Gary Blau

Defining the system of care concept and philosophy: to update or not to update?

This commentary considers the task of updating the system of care concept and philosophy within its historical context, reviewing the original intent of the definition and clarifying misconceptions about its meaning. The authors identify the aspects of the concept and philosophy that should be updated based on the latest thinking, experience, and data, such as incorporating applicability to a broader range of populations, increasing the emphasis on the core values, specifying desired outcomes, and adding accountability as a critical element. An updated definition and values and principles are proposed, and the importance of always presenting the definition along with the accompanying specification of the philosophy is emphasized in order to increase its utility in assisting the field to move from theory to practice.

Family-Driven Youth-Guided Practices in Residential Treatment: Findings from a National Survey of Residential Treatment Facilities

Family-driven, youth-guided practices have shaped the development of community-based mental health services for children and youth; however, the extent to which residential treatment providers have adopted these practices is unclear. This study reports the findings from a survey of 293 residential treatment providers conducted to examine the adoption of family-driven, youth-guided care. Residential treatment providers reported several practices consistent with family-driven, youth-guided care, including strength-based individualized treatment planning, collaboration with community-based providers to develop treatment plans, and the provision of various forms of support to families. Thirty percent of providers reported that the youth or family member was the primary decision maker in the development of treatment plans, 20.9% included youth or family members in program oversight, and 88.0% reported that staff had not heard of family-driven, youth-guided principles or required further training to implement them.

Seclusion and restraint practices in residential treatment facilities for children and youth.

Policymakers, advocates, and families remain concerned about the use of seclusion and restraint in residential treatment facilities for children and youth. This study used data from 2 national surveys to examine the extent to which residential treatment facilities consistently implement certain practices following incidents of seclusion or restraint. The study found that 76% of facilities reported having secluded or restrained youth in the previous year; 34% of these facilities reported that, following such incidents, they always debrief the youth, family, and staff; notify the attending physician; and record the incident in the treatment plan. Accredited facilities and those that conduct a trauma assessment upon admission were more than twice as likely as others to consistently implement these practices. States and providers should continue to monitor seclusion and restraint practices and identify opportunities for quality improvement.

Outcomes Monitoring After Discharge From Residential Treatment Facilities for Children and Youth

Residential treatment facilities operate under increased pressure to demonstrate outcomes, yet little is known about the outcomes monitoring practices of such facilities. This study analyzed data from a survey of residential treatment facilities to examine the extent to which residential treatment facilities monitor outcomes after discharge. Sixty-nine percent of facilities measured satisfaction with residential treatment after discharge; roughly half measured the use of mental health services, housing status, school performance, and/or clinical functioning after discharge. Facilities that were licensed by the state had 2.17 higher odds (95% CI: 1.22–3.84) of measuring at least one of these outcomes after discharge. Most facilities that measured outcomes did so for no more than sixmonths after discharge. Continued efforts are needed to encourage the monitoring of outcomes after discharge from residential treatment.

Youth and Family Participation in the Governance of Residential Treatment Facilities

This study used data from a national survey of residential treatment facilities and conducted interviews with stakeholders in systems of care that serve children and youth with serious emotional disturbances to examine the extent to which youth and families participate in the governance activities of residential treatment facilities. Twenty percent of residential treatment facilities included youth and families in some type of governance activity, such as serving on the board of directors or participating in quality assurance. Thirty-eight percent of residential treatment providers agreed that licensing or accreditation standards should require the participation of youth and families in facility governance, and these facilities were more likely to have adopted treatment practices consistent with a commitment to partnering with youth and families in the delivery of services. These practices include unrestricted visitation and allowing youth and families to select their treatment team. Residential treatment providers and other stakeholders in systems of care identified several challenges to engaging youth and families in facility governance and proposed solutions for overcoming them. Further work is needed to encourage and monitor the participation of youth and families in the governance of residential treatment.

Measurement of Childhood Serious Emotional Disturbance: State of the Science and Issues for Consideration:

Surveys suggest that between 4.3% and 11.5% of children living in the United States have a serious emotional disturbance (SED). SED is defined in the Federal Register, and federal block grants are allocated to states based on the prevalence of SED. Accurate measurement of SED is critical, yet surveys have used different methodologies and instrumentation to obtain prevalence estimates. Two expert panels were convened by the Substance Abuse and Mental Health Services Administration (SAMHSA) in the fall of 2014 to discuss the current state of the field in operationalizing and measuring SED. The aims of this article are to (a) provide an update on SED prevalence rates from survey research, (b) summarize key discussion points that emerged during the SAMHSA expert panel meetings, and (c) make specific recommendations for next steps in measuring the prevalence of SED. Issues addressed in this article are important not only for federal allocation of service dollars to meet the needs of children with SED, but also for broader mental health surveillance efforts within the context of large national research surveys.