Lenore Behar

Community-Based, Acute Posttraumatic Stress Management: A Description and Evaluation of a Psychosocial-Intervention Continuum

&NA; Much of todays psychological trauma can be identified as resulting from sudden and seemingly random events, and particularly from events that involve the loss of human life. This article presents a perspective on how behavioral health providers may approach the design, development, and implementation of community‐based psychological trauma interventions. These interventions allow those community members most affected by the trauma to play a central role in the resolution of, and community adaptation to, traumatic losses. After a brief discussion of “critical incident stress debriefing”—a common form of psychological “first aid” that is sometimes used following traumatic events that affect a community—the article turns to the description of a community‐based trauma‐response program that provides a continuum‐of‐care model for the care and management of individual and group reactions to shared, traumatic events. A recent evaluation of that program, which was developed by the Community Services Program of the Trauma Center in Boston, is presented as an important first step toward determining the types of community‐based responses that show promise in our efforts to ameliorate the impact of traumatic events in communities nationwide and internationally.

Unlicensed residential programs: the next challenge in protecting youth.

Over the past decade in the United States, the number of private residential facilities for youth has grown exponentially, and many are neither licensed as mental health programs by states, nor accredited by respected national accrediting organizations. The Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (A START) is a multi-disciplinary group of mental health professionals and advocates that formed in response to rising concerns about reports from youth, families and journalists describing mistreatment in a number of the unregulated programs. This article summarizes the information gathered by A START regarding unregulated facilities. It provides an overview of common program features, marketing strategies and transportation options. It describes the range of mistreatment and abuse experienced by youth and families, including harsh discipline, inappropriate seclusion and restraint, substandard psychotherapeutic interventions, medical and nutritional neglect, rights violations and death. It reviews the licensing, regulatory and accrediting mechanisms associated with the protection of youth in residential programs, or the lack thereof. Finally, it outlines policy implications and provides recommendations for the protection of youth and families who pursue residential treatment.

Defining Community Readiness for the Implementation of a System of Care

Developing systems of care for children with emotional disorders requires changes in the organization and delivery of services. Using concept mapping, the authors conducted a study to define factors of a community’s readiness to make such changes. Participants were from 25 of 27 federally-funded, advanced sites, plus a panel of experts. The participants completed three tasks: brainstorming, rating, and sorting. This process produced eight factors: Leadership, Network of Local Partners, Shared Goals, Collaboration, Families and Youth as Partners, Accountability, Evaluation, and Plans to Expand Services. Understanding factors that contribute to successful implementation should help communities identify and make needed changes.

Distribution and costs of mental health service within a system of care for children and adolescents

As the concept of the system of care is implemented in states and localities across the country, it is important to define the kinds, the volume, and the cost of services necessary to address the needs of children and adolescents with mental health problems. This article focuses on the services that are usually the responsibility of the mental health system and provides a model for planning based on experiences in one state.

USING LITIGATION TO IMPROVE CHILD MENTAL HEALTH SERVICES: PROMISES AND PITFALLS

Litigation against state governments has been one of the strategies to improve services for children with emotional and behavioral problems. The results of such litigation have been spotty in terms of expanding and improving services. Cases in North Carolina and Hawaii are used as examples of successful litigation that had substantial impacts, resulting in new, more appropriate services and expanded budgets. The similarities and differences in these two cases are discussed, as are the elements that appear to contribute to success and the risks associated with such litigation.

Improving mental health and substance abuse services for adolescents

This paper focuses on nine overlapping topics dealing with improving mental health and substance abuse services for adolescents and their families. Depending on the state of knowledge of each topic, the authors either highlight the importance of the area or offer a specific position statement. It is intended that these statements be reviewed for possible endorsement by the American College of Mental Health Administration (ACMHA) and for transmission to other professional organizations, federal and state governmental agencies and the field in general.

Community Readiness Within Systems of Care: The Validity and Reliability of the System of Care Readiness and Implementation Measurement Scale (SOC-RIMS)

Establishing a system of care requires communities to identify ways to successfully implement strategies and support positive outcomes for children and their families. Such community transformation is complex and communities vary in terms of their readiness for implementing sustainable community interventions. Assessing community readiness and guiding implementation, specifically for the funded communities implementing a system of care, requires a well-designed tool with sound psychometric properties. This scale development study used the results of a previously published concept mapping study to create, administer, and assess the psychometric characteristics of the System of Care Readiness and Implementation Measurement Scale (SOC-RIMS). The results indicate the SOC-RIMS possesses excellent internal consistency characteristics, measures clearly discernible dimensions of community readiness, and demonstrates the target constructs exist within a broad network of content. The SOC-RIMS can be a useful part of a comprehensive assessment in communities where system of care practices, principles, and philosophies are implemented and evaluated.