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.
Similar content being viewed by others
References
Achenbach, T. M., & Edelbrock, C. (1983).Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Burlington, VT: Queen City Printers.
Achenbach, T. M., & Edelbrock, C. (1987).Manual for the Youth Self-Report and Profile. Burlington, VT: University of Vermont, Department of Psychology.
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.
Behar, L. (1985). Changing patterns of state responsibility: A case study of North Carolina.Journal of Clinical Child Psychology, 14, 188–195.
Bickman, L. (1985). Improving established statewide programs: A component theory of evaluation.Evaluation Review, 9, 189–208.
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.
Bickman, L. (Ed.). (1990).Advances in program theory. San Francisco, CA: Jossey-Bass, Inc.
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.
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 Unpublished manuscript, Center for Mental Health Policy, Vanderbilt University, Nashville, TN.
Bickman, L., & Dokecki, P. (1989). The for-profit delivery of mental health services.American Psychologist, 44, 1133–1137.
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.
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.
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.
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.
Chen, H. (1990).Theory driven evaluations. Beverly Hills, CA: Sage.
Chen, H., & Rossi, P. (1983). Evaluating with sense: The theory driven approach.Evaluation Review, 7, 283–302.
Costello, E. J. (1989). Developments in child psychiatric epidemiology.Journal of American Academy of Child and Adolescent Psychiatry, 28, 836–841.
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.
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.
Duchnowski, A. J., & Friedman, R. M. (1990). Children's mental health: Challenges for the nineties.Children's Mental Health, 17, 3–12.
Hedrick, T.E., Bickman, L., & Rog, D.J. (1993).Planning applied social research. Newbury Park, CA: Sage Publications.
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.
Hobbs, N. (1982).The troubled and troubling child. San Francisco, CA: Jossey-Bass Publishers.
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.
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.
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.
Huberty, C. J., & Morris, J. D. (1989). Multivariate analysis versus multiple univariate analyses.Psychological Bulletin, 105, 302–308.
Jerrell, P., & Hargreaves, W. A. (1991).The operating philosophy of community programs (Working paper series 18). Berkeley, CA: Institute for Mental Health Services Research.
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.
Kiesler, C. A., & Simpkins, C. G. (1993).The unnoticed majority in psychiatric inpatient care. New York, NY: Plenum Press.
Knitzer, J. (1982).Unclaimed children. Washington, DC: National Academy Press.
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.
Lipsey, M. W. (1990).Design sensitivity: Statistical power for experimental research. Newbury Park, CA: Sage Publications.
Marsden, P. V. (1990). Network data and measurement.Annual Review of Sociology, 16, 435–463.
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.
National Mental Health Association. (1989).Invisible Children Project. (Prepared by C. Zeigler-Dendy, Alexandria, VA).
Nelson, S. S. (1993, October 11).Benefit available...partially. Army Times.
OCHAMPUS. (1992).CHAMPUS handbook (1992-675-578). Washington, DC: U.S. Government Printing Office.
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.
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.
Saxe, L., Cross, T., Silverman, N., Batchelor, W. F., & Dougherty, D. (1987).Children's mental health: Problems and services. Durham, NC: Duke University Press.
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.
Silver, A. A. (1984). Children in classes for the severely emotionally handicapped.Journal of Developmental and Behavioral Pediatrics, 5, 49–54.
Soler, M., & Shaffer, C. (1990). Fighting fragmentation: Coordination of services for children and families.Nebraska Law Review, 69, 278–297.
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.
Weisz, J. R., & Weiss, B. (1993).Effects of psychotherapy with children and adolescents. Newbury Park, CA: Sage.
Weithorn, L. A. (1988). Mental hospitalization of troublesome youth: An analysis of skyrocketing admission rates.Stanford Law Review, 40, 773–838.
Yin, R. (1986).Case study research. Newbury Park, CA: Sage.
Yin, R. (1993).Application of case study research. Newbury Park, CA: Sage.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bickman, L., Heflinger, C.A., Lambert, E.W. et al. The Fort Bragg managed care experiment: Short term impact on psychopathology. J Child Fam Stud 5, 137–160 (1996). https://doi.org/10.1007/BF02237936
Issue Date:
DOI: https://doi.org/10.1007/BF02237936