethnicity, and psychiatric disorder: a study of rural children. American Journal of Public Health. 2001;91(9):1494–1498.PubMedGoogle Scholar
  4. 4.
    Center for Mental Health Services. Annual Report to Congress on the Evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program, 2001. Atlanta: ORC Macro; 2001.Google Scholar
  5. 5.
    National Institute of Mental Health. National Institute of Mental Health Five-Year Strategic Plan for Reducing Health Disparities, 2001;, last accessed June 10, 2007.
  6. 6.
    U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office; 2000, November.Google Scholar
  7. 7.
    American Psychiatric Association. Diagnostic and Statistical Manual for Mental Disorders—Fourth Edition. Washington DC: American Psychiatric Association; 1994.Google Scholar
  8. 8.
    Stroul BA, Friedman RM. A System of Care for Seriously Emotionally Disturbed Children and Youth. Washington, DC: CASSP Technical Assistance Center, Georgetown University Child Development Center; 1986.Google Scholar
  9. 9.
    Center for Mental Health Services. Estimation methodology for children with a serious emotional disturbance (SED). Federal Register. 1997;62:52139–52145.Google Scholar
  10. 10.
    Angold A, Erkanli A, Farmer EM, et al. Psychiatric disorder, impairment, and service use in rural African American and white youth. Archives of General Psychiatry. 2002;59(10):893–901.PubMedCrossRefGoogle Scholar
  11. 11.
    Busch SH, Horwitz SM. Access to mental health services: are uninsured children falling behind? Mental Health Services Research. 2004;6(2):109–116.PubMedCrossRefGoogle Scholar
  12. 12.
    Zahner GEP, Daskalakis C. Factors associated with mental health, general health, and school-based service use for child psychopathology. American Journal of Public Health. 1997;87(9):1440–1448.PubMedGoogle Scholar
  13. 13.
    Ganz ML, Tendulkar SA. Mental health care services for children with special health care needs and their family members: prevalence and correlates of unmet needs. Pediatrics. 2006;118(4):2138–2148.CrossRefGoogle Scholar
  14. 14.
    Elster A, Jarosik J, VanGeest J, et al. Racial and ethnic disparities in health care for adolescents: a systematic review of the literature. Archives of Pediatrics and Adolescent Medicine. 2003;157(9):867–874.PubMedCrossRefGoogle Scholar
  15. 15.
    Hough RL, Hazen AL, Soriano FI, et al. Mental health services for Latino adolescents with psychiatric disorders. Psychiatric Services. 2002;53(12):1556–1562.PubMedCrossRefGoogle Scholar
  16. 16.
    Garland AF, Lau AS, Yeh M, et al. Racial and ethnic differences in utilization of mental health services among high-risk youths. American Journal of Psychiatry. 2005;162(7):1336–1343.PubMedCrossRefGoogle Scholar
  17. 17.
    Substance Abuse and Mental Health Services Administration. Request for Applications: Cooperative Agreements for Comprehensive Community Mental Health Services for Children and Their Families Program;, last accessed November 14, 2007.
  18. 18.
    Holden E, Friedman R, Santiago R. Overview of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families. Journal of Emotional and Behavioral Disorders. 2001;9(1):4–12.CrossRefGoogle Scholar
  19. 19.
    US Census Bureau. Census 2000 Summary File 3—United States. Washington, DC: US Census Bureau; 2002.Google Scholar
  20. 20.
    Sharp S, Sterne J. sbe16: Meta-analysis. STATA Technical Bulletin. 1997;38:9–14.Google Scholar
  21. 21.
    Stephens RL, Connor T, Nguyen H, et al. The longitudinal comparison study of the national evaluation of the comprehensive community mental health services for children and their families program. In: Epstein MH, Kutash K, Duchnowski AJ, eds. Outcomes for Children and Youth with Behavioral and Emotional Disorders and Their Families: Programs and Evaluation Best Practices. Austin: PRO-ED; 2005:525–550.Google Scholar
  22. 22.
    Stephens RL, Holden EW, Hernandez M. System-of-care practice review scores as predictors of behavioral symptomatology and functional impairment. Journal of Child and Family Studies. 2004;13(2):179–191.CrossRefGoogle Scholar
  23. 23.
    Foster EM, Qaseem A, Connor T. Can better mental health services reduce the risk of juvenile justice involvement? American Journal of Public Health. 2004;94(5):859–865.PubMedCrossRefGoogle Scholar

Copyright information

© National Council for Community Behavioral Healthcare 2008

Authors and Affiliations

  • Richard Miech
    • 1
    Email author
  • Melissa Azur
    • 2
  • Tracy Dusablon
    • 2
  • Keri Jowers
    • 2
  • Amy B. Goldstein
    • 3
  • Elizabeth A. Stuart
    • 2
    • 4
  • Christine Walrath
    • 5
    • 7
    • 8
  • Philip J. Leaf
    • 2
    • 6
  1. 1.Department of Health and Behavioral SciencesUniversity of Colorado at Denver and Health Sciences CenterDenverUSA
  2. 2.Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Child and Adolescent Preventive Intervention ProgramNational Institute of Mental HealthRockvilleUSA
  4. 4.Department of BiostatisticsJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  5. 5.Macro International Inc.New YorkUSA
  6. 6.Department of PsychiatryJohns Hopkins School of MedicineBaltimoreUSA
  7. 7.Johns Hopkins University Bloomberg School of Public HealthBaltimoreUSA
  8. 8.University of Maryland Baltimore CountyCatonsvilleUSA

Personalised recommendations