Annual Report to Congress on the Evaluation of the Comprehensive Community Mental Health Services Program for Children and Their Families

Summary

As expected, the CMHS initiative has influenced the development of integrated systems of care across the five graduating sites. Each community began with its own unique set of resources and organizational structure that have evolved across the period of grant funding into a more mature approach to service delivery for children with serious emotional disturbance. The sites have displayed fundamental system-of-care principles such as:

interagency linkages with coordination and collaboration occurring across management and administrative structures,
family involvement at the level of case planning and in the areas of advocacy and governance with family members as partners in the further development of systems of care,
coordination of a wide service array, including community-based service options,
culturally competent services, and
the use of evaluative feedback as a mechanism for improving quality outcomes and influencing the direction of development of systems of care.

It is important to note that these consistent themes have emerged across diverse settings, including urban areas, rural areas, and entire States, attesting to the ability of the system-of-care approach to be modified to fit varying and complex community configurations and needs.

Program evaluation data analyzed from each of the sites supports the conclusion that a wide range of children with varying problems are being served by the graduating systems of care. As they participate in the system of care, improvements are occurring overall in behavioral and emotional status through the 1-year evaluation point. Functioning is also improving across school, home, and community settings. Caregivers’ ratings indicate a high level of satisfaction with the services that they receive. Variability across sites in information available from management information systems places constraints on our current ability to comprehensively understand the impact of case and services mix on outcomes in systems of care. Based on the information available, specific service characteristics that appear related to outcomes include:

range of services,
continuity of services,
intensity level of services,
home-based services, and
case management and case coordination.

Although children with more severe problems cost more to serve in systems of care, residential placements are reduced and the expenses associated with providing system-of-care services in the community are substantially lower.

Many important questions are raised by the synthesis and presentation of evaluation information at the graduating system-of-care sites. Questions remain about the matching of specific characteristics of children and families to different service mixes to achieve optimal outcomes. A more refined question to pursue at this point in time is to identify which children and families benefit from which specific services in the context of community-based systems of care. This will allow us to more fully understand the process of providing integrated, community-based interventions and to replicate this process across different settings. As the system-of-care approach evolves across time, articulating the direct linkages between community-based changes, service mixes and outcomes will provide important feedback to this evolutionary process. Continuing evaluation of Phase I sites and specific modifications made in the Phase II evaluation will improve evaluative information to shape this process.

Sustaining systems of care into the future is an important issue for graduating sites who matured at the end of their 5-year funding cycle. System development site visits indicate that multiple partnerships have formed across community, local, and State agencies and organizations to support the system-of-care approach for services to children with serious emotional disturbance once grant funding terminates. The active participation of family members in the infrastructure, service delivery, and advocacy components of systems of care also bodes well for their continued survival during times of increased managed care and fiscal constraints surrounding behavioral health care.

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