Abstract
We evaluated the Starting Early Starting Smart (SESS) national initiative to integrate behavioral health services (parenting, mental health, and drug treatment) into the pediatric health care setting for families with young children. Data are presented from five pediatric care (PC) sites, drawing from families at risk due to demographic and behavioral health factors, with infants less than 12 months of age (n = 612). Families were randomly assigned to either the SESS program or a standard care Comparison group. We utilized longitudinal analyses to estimate differences in utilization rates for parenting, mental health, and drug treatment over 6 follow-up time points (3, 6, 9, 12, 15 and 18 months). Our findings indicate that SESS caregiver participants were 4.6 times (p < 0.001; CI = 3.33–6.26) more likely to receive parenting services, 2.1 times (p < 0.001; CI = 1.48–2.86) more likely to receive outpatient mental health treatment, and 1.8 times (p = 0.025; CI = 1.08–3.14) more likely to receive drug treatment than Comparison group participants. Our results demonstrate the success of the SESS program in coordinating and improving access to behavioral health services for high-risk caregivers within the pediatric health care setting and highlight the importance of continuing to focus public health policy on the behavioral health care needs of families with young children.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Accornero, V. H., Morrow, C. E., Bandstra, E. S., Johnson, A. L., & Anthony, J. C. (2002). Behavioral outcome of preschoolers exposed prenatally to cocaine: Role of maternal behavioral health. Journal of Pediatric Psychology, 27, 259–269.
Anhalt, K., Telzrow, C. F., & Brown, C. L. (2007). Maternal stress and emotional status during the perinatal period and childhood adjustment. School Psychology Quarterly, 22, 74–90.
Annie E. Casey Foundation. (1999). Kids count data book 1999: State profiles of child well-being Baltimore. MD: Author.
Bean, D. L., Leibowitz, A., Rotheram-Borus, M. J., Duan, N., Horwitz, S. M., Jordan, D., et al. (2000). False-negative reporting and mental health services utilization: Parents’ reports about child and adolescent services. Mental Health Services Research, 2, 239–249. doi:10.1023/A:1010116604540.
Bickman, L. (1996). A continuum of care—More is not always better. The American Psychologist, 51, 689–701. doi:10.1037/0003-066X.51.7.689.
Bruner, C. (1994). State government and family support: From marginal to mainstream. In S. L. Kagan & B. Weissbourd (Eds.), Putting families first: America’s family support movement and the challenge of change (pp. 338–357). San Francisco, CA: Jossey-Bass.
Brunette, M. F., & Dean, W. (2002). Community mental health care for women with severe mental illness who are parents. Community Mental Health Journal, 38, 153–165. doi:10.1023/A:1014599222218.
Canino, G., Shrout, P. E., Alegria, M., Rubio-Stipec, M., Chavez, L. M., Ribera, J. C., et al. (2002). Methodological challenges in assessing children’s mental health services utilization. Mental Health Services Research, 4, 97–107. doi:10.1023/A:1015252217154.
Carnegie Corporation of New York & Task Force on Meeting the Needs of Young Child. (1994). Starting points: Meeting the needs of our youngest children: The report of the Carnegie Task Force on Meeting the Needs of Young Children. New York, NY: Carnegie Corporation of New York.
Department of Health and Human Services. (2001). Report of a surgeon general’s working meeting on the integration of mental health services and primary health care. Rockville, MD: US DHHS, Public Health Service, Office of the Surgeon General.
Derogatis, L. R., Rickels, K., & Rock, A. F. (1976). The SCL-90 and the MMPI: A step in the validation of a new self-report scale. The British Journal of Psychiatry, 128, 280–289. doi:10.1192/bjp.128.3.280.
Derogatis, L. R., & Spencer, P. M. (1999). The brief symptom inventory: Administration, scoring, and procedures manual (2nd ed.). Baltimore, MD: Clinical Psychometric Research, Inc.
Diggle, P., Liang, K. Y., & Zeger, S. L. (1994). Analysis of longitudinal data. London, UK: Oxford University Press.
Evans, G. W., Boxhill, L., & Pinkaya, M. (2008). Poverty and maternal responsiveness: The role of maternal stress and social resources. International Journal of Behavioral Development, 32, 232–237. doi:10.1177/0165025408089272.
Farmer, E. M. Z. (2000). Issues confronting effective services in systems of care. Children and Youth Services Review, 22, 627–650. doi:10.1016/S0190-7409(00)00107-9.
Foster, E. M., Stephens, R., Krivelyova, A., & Gamfi, P. (2007). Can system integration improve mental health outcomes for children and youth? Children and Youth Services Review, 29, 1301–1319. doi:10.1016/j.childyouth.2007.05.004.
Friedman, R. M., & Burns, B. J. (1996). The evaluation of the Fort Bragg Demonstration Project: An alternative interpretation of the findings. Journal of Mental Health Administration, 23, 128–136. doi:10.1007/BF02518651.
Goldberg, R. W., Seybolt, D. C., & Lehman, A. (2002). Reliable self-report of health service use by individuals with serious mental illness. Psychiatric Services (Washington, DC), 53, 879–881. doi:10.1176/appi.ps.53.7.879.
Hanson, L., Deere, D., Lee, C. A., Lewin, A., & Seval, C. (2001). Key principles in providing integrated behavioral health services for young children and their families: The starting early starting smart experience. Washington, DC: Casey Family Programs and the US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.
Hawley, T. (1998). Ready to succeed: The lasting effects of early relationships. An ounce of prevention fund and zero to three paper. Washington, DC: Zero to Three: National Center for Infants, Toddlers and Families.
Hoagwood, K., & Olin, S. S. (2002). The NIMH blueprint for change report: Research priorities in child and adolescent mental health. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 760–767. doi:10.1097/00004583-200207000-00006.
Johnson, A. L., Bandstra, E. S., Morrow, C. E., Accornero, V. H., Xue, L., & Anthony, J. C. (2002). Maternal cocaine use: Estimated effects on mother-child play interactions in the preschool period. Journal of Developmental & Behavioral Pediatrics, 23, 191–202.
Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry, 51, 8–19.
Knitzer, J. (2001). Building services and systems to support the healthy emotional development of young children: An action guide for policymakers. New York, NY: National Center for Children in Poverty.
Lavigne, J. V., Gibbons, R. D., Arend, R., Rosenbaum, D., Binns, H. J., & Christoffel, K. K. (1999). Rational service planning in pediatric primary care: Continuity and change in psychopathology among children enrolled in pediatric practices. Journal of Pediatric Psychology, 24, 393–403. doi:10.1093/jpepsy/24.5.393.
Leinonen, J. A., Solantaus, T. S., & Punamaki, R. L. (2003). Parental mental health and children’s adjustment: The quality of marital interaction and parenting as mediating factors. Journal of Child Psychology and Psychiatry and Allied Disciplines, 44, 227–241. doi:10.1111/1469-7610.t01-1-00116.
Liang, K. Y., & Zeger, S. L. (1986). Longitudinal data analysis using generalized linear models. Biometrika, 73, 13–22. doi:10.1093/biomet/73.1.13.
McLellan, A., Parikh, G., Bragg, A., Cacciola, J., Fureman, B., & Incmikoski, R. (1990). Addiction severity index-administration manual (5th ed.). Penn, VA: Center for Studies of Addiction.
Mordock, J. B. (1997). The Fort Bragg continuum of care demonstration project: The population served was unique and the outcomes are questionable. Child Psychiatry and Human Development, 27, 241–254. doi:10.1007/BF02353353.
National Research Council Institute of Medicine. (2000). From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press.
Nicholson, J., & Biebel, K. (2002). Commentary on “Community mental health care for women with severe mental illness who are parents”—The tragedy of missed opportunities: What providers can do. Community Mental Health Journal, 38, 167–172. doi:10.1023/A:1014551306288.
Nicholson, J., Sweeney, E. M., & Geller, J. L. (1998). Mothers with mental illness: I. The competing demands of parenting and living with mental illness. Psychiatric Services (Washington, DC), 49, 635–642.
Poulsen, M. K. (1994). The development of policy recommendations to address individual and family needs of infants and young children affected by family substance use. Topics in Early Childhood Special Education, 14, 275–292. doi:10.1177/027112149401400209.
Roberts, R. N., & Akers, A. L. (1996). Family-level service coordination within home visiting programs. Topics in Early Childhood Special Education, 16, 279–302. doi:10.1177/027112149601600303.
Roberts, R. N., & Behl, D. D. (1996). Community-level service integration within home visiting programs. Topics in Early Childhood Special Education, 16, 302–322. doi:10.1177/027112149601600304.
Statacorp. (1999). Stata statistical software. College Station, TX: Stata Corporation.
The President’s New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Final Report. http://www.mentalhealthcommission.gov/reports/FinalReport/toc.html [On-line]. Accessed November 2008.
Tolan, P. H., & Dodge, K. A. (2005). Children’s mental health as a primary care and concern—A system for comprehensive support and service. The American Psychologist, 60, 601–614. doi:10.1037/0003-066X.60.6.601.
US Public Health Service. (2000). Report of the Surgeon General’s conference on children’s mental health: A national action agenda. Washington, DC: Department of Health and Human Services.
Zeger, S. L., & Liang, K. Y. (1986). Longitudinal data analysis for discrete and continuous outcomes. Biometrics, 42, 121–130. doi:10.2307/2531248.
Zima, B. T., Wells, K. B., Benjamin, B., & Duan, N. (1996). Mental health problems among homeless mothers: Relationship to service use and child mental health problems. Archives of General Psychiatry, 53, 332–338.
Acknowledgments
The “Starting Early Starting Smart” cross-site collaborative initiative was supported by Grant 6 UD1 SP08255 from the US Department of Health and Human Services (DHHS), the Substance Abuse and Mental Health Services Administration (SAMHSA) and its three centers, the Center for Mental Health Services (CMHS), the Center for Substance Abuse Prevention (CSAP) and the Center for Substance Abuse Treatment (CSAT), and Casey Family Programs. This report would not have been possible without the contributions of staff from DHHS, the SAMHSA Office on Early Childhood, Casey Family Programs, the Starting Early Starting Smart (SESS) principal investigators, project directors and researchers, and the parent representatives, who helped design and supervise the data collection. The content of this publication does not necessarily reflect the views or policies of DHHS or Casey Family Programs, nor does the mention of trade names, commercial products or organizations imply endorsement by the US Government. Responsibility for the content of this report, however, rests solely with the named authors.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Morrow, C.E., Mansoor, E., Hanson, K.L. et al. The Starting Early Starting Smart Integrated Services Model: Improving Access to Behavioral Health Services in the Pediatric Health Care Setting for At-Risk Families with Young Children. J Child Fam Stud 19, 42–56 (2010). https://doi.org/10.1007/s10826-009-9280-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10826-009-9280-z