Nancy Koroloff

Family-centered services: Implications for mental health administration and research

Efforts to move the system of care for children with serious emotional disorders toward community-based alternatives has prompted a growing recognition of the need for supportive services for families. This article examines the shifts in policy and administrative practice that are needed in order to move toward a family-centered system of care. Proactive administrative support is particularly important in this system shift. Four important barriers to a family-centered system of care are examined: (1) efforts have tended to focus on the child as the unit of services, rather than on the family; (2) efforts have tended to focus primarily on mental health services, rather than considering the full range of services needed by the child and family; (3) efforts have tended to emphasize formal services, often ignoring the support provided by informal networks; and (4) the resources and expertise of parents and other family members have not been used. New roles for parents—which involve working with administrators and providers as partners—are described, and implications for mental health administrators and researchers are discussed.

Juvenile Offenders With Mental Health Needs: Reducing Recidivism Using Wraparound:

The rate of youth with mental health needs is disproportionately high in juvenile justice. Wraparound planning involves families and providers in coordinating juvenile justice, mental health, and other services and supports. This study compares data from two groups of juvenile offenders with mental health problems: 106 youth in a juvenile justice wraparound program called Connections and a historical comparison group of 98 youth in traditional mental health services. Cox regression survival analyses revealed that youth in Connections were significantly less likely to recidivate at all, less likely to recidivate with a felony offense, and served less detention time.

Connecting Low-Income Families to Mental Health Services: The Role of the Family Associate

The family associate is a parent without professional mental health training who acts as a system guide to low-income families whose children have been referred to mental health services through the Early and Periodic Screening, Diagnosis and Treatment program. The family associate provides emotional support, information about mental health services and community resources, and directs assistance, such as help with transportation and child care. Based on the belief that parent-to-parent support can be a powerful tool in overcoming the barriers to accessing services, the family associate role has been successfully implemented in three counties in Oregon. The family associate role and its implementation, characteristics of the families who participated, and the implications for introducing this role into traditional mental health service systems are described.

Grounded Theory and Backward Mapping: Exploring the Implementation Context for Wraparound

Within children’s mental health, there is an increasing demand for wider implementation of wraparound and other interventions that can provide comprehensive, individualized, family-driven care. Unfortunately, implementation has proven difficult because these approaches do not necessarily flourish within traditionally organized agencies and systems. This has highlighted the need for information about how mental health agencies and systems must evolve if they are to provide a hospitable implementation environment for these interventions. A first step in developing this information is through research that advances conceptual and theoretical understanding of the impact of contextual factors on implementation. At the same time, there is an immediate need for practical information to guide decision making and policy development in settings where implementation is being undertaken. This article describes a study of wraparound implementation that used a combination of qualitative strategies to meet both of these needs simultaneously. It is argued that these strategies are particularly well suited to the study of emerging practices that reflect—and help drive—transformation in mental health systems.

Linking Low-Income Families to Children's Mental Health Services: An Outcome Study.

An intervention designed to address barriers that interfere with access to childrens mental health services for low-income families was implemented in three Oregon counties; four other counties were included as a comparison condition. The intervention involved the use of paraprofessionals called Family Associates who provided families with information, emotional support, and tangible assistance to reduce barriers to services. Families in the intervention group (n = 96) were significantly more likely to initiate childrens mental health services than were those in the comparison group (n = 143); however, the groups did not differ in their rates of appointment attendance or discontinuing services prematurely. A modest but significant difference between the groups was found for family and service system empowerment, with the intervention families reporting higher levels of empowerment at post-test. The barriers to childrens mental health services experienced by the intervention families and the barriers for which Family Associate services were provided are described.

Support groups for parents of children with emotional disorders: a comparison of members and non-members.

This study involving more than 800 parents whose children have emotional disorders focuses on comparisons between parents who are members of support groups and those who are not. While no difference was found between members and non-members on most demographic variables, members reported needing and using more information and services and found each more difficult to locate than nonmembers. Thirty-one percent of all respondents identified involvement with other parents as the most helpful activity in coping with their childs problems.

Challenges in Conducting Family-Centered Mental Health Services Research

In this article, the authors provide an analysis of the challenges facing researchers as they respond to the ideas that guide family-centered services and incorporate these themes into research focused on improving services for children with emotional, behavioral, or mental disorders and their families. The concept of “family-centered services” has emerged only recently as a generally well understood set of practice principles. Traditional approaches to conducting mental health research have not yet responded to the fundamental changes in thinking about service delivery evoked by a family-centered service system. The authors examine the fit between traditional mental health research and family-centered services and provide an introduction to the articles in this special issue.

The Great Divide: How Mental Health Policy Fails Young Adults

All individuals are challenged by the movement from being an adolescent living at home and attending school to being an adult typically heading a household and working to support him or herself. This period of time is called the transition to adulthood and is even more challenging for youth from vulnerable populations such as youth with disabilities, in foster care, in juvenile justice system, and the like (Osgood, Foster, Flanagan, & Ruth, 2005). The ages that transition encompasses have not gained consensus in research literature or policy. It begins at ages 14–16 in policies such as the Individuals with Disabilities Education Act (IDEA; PL101-476, 1997 and 2004 amendments) or Federal programs such as the Social Security Administrations SSI Youth Transition Demonstration Projects, which identifies ages 22 and 25, respectively, as ending transition. Recent studies on young adulthood in the general population (Settersten, Frustenberg, & Rumbaut, 2005), found that by age 30, the rapid changes of young adulthood had typically stabilized. Thus, using the broadest ages indicated by policy and research, transition to stable adulthood encompasses ages 14–30.

Between Adolescence and Adulthood: Rehabilitation Research to Improve Services for Youth and Young adults

University of Massachusetts Medical School Learning and Working During the Transition to Adulthood Rehabilitation Research and Training Center (Transitions RTC) ENRM Veterans Hospital, Bedford, MA In what ways are current evidencebased or informed services well suited for the needs of older adolescents or young adults (i.e., 16-30 year olds) with serious mental health conditions (SMHC)? In what ways would modifications improve their efficacy? These are the questions at the heart of this Special Issue. The papers published in this Special Issue describe examples of current efforts to modify and test the effectiveness of evidence-based interventions, originally designed for other age groups, on this population. Other papers investigate elements of services that may have particular importance for this age group e.g., social media. As Guest Editors, we hope this Special Issue serves to increase the evidence base, and to invite more research on youth and young adults of transition age.

Research on Transition to Adulthood: Building the Evidence Base to Inform Services and Supports for Youth and Young Adults with Serious Mental Health Disorders

Since the mid-1990s, research has established a clear picture of the poor real-life outcomes achieved by transition-age youth and young adults who have been diagnosed with a serious mental health disorder. The purpose of this article is to: (1) introduce the reader to the other eight articles in this special issue on Transition to Adulthood Research; (2) illustrate how each is contributing to the research base available to more fully understand these challenges as well as guide the creation of developmentally appropriate and effective services and supports for youth and young adults and their families; and (3) suggest future directions for continuing to advance this field of research and program implementation to improve outcomes though practice and policy improvements.