Child, Adolescent & Family

Comprehensive Community Mental Health Services Program for Children and Their Families In-depth

DESCRIPTION: The Comprehensive Community Mental Health Services Program for Children and their Families was first authorized in 1992 to encourage the development of intensive community-based services based on a multi-agency, multi-disciplinary approach involving both the public and private sectors. Funds are available to States, communities, Territories, and Indian tribes or tribal organizations to improve upon and expand previously developed infrastructure and to better provide the array of services necessary to fully meet the needs of the target population. Grants are limited to six years of funding.

The target population for these grants is children and adolescents (under 22 years of age) with diagnosable serious emotional, behavioral, or mental disorders accompanied by disability (present, or expected to be present, for at least one year) and who require services from multiple agencies. The goals of the CMHS Comprehensive Community Mental Health Services Program for Children and their Families are to:

• Expand the service capacity in communities that have developed an infrastructure for a community-based, interagency approach to serving children and adolescents in the target population.
  
  
• Provide a broad array of mental health services that are community-based, family-centered and tailored to meet the needs of the child or adolescent through an individualized service planning process.
  
  
• Ensure the full involvement of families in the development of local services and in the care of their children and adolescents.

Grantees must develop sources for non-federal matching contributions. Over the term of a six-year award, local or state matching resources must increase from $1 for each $3 of Federal funds to $2 for each $1 of Federal funds. Funded service systems must include diagnosis and evaluation, outpatient, emergency, intensive home-based and day-treatment services, transitional and case management services, and respite care.

Funded service systems must include diagnosis and evaluation, outpatient, emergency, intensive home-based and day-treatment services, transitional and case management services, and respite care. It is essential to ensure the full involvement of families in the development of local services and in the treatment planning for the care of their children and adolescents.

There is an extensive evaluation on the implementation and outcomes of this service program. Data collection is being done by the individual grantees with an Office of Management and Budget - approved set of measures. Some of the outcomes that are being assessed in the program include school performance, involvement with the juvenile justice system, behavioral and mental health functioning, family satisfaction, and system-of-care development.

Preliminary data from local level evaluations suggest reductions in out-of-home placements for children with serious emotional disturbance. For example, the ACCESS Program in Alexandria, Virginia, showed a 48 percent reduction in out-of-city residential placements for children with serious emotional disturbance since that program began in 1995. Some sites are showing that acute psychiatric hospitalizations have been reduced. The program in Sonoma County, California, reported that the average number of acute psychiatric hospitalizations per month among children and youth was reduced by 34 percent during 1997. These reductions represented a 48 percent cost savings. Other sites showed that residential lengths-of-stay have been reduced. An example of this occurred in the Wraparound Program in Milwaukee, Wisconsin, where the site found that a child's average length-of-stay in residential placements was 112 days compared with 270 days before the Program began, a difference of 58 percent.

Some sites show that fewer crimes were committed by children in the program. For instance, in a two year study, the Crossroads Program of San Mateo County, California, reported a 61 percent reduction in the number of crimes committed by youth in probation in the 12 months after entry into the program compared with the twelve months prior to entry.

Across the initial 22 sites funded in 1993, the percent of children who were rated Average or Above Average in their school performance improved by 12.3 percentage points after six months in services, and by 19.0 percentage points after one year in services. In regards to mental health functioning, the Total Problem Score for children on the Child and Adolescent Functional Assessment Scale (Hodges, 1994) improved by 16.5 percent after six months in services and by 19.7 percent after one year in services. Concerning juvenile justice outcomes, 33 percent of the children across the sites were reported to have some contacts with law enforcement in the previous 12 months. After one year in services, 42 percent of these children with law enforcement contacts were reported to have no contacts. With respect to family satisfaction, 75.7 percent of families were satisfied or very satisfied with services after six months.

ACCOMPLISHMENTS: Since 1984, the Federal government has supported the development of more accessible and appropriate service delivery systems for children and adolescents with a serious emotional disturbance and for their families. The program builds on earlier successes of the Child and Adolescent Service System Program (CASSP) and other private sector-sponsored demonstrations (e.g., Robert Woods Johnson Foundation) by funding communities to provide a broad array of services within a developed infrastructure.

The Comprehensive Community Mental Health Services Program for Children and their Families has been a leader in interagency collaboration, and was recognized with the Vice President's Hammer award for the accomplishments of an interagency team formed by CMHS in order to consolidate training and technical assistance from several agencies into a single comprehensive effort.

To disseminate findings and lessons, the Child, Adolescent, and Family Branch of CMHS, which administers the children's services program, has published several monographs on promising practices in children's services that have potential for replication across the country. The monographs are part of an annual series and, to date, 13 have been published. A list of these monographs, and links to their texts, is available at http://mentalhealth.samhsa.gov/cmhs/ChildrensCampaign/practices.asp.

The 1999 Annual Report to Congress on the Evaluation of Comprehensive Community Mental Health Services Program for Children and Their Families Program has been approved by the Secretary of the Department of Health and Human Services, Tommy G. Thompson. It provides a wealth of information on the characteristics of children, families, and service environments as the children enter systems of care; the outcomes of children who remain in services after six months; service ratings from families of children who remain in services after six months; two-year results of system-of-care development; and the relationship between service elements and child outcomes.

In addition, several studies have been published focusing on preliminary findings of specific sites in the children's program. The references for these studies are as follows:

Rosenblatt, J., Robertson, M. B., Wood, M., Furlong, M. J., & Sosna, T. (1998). Troubled or troubling? Characteristics of youth referred to a system of care without system-level referral constraints. Journal of Emotional and Behavioral Disorders, 6, 42-54

Walrath, C. M., Nickerson, K. J., Crowel, R. L., & Leaf, P. J. (1998). Serving children with serious emotional disturbance in a system of care: Do mental health and non-mental health agency referrals look the same? Journal of Emotional and Behavioral Disorders, 6(4), 205-213

Many of the initial 22 sites have helped bring state-wide changes in policies for children's services. For instance, in 1997 and 1998, staff from two CMHS-funded sites were instrumental in designing the Home and Community Medicaid Waiver for the State of Kansas. In 1998, the Wings Program in the State of Maine produced invaluable outcome data that was used to support the state legislature to pass a new law stipulating that services for children with serious emotional disturbance will be developed across the State using a system-of-care approach. In 1997, the Rhode Island State legislature passed a law authorizing the creation of two pilot programs, a rural and an urban one, to keep children with serious emotional disturbance in their home school districts and their own neighborhood schools, rather than placing them outside of their communities. Evaluation data from the Project Reach Program in Rhode Island was critical to making an argument in support of the pilot programs.

Several media products from the national public education campaign, "Caring for Every Child's Mental Health: Communities Together Campaign," administered by the Child, Adolescent, and Family Branch, have received several national awards. The video "Voices of Strength: An Inside Look at Children's Mental Health" received a Bronze in the 1997 Mercury Awards and the print public service advertisement, "Are They As Healthy as They Look?" was Finalist in the 1998 Mercury Awards. The Mercury Awards celebrate excellence in public relations and corporate communications.

The National Association of Government Communicators (NAGC) recognizes outstanding government communications projects and their producers. The following Campaign products have received Blue Pencil Awards from the NAGC:

You and Mental Health: What's the Deal", 1996 brochure, 2nd place;

"Caring for Every Child's Mental Health", 1996 press kit, 3rd place;

"Your Child's Mental Health: What Every Child Should Know", 1997 brochure, 2nd place;

"Drawing on Strengths", 1998 poster, 3rd place;

"Are They as Healthy as They Look", 1998 print ad, 2nd place.

EVALUATION/PERFORMANCE MEASURES:

The following are the proposed performance measures for the Government Performance and Results Act (GPRA) plan of the Substance Abuse and Mental Health Services Administration:

• Increase interagency collaboration as measured by referrals from other non-mental health agencies, referrals from juvenile justice programs, and case records that reflect cross-agency treatment planning;
  
  
• Decrease utilization of inpatient or residential treatment by 20 percent as measured by average days in facility;
  
  
• Improve child outcomes in areas such as school attendance and law enforcement contacts (reduced);
  
  
• Increase the level of family satisfaction with services;
  
  
• Increase stability of living arrangements by decreasing the number of children having more than one living arrangement after six months in services.