Journal of Child and Family Studies

, Volume 5, Issue 2, pp 137–160 | Cite as

The Fort Bragg managed care experiment: Short term impact on psychopathology

  • Leonard Bickman
  • Craig Anne Heflinger
  • E. Warren Lambert
  • Wm. Thomas Summerfelt
Article

Abstract

Many concerns have been raised about mental health services for children and adolescents. These concerns have included not treating those in need and providing inappropriate services to those who are treated. The continuum of care philosophy purports to remedy these problems by offering a comprehensive and coordinated range of services emphasizing community-based treatment. Services in the continuum include alternatives to trditional restrictive forms of care such as hospitalization. The provision of more appropriate care is hypothesized to improve the clinical outcomes of children treated in a continuum of care. The Fort Bragg Evaluation compared quality, use, outcome, and cost of the continuum of care model to a more traditional, fragmented system of care. This paper presents the effects of a service delivery system on short term psychopathology outcomes.

Key Words

Fort Bragg continuum of care psychopathology managed care 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Achenbach, T. M., & Edelbrock, C. (1983).Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Burlington, VT: Queen City Printers.Google Scholar
  2. Achenbach, T. M., & Edelbrock, C. (1987).Manual for the Youth Self-Report and Profile. Burlington, VT: University of Vermont, Department of Psychology.Google Scholar
  3. Baine, D. P. (1992). Prepared statement to the Select Committee on Children, Youth, and Families of the U.S. House of Representatives,The profits of misery: How inpatient psychiatric treatment bilks the system and betrays our trust (Publication No. 58-362). Washington, DC: Government Printing Office.Google Scholar
  4. Behar, L. (1985). Changing patterns of state responsibility: A case study of North Carolina.Journal of Clinical Child Psychology, 14, 188–195.Google Scholar
  5. Bickman, L. (1985). Improving established statewide programs: A component theory of evaluation.Evaluation Review, 9, 189–208.Google Scholar
  6. Bickman, L. (1987). The functions of program theory. In L. Bickman (Ed.),Using program theory in evaluation (pp. 5–18). San Francisco, CA: Jossey Bass.Google Scholar
  7. Bickman, L. (Ed.). (1990).Advances in program theory. San Francisco, CA: Jossey-Bass, Inc.Google Scholar
  8. Bickman, L. (1992). Designing outcome evaluations for children's mental health services: Improving internal validity. In L. Bickman & D. J. Rog (Eds.),Evaluating mental health services for children (pp. 57–68). San Francisco, CA: Jossey-Bass, Inc.Google Scholar
  9. Bickman, L., Bryant, D., & Summerfelt, W. T. (1993).The final report of the quality study of the Fort Bragg Evaluation Project. Unpublished manuscript, Center for Mental Health Policy, Vanderbilt University, Nashville, TN.Google Scholar
  10. Bickman, L., & Dokecki, P. (1989). The for-profit delivery of mental health services.American Psychologist, 44, 1133–1137.Google Scholar
  11. Bickman, L., Guthrie, P., Foster, E. W., Summerfelt, W. T., Breda, C., & Heflinger, C. A. (1995).Managed care in mental health: The Fort Bragg Experiment. New York, NY: Plenum Publishing.Google Scholar
  12. Bickman, L. & Heflinger, C. A. (in press). Seeking success by reducing implementation and evaluation failures. In L. Bickman & D. J. Rog (Eds.),Children's Mental Health Services: Research, Policy and Innovation. Newbury Park, CA: Sage Publications.Google Scholar
  13. Bickman, L., Heflinger, C. A., Pion, G., & Behar, L. (1992). Evaluation planning for an innovative children's mental health system.Clinical Psychology Review, 12, 853–865.Google Scholar
  14. Burns, B. J. (1990). Mental health service use by adolescents in the 1970s and 1980s. In A. A. Algarin & R. M. Friedman (Eds.),Proceedings from the Third Annual Research Conference on A System of Care for Children's Mental Health (pp. 3–19). Tampa, FL: Florida Mental Health Institute, University of South Florida.Google Scholar
  15. Chen, H. (1990).Theory driven evaluations. Beverly Hills, CA: Sage.Google Scholar
  16. Chen, H., & Rossi, P. (1983). Evaluating with sense: The theory driven approach.Evaluation Review, 7, 283–302.Google Scholar
  17. Costello, E. J. (1989). Developments in child psychiatric epidemiology.Journal of American Academy of Child and Adolescent Psychiatry, 28, 836–841.Google Scholar
  18. Costello, E. J., Burns, B. J., Angold, A., & Leaf, P. J. (1993). How can epidemiology improve mental health services for children and adolescents?Journal of American Academy of Child and Adolescent Psychiatry, 32, 1106–1116.Google Scholar
  19. Dorwart, R. A., Schlesinger, M., Davidson, H., Epstein, S., & Hoover, C. (1991). A national study of psychiatric hospital care.American Journal of Psychiatry, 148, 204–210.Google Scholar
  20. Duchnowski, A. J., & Friedman, R. M. (1990). Children's mental health: Challenges for the nineties.Children's Mental Health, 17, 3–12.Google Scholar
  21. Hedrick, T.E., Bickman, L., & Rog, D.J. (1993).Planning applied social research. Newbury Park, CA: Sage Publications.Google Scholar
  22. Heflinger, C. A. (1993, October).Final report of the implementation study of the Fort Bragg Evaluation Project. Nashville, TN: Center for Mental Health Policy, Vanderbilt University.Google Scholar
  23. Hobbs, N. (1982).The troubled and troubling child. San Francisco, CA: Jossey-Bass Publishers.Google Scholar
  24. Hodges, K., Kline, J., Fitch, P., McKnew, D., & Cytryn, L. (1981). The Child Assessment Scale: A diagnostic interview for research and clinical use.Catalog of Selected Documents in Psychology, 11, 56.Google Scholar
  25. Hodges, K., Kline, J., Stern, L., Cytryn, L., & McKnew, D. (1982). The development of a child assessment schedule for research and clinical use.Journal of Abnormal Child Psychology, 10, 173–189.Google Scholar
  26. Heneghan, A. M., Horwitz, S. M., & Leventhal, J. M. (1993).Do intensive family preservation services really work? Departments of Medicine, Pediatrics, and Public Health. New Haven, CT: Yale University.Google Scholar
  27. Huberty, C. J., & Morris, J. D. (1989). Multivariate analysis versus multiple univariate analyses.Psychological Bulletin, 105, 302–308.Google Scholar
  28. Jerrell, P., & Hargreaves, W. A. (1991).The operating philosophy of community programs (Working paper series 18). Berkeley, CA: Institute for Mental Health Services Research.Google Scholar
  29. Kiesler, C. A., & Simpkins, C. G. (1991). Changes in psychiatric inpatient treatment of children and youth in general hospitals, 1980–85.Hospital and Community Psychiatry, 42, 601–604.Google Scholar
  30. Kiesler, C. A., & Simpkins, C. G. (1993).The unnoticed majority in psychiatric inpatient care. New York, NY: Plenum Press.Google Scholar
  31. Knitzer, J. (1982).Unclaimed children. Washington, DC: National Academy Press.Google Scholar
  32. Lambert, W. (1993).Power analysis of the Ft. Bragg Evaluation Project: Technical details of a practical Monte Carlo power analysis. Unpublished manuscript, Center for Mental Health Policy, Vanderbilt University, Nashville, TN.Google Scholar
  33. Lipsey, M. W. (1990).Design sensitivity: Statistical power for experimental research. Newbury Park, CA: Sage Publications.Google Scholar
  34. Marsden, P. V. (1990). Network data and measurement.Annual Review of Sociology, 16, 435–463.Google Scholar
  35. Morrissey, J. (1992). An interorganizational network approach to evaluating children's mental health service systems. In L. Bickman & D. Rog (Eds.),Evaluating mental health services for children (pp. 85–98). San Francisco, CA: Jossey-Bass, Inc.Google Scholar
  36. National Mental Health Association. (1989).Invisible Children Project. (Prepared by C. Zeigler-Dendy, Alexandria, VA).Google Scholar
  37. Nelson, S. S. (1993, October 11).Benefit available...partially. Army Times.Google Scholar
  38. OCHAMPUS. (1992).CHAMPUS handbook (1992-675-578). Washington, DC: U.S. Government Printing Office.Google Scholar
  39. Ring-Kurtz, S., & Hodges, V. K. (1993).Developing a training program for interviewers administering diagnostic instruments for outcome studies. Presented at the 6th Annual Research Conference: A System of Care for Children's Mental Health: Expanding the Research Base, Tampa, FL.Google Scholar
  40. Saxe, L., Cross, T., & Silverman, N. (1988). Children's mental health: The gap between what we know and what we do.American Psychologist, 43, 800–807.Google Scholar
  41. Saxe, L., Cross, T., Silverman, N., Batchelor, W. F., & Dougherty, D. (1987).Children's mental health: Problems and services. Durham, NC: Duke University Press.Google Scholar
  42. Select Committee on Children, Youth, and Families of the U.S. House of Representatives (1992, April).The profits of misery: How inpatient psychiatric treatment bilks the system and betrays our trust (GPO1992-58-362). Washington, DC: U.S. Government Printing Office.Google Scholar
  43. Silver, A. A. (1984). Children in classes for the severely emotionally handicapped.Journal of Developmental and Behavioral Pediatrics, 5, 49–54.Google Scholar
  44. Soler, M., & Shaffer, C. (1990). Fighting fragmentation: Coordination of services for children and families.Nebraska Law Review, 69, 278–297.Google Scholar
  45. Stroul, B. A., & Friedman, R. M. (1986).A system of care for severely emotionally disturbed children and youth. Washington, DC: Georgetown University Child Development Center.Google Scholar
  46. Weisz, J. R., & Weiss, B. (1993).Effects of psychotherapy with children and adolescents. Newbury Park, CA: Sage.Google Scholar
  47. Weithorn, L. A. (1988). Mental hospitalization of troublesome youth: An analysis of skyrocketing admission rates.Stanford Law Review, 40, 773–838.Google Scholar
  48. Yin, R. (1986).Case study research. Newbury Park, CA: Sage.Google Scholar
  49. Yin, R. (1993).Application of case study research. Newbury Park, CA: Sage.Google Scholar

Copyright information

© Human Sciences Press, Inc 1996

Authors and Affiliations

  • Leonard Bickman
    • 1
  • Craig Anne Heflinger
    • 1
  • E. Warren Lambert
    • 1
  • Wm. Thomas Summerfelt
    • 1
  1. 1.Center for Mental Health PolicyVanderbilt UniversityNashville

Personalised recommendations