Gary M. Blau

Evidence-based Treatments in the Field: A Brief Report on Provider Knowledge, Implementation, and Practice

This study examined familiarity, perceived effectiveness, and implementation of evidence-based treatments for children in community settings. A sample of service providers in agencies affiliated with federal programs to improve childrens mental health services was identified using a snowball sampling procedure. Forty-four percent of the sample (n = 616) responded to a Web-based survey designed to collect data on evidence-based treatments. High familiarity with, relatively high-perceived effectiveness, and generally high use of evidence-based treatments were reported. Partial implementation of treatment protocols within the context of few agency mandates and widely ranging supports for the implementation of evidence-based treatments was found. Results support the inclusion of more complex models of diffusion, dissemination and implementation in research, and development efforts for evidence-based treatments.

Advancing Efforts to Improve Children’s Mental Health in America: A Commentary

Childhood emotional and behavioral disorders are the most prevalent and costly of all chronic illnesses in youth. In 2006, 8.9 billion dollars was spent for the treatment of mental disorders in children which was highest of any children’s health care expenditures exceeding asthma, trauma-related disorders, acute bronchitis, and infectious disease (Soni 2009). It is estimated that 20% of children and adolescents have a diagnosable mental, emotional, or behavioral disorder and this costs the public

Sustaining and Expanding Systems of Care to Provide Mental Health Services for Children, Youth and Families Across America

247 billion annually (National Research Council and Institutes of Medicine et al. 2009). Of children and youth in need of mental health services, 75– 80% of these youth do not receive services (Kataoka et al. 2002). It is also estimated that of the 2 million youth aged 12– 17 in 2007 that met criteria for a major depressive episode, only 39% actually received services (SAMHSA/OAS 2009). Given the estimated prevalence of emotional and behavioral disorders, the limited access to appropriate services and the costs associated with these conditions it is critical that we continue to develop efficient and effective strategies for addressing this public health crisis (Alegria et al. 2010; Stelk and Slaton under 2010). This issue of Administration and Policy in Mental Health and Mental Health Services Research dedicated to children’s mental health provides an important forum for examining where we are in children’s mental health and where we need to go. The papers represent an important dialogue and a rich exchange of ideas and perspectives from the September 2009 Conference entitled, Child and Adolescent Mental Health Services: Issues and Solutions. We are pleased the have the opportunity to comment on these discussions. The Children’s Mental Health Initiative, legislated by the US Congress and implemented by the Substance Abuse and Mental Health Services Administration (SAMHSA), has been the major funded effort in the field of children’s mental health services for the past 17 years. Building on the systems of care principles and philosophy (Stroul and Friedman 1986) what started as a small demonstration program in 1993 has now become a

Improving the Mental Health Outcomes of LGBTQ Youth and Young Adults: A Longitudinal Study

120 million program in 2010. Since its inception, this CMHI has served 164 Communities in all states, multiple tribes, territories, and jurisdictions. Over 100,000 children have received direct services through a system of care approach. An increasingly sophisticated and systematic evaluation of this program shows important outcomes in terms of functional status and quality of living for the children and families engaged in the system of care approach. Data collected as part of the national evaluation of systems of care indicates improved emotional and behavioral functioning, reductions in the use of inpatient and juvenile justice facilities, and improvements in school attendance and performance (Manteuffel et al. 2008). More specifically, 2008 data showed that emotional and behavioral problems were reduced significantly or remained stable for 93 percent of children and youth 24 months after entering services, child/youth suicide attempts were reduced by one third within 6 months after entering systems of care, and further reduced by over two thirds after 24 months, regular school attendance (i.e., 80 percent of the time or more) increased from 82 percent at intake to nearly 90 percent after 24 months in systems of care, and the percentage of children and youth suspended or expelled G. M. Blau (&) L. N. Huang Substance Abuse and Mental Health Services Administration, Rockville, MD, USA e-mail: Gary.Blau@SAMHSA.hhs.gov

Evaluation of the Connecticut Title IV-E Waiver Program: Assessing the Effectiveness, Implementation Fidelity, and Cost/Benefits of a Continuum of Care

The Substance Abuse and Mental Health Services Administration has been instrumental in supporting the development and implementation of systems of care to provide services to children and youth with serious mental health conditions and their families. Since 1993, 173 grants have been awarded to communities in all 50 states, Puerto Rico, Guam, the District of Columbia, and 21 American Indian/Alaska Native communities. The system of care principles of creating comprehensive, individualized services, family-driven and youth-guided care and cultural and linguistic competence, supported by a well-trained and competent workforce, have been successful in transforming the field of children’s mental health and facilitating the integration of child-serving systems. This approach has achieved positive outcomes at the child and family, practice and system levels, and numerous articles have been published using data collected from system of care communities, demonstrating the effectiveness of this framework. This article will describe lessons learned from implementing the system of care approach, and will discuss the importance of expanding and sustaining systems of care across the country.

Family-Driven Care in America: More Than a Good Idea

ABSTRACT The purpose of this groundbreaking study was to evaluate outcomes of 482 LGBTQ (lesbian, gay, bisexual, transgender, or questioning) youth and young adults who received services and supports through the Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances Program (CMHI). This study was a secondary data analysis using data from a larger study of 3208 LGBTQ and non-LGBTQ youth ages 11 through 21 who had a serious emotional disturbance (SED). This study is significant in that it evaluates functional outcomes for young people identified as LGBTQ based on a specialized service framework (i.e., system of care approach). In essence, do LGBTQ youth with SED benefit from a specific approach to intervention? In addition, a comparison at intake on suicidality, bullying and victimization was conducted between the LGBTQ and non-LGBTQ identifying youth from the larger sample. The youth and a caregiver were interviewed face-to-face separately at intake, 6-months, and 12-months. Significant improvements were found across all of the dependent variables, supporting the viability of SOC for improving outcomes for LGBTQ youth. Future research should continue to build on this study by adding to the design a control group to improve internal validity of the findings.