Leyla Stambaugh

Outcomes From Wraparound and Multisystemic Therapy in a Center for Mental Health Services System-of-Care Demonstration Site

This study examined outcomes for 320 youth in a Center for Mental Health Services system-of-care demonstration site. Youth received wraparound-only (n = 213), MST-only (n = 54), or wraparound + MST (n = 53). Participants were 12 years old on average and mostly White (90%), and 75% were Medicaid-eligible. Service use and functional and clinical outcomes were examined at 6-month intervals out to 18 months.All three groups improved over the study period. The MST-only group demonstrated more clinical improvement than the other groups. Functional outcomes did not differ significantly across groups.Youth in wrap + MST had higher baseline severity and experienced less clinical and functional change than the other two groups, despite more mental health service use. Targeted, evidence-based treatment may be more effective than system-level intervention alone for improving clinical symptoms among youth with serious emotional disorders served in community-based settings. New or amended approaches may be needed for youth with the most severe disorders.

Mental Health Service Use During the Transition to Adulthood for Adolescents Reported to the Child Welfare System

OBJECTIVE This study analyzed patterns of outpatient mental health service use from adolescence into early adulthood among young adults who were reported as victims of maltreatment in adolescence. METHODS Data were from the National Survey of Child and Adolescent Well-Being, a national probability study of children for whom maltreatment was investigated by the child welfare system. The sample consisted of 616 young adults aged 12 to 15 at baseline. Analysis used descriptive statistics to determine need for and use of outpatient mental health services across time. Logistic regression was used to examine predictors of use of outpatient mental health services in young adulthood. RESULTS Almost half of the young adults in this sample had one or more indicators of mental health problems. There was a significant decrease in use of specialty mental health services from adolescence to young adulthood, declining from 47.6% at baseline, to 14.3% at the five- to six- year follow-up. Among young adults with mental health problems, less than a quarter used outpatient mental health services. Logistic regression results indicated that having mental health problems, having Medicaid, and being white were positively associated with use of outpatient mental health services in young adulthood. CONCLUSIONS Mental health problems were prevalent among young adults who were suspected of being maltreated when they were adolescents, but only about a quarter of those in need used outpatient mental health services. Interventions to improve access to outpatient mental health services for this vulnerable population should particularly support outreach and engagement of young adults who are uninsured and from racial or ethnic minority groups with a history of involvement with the child welfare system in order to meet their unique developmental needs.

Family Education and Support Services in Systems of Care

This study examines the use of family education and support (FES) services within community-based mental health systems. Using data from the national evaluation of the Children’s Mental Health Initiative (CMHI), 2,853 caregivers and their children ages 6 to 18 years from 39 communities participated in this study. The findings indicated that during the first 6 months of entry into services, one third of families received FES services, and the clinical characteristics of children whose families received FES services were found to be more severe at intake into services with significantly higher internalizing and externalizing problems and significantly lower strengths than those families who did not. Similarly, caregivers who received FES services entered services experiencing more strain. The findings have implications for the impact of FES services on children.