Abstract
Data from 14 years of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program were used to understand the trends of the emotional and behavioral problems and demographic characteristics of children entering services. The data for this study were derived from information collected at intake into service in 90 sites who received their initial federal funding between 1993 and 2004. The findings from this study suggest children entering services later in a site’s funding cycle had lower levels of behavioral problems and children served in sites funded later in the 14 year period had higher levels of behavioral problems. Females have consistently entered services with more severe problems and children referred from non-mental health sources, younger children, and those from non-white racial/ethnic backgrounds have entered system of care services with less severe problems. The policy and programming implications, as well as implications for local system of care program development and implementation are discussed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Many site-specific factors, such as obtaining a large enough sample using sampling strategies and maintaining the sampling frame across time, influenced the ability of local evaluation teams to maintain a random sampling strategy.
References
Achenbach, T. (1991). Manual for the child behavior checklist/4–18 and 1991 profile. Burlington, VT: Department of Psychiatry, University of Vermont.
Achenbach, T. M., Dumenci, L., & Rescorla, L. A. (2003). Are American children’s problems still getting worse? A 23-year comparison. Journal of Abnormal Child Psychology, 31(1), 1–11.
Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the AESBA school-age forms & profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.
Bafumi, J., & Gelman, A. (2006). Fitting multilevel models when predictors and group effects correlate. Prepared for the 2006 Annual Meeting of the Midwest Political Science Association, Chicago, Il. Available at: http://www.stat.columbia.edu/~gelman/research/unpublished/Bafumi_Gelman_Midwest06.pdf.
Berg, I., Lucas, C., & McGuire, R. (1992). Measurement of behavior difficulties in children using standard scales administered to mothers by computer: Reliability and validity. European Child and Adolescent Psychiatry, 1(1), 14–23.
Briggs-Gowan, M. J., Horwitz, S. M., Schwab-Stone, M. E., Leventhal, J. M., & Leaf, P. J. (2000). Mental health in pediatric settings: Distribution of disorders and factors related to service use. Journal of the American Academy of Child and Adolescent Psychiatry, 39(7), 841–849.
Burns, B. J., Costello, E. J., Angold, A., Tweed, D., Stangl, D., Farmer, E. M., et al. (1995). Children’s mental health service use across service sectors. Health Affairs, 14(3), 147–159.
Center for Mental Health Services. (1996). Annual report to congress on the evaluation of the comprehensive community mental health services for children and their families program, 1996 (Unpublished manuscript).
Center for Mental Health Services. (1997). Annual report to congress on the evaluation of the comprehensive community mental health services for children and their families program, 1997. Atlanta, GA: Macro International Inc.
Center for Mental Health Services. (1998). Annual report to congress on the evaluation of the comprehensive community mental health services for children and their families program, 1998. Atlanta, GA: Macro International Inc.
Center for Mental Health Services. (1999). Annual report to congress on the evaluation of the comprehensive community mental health services for children and their families program, 1999. Atlanta, GA: ORC Macro.
Center for Mental Health Services. (2000). Annual report to congress on the evaluation of the comprehensive community mental health services for children and their families program, 2000. Atlanta, GA: ORC Macro.
Center for Mental Health Services. (2001). Annual report to congress on the evaluation of the comprehensive community mental health services for children and their families program, 2001. Atlanta, GA: ORC Macro.
Center for Mental Health Services. (2003). The comprehensive community mental health services for children and their families program: Evaluation findings—Annual report to Congress, 2002–2003. Atlanta, GA: ORC Macro.
Center for Mental Health Services. (2004). The comprehensive community mental health services for children and their families program: Evaluation findings—Annual report to congress, 2004. Atlanta, GA: Macro International Inc.
Center for Mental Health Services. (2006). In R. W. Manderscheid & J. T. Berry (Eds.), Mental Health, United States, 2004. DHHS Pub no. (SMA)-06-4195. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Costello, E. J., Burns, B. J., Costello, A. J., Edelbrock, C., Dulcan, M., & Brent, D. (1988). Service utilization and psychiatric diagnosis in pediatric primary care: The role of the gatekeeper. Pediatrics, 82(3 Pt 2), 435–441.
Farmer, E. M. Z., Mustillo, S., Burns, B. J., & Costello, E. J. (2005). The epidemiology of mental health problems and service use in youth: Results from the Great Smoky Mountains study. In M. H. Epstein, K. Kutash, & A. Duchnowski (Eds.), Outcomes for children and youth with emotional and behavioral disorders and their families: Programs and evaluation best practices (2nd ed., pp. 23–44). Austin, TX: Pro-Ed.
Federal Interagency Forum on Child and Family Statistics. (2007). America’s children: Key national indicators of well-being, 2007. Washington DC: U.S. Government Printing Office.
Federal Interagency Forum on Child and Family Statistics. (2008). America’s children in brief: Key national indicators of well-being, 2008. Washington DC: U.S. Government Printing Office.
Ferreira, K., Hodges, S., Kukla-Acevedo, S., & Mazza, J. (2008). System implementation issue brief #5—What works: System development strategies across communities. Tampa: University of South Florida, Louis de la Parte Florida Mental Health Institute, Research and Training Center for Children’s Mental Health.
Fox, J. (1997). Applied regression analysis, linear models, and related methods. Thousand Oaks, CA: Sage.
Goldstein, H. (1995). Multilevel statistical models (2nd ed.). London: Edward Arnold. Available at http://www.cmm.bristol.ac.uk/team/HG_Personal/multbook1995.pdf.
Holden, E., Friedman, R., & Santiago, R. (2001). Overview of the national evaluation of the comprehensive community mental health services for children and their families program. Journal of Emotional and Behavioral Disorders, 9, 4–12.
Joint Commission on the Mental Health of Children. (1969). Crisis in child mental health: Challenge for the 1970s. New York: Harper & Row.
Knitzer, J. (1982). Unclaimed children: The failure of public responsibility to children and adolescents in need of mental health services. Washington DC: Children’s Defense Fund.
Kutash, K., Duchnowski, A. J., & Friedman, R. M. (2005). The system of care twenty years later. In M. H. Epstein, K. Kutash, & A. J. Duchnowski (Eds.), Outcomes for children with emotional and behavioral disorders and their families: Program and evaluation best practices (2nd ed., pp. 3–22). Austin, TX: Pro-Ed.
Leaf, P. J., Alegria, M., Cohen, P., Goodman, S. H., Horwitz, S. M., Hoven, C. W., et al. (1996). Mental health service use in the community and schools: Results from the four-community MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35(7), 889–897.
Miech, R., Azur, M., Dusablon, T., Jowers, K., Goldstein, A. B., Stuart, E. A., et al. (2008). The potential to reduce mental health disparities through the comprehensive community mental health services for children and their families program. Journal of Behavioral and Health Services Research, 35(3), 253–264.
New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Final report. DHHS Pub. No. SMA-03-3832.
Pinheiro, J., Bates, D., DebRoy, S., Sarkar, D., & The R Core Team. (2007). nlme: Linear and nonlinear mixed effects models. R package version 3. 1–86.
Pires, S. (2002). Building systems of care: A primer. Washington, DC: National Technical Assistance Center for Children’s Mental Health, Georgetown University Child Development Center.
Pumariega, A. J., Winters, N. C., & Huffine, C. (2003). The evolution of systems of care for children’s mental health: Forty years of community child and adolescent psychiatry. Community Mental Health Journal, 39(5), 399–425.
R Development Core Team. (2007). R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing. ISBN 3-900051-07-0, URL http://www.R-project.org.
Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Thousand Oaks, CA: Sage.
Sourander, A., Santalathi, P., Haavisto, A., Piha, J., Ikaheimo, K., & Helenius, H. (2004). Have there been changes in children’s psychiatric symptoms and mental health service use? A 10-year comparison from Finland. Journal of the American Academy of Child and Adolescent Psychiatry, 43(9), 1134–1145.
Stroul, B., & Friedman, R. (1986). A system of care for children and youth with severe emotional disturbances. Washington DC: Georgetown University Child Development Center.
Stroul, B. A., & Friedman, R. M. (1994). A system of care for children and youth with severe emotional disturbances (Revised edition ed.). Washington DC: Georgetown University Child Development Center.
U.S. Department of Health Human Services. (1999). Mental health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. National Institutes of Health. National Institute of Mental Health.
U.S. Department of Health Human Services. (2006). Healthy people 2010 midcourse review. Washington DC: U.S. Government Printing Office.
Acknowledgments
This research was supported by National Institute of Mental Health Grant # 1R01MH075828. The views expressed are the opinions of the authors and not those of the Substance Abuse and Mental Health Services Agency, the National Institute of Mental Health, the National Institute of Health, or the federal government.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Walrath, C., Garraza, L.G., Stephens, R. et al. Trends in Characteristics of Children Served by the Children’s Mental Health Initiative: 1994–2007. Adm Policy Ment Health 36, 361–373 (2009). https://doi.org/10.1007/s10488-009-0231-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-009-0231-1