Wraparound care in vermont: Program development,implementation, and evaluation of a statewide system of individualized services

Over the past decade, there has been a dramatic shift in the provision of mental health services to children, adolescents, and their families. This shift has been marked by a movement away from restrictive treatment options toward the development of comprehensive community-based systems of care designed to keep the most challenging children in their homes, schools, and communities. Based on a model of intensive case management referred to as Wraparound Care, Vermont's statewide approach emphasizes aggressive outreach, use of the least restrictive treatment options, and care that is flexible, unconditional, and child- and family-centered. We chart the development of Vermont's Wraparound Care Initiative and present residential, educational, and behavioral outcome data for a cohort of 40 youth receiving Wraparound Care over a 12-month period. The results showed that after 12-months, youth who had been previously removed from their homes or were at imminent risk of such removal, were residing in significantly less restrictive community-based living arrangements and exhibiting significantly fewer problem behaviors than at intake. These results are discussed in light of recent national studies and previous studies on similar cohorts of Vermont youth receiving Wraparound Care.     

An Investigation of Psychology Staffing in Australian Metropolitan Acute Public Hospitals

Psychology is one component of the multidisciplinary services provided to patients in acute public hospitals, with research demonstrating that psychological intervention significantly enhances clinical outcomes for patients across a range of health issues. Despite the increasingly important role that psychologists play in Australian hospitals, there remains a lack of information available about staff levels, discipline structures, and clinical activity for psychological services within acute hospital settings. The most recent Australian data about hospital‐based psychology services was collected 20 years ago. The current study provides updated information from a survey of 15 Australian metropolitan, acute public hospitals: presenting and critically reviewing staffing configurations and models of service delivery. Results suggest that: (a) hospitals employ a highly skilled workforce at a rate of 0.16 full‐time equivalent psychology staff for every 10 hospital beds; (b) psychologists have a viable career pathway within the hospital‐based health sector; (c) role diversity is common, with the primary focus varying as a function of position level; (d) neuropsychology staffing requires urgent attention to address significant delays in access to services; and (e) public hospitals actively contribute to current and future workforce development through supervision, research, and training. The implications of these results for the future of psychological services in Australian healthcare are discussed.     

A Longitudinal Analysis of Family Empowerment and Client Outcomes

We examined the relationship between family empowerment, parent satisfaction, and mental health outcome across time. Based on the Vanderbilt Family Empowerment Project Model, increased empowerment should lead to positive changes in client outcomes. Data consisted of the Family Empowerment Scale (FES), which was used to assess the caregiver's perception of empowerment, Child and Adolescent Functional Assessment Scale (CAFAS), which measures the degree of disruption in the youth's current functioning, Client Satisfaction Questionnaire (CSQ), and demographic information gathered from families receiving services from a county mental health service system at intake and discharge. The results showed that the CAFAS and CSQ were related to empowerment at intake and discharge. Results also indicated significant increases in the knowledge subscale of the FES and the CAFAS and moderate increases in the advocacy subscale of the FES and the CSQ. We discuss the implications of these findings for systems of care, such as stronger parent-professional relationships.     

Concordance Between Parent Reports of Children's Mental Health Services and Service Records: The Services Assessment for Children and Adolescents (SACA)

The concordance between parent reports of children's mental health services and medical and administrative service records were assessed in a field test of the Services Assessment for Children and Adolescents (SACA) interview instrument. Service use reports from primary caregivers, usually mothers, for their child's emotional or behavioral problems were compared against inpatient, outpatient, and school records in St. Louis, one of the pilot sites for the Multi-Site Study of Service Use, Need, Outcomes and Costs in Child and Adolescent Populations (UNOCCAP). A global any use service variable, comprised of inpatient, outpatient, and school reports, yielded an overall service use concordance kappa of .76 between parent reports and records. Parent reports of inpatient hospitalization services using the SACA yielded the highest agreement with medical records, with kappa statistics of 1.00 for use of any inpatient hospital care and for medication use. Parent reports of specific inpatient services concurred with medical records more moderately, yielding kappas from .50 to .66. Reports of any outpatient mental health services yielded variable rates of agreement, with kappas ranging from .67 for any use of outpatient care, to .66 for medication use, to negligible kappas for specific treatments. Parent reports of school services were weakly related to records for most services, except for moderate agreement (.48) on placement in special classrooms for emotional or behavioral problems. Family burden or impact discriminated more powerfully than other variables between respondents who concurred with records and those who did not.     

Mental Health and Other Service Use by Youth in Therapeutic Foster Care and Group Homes

Little is known about what additional services youth receive while they reside in out-of-home treatment settings. However, such information may be crucial for explaining effectiveness and variation in outcomes for youth in such settings. Our research examines patterns of multi-sector service use for youth in two settings—Therapeutic Foster Care and group homes. Data come from in-person interviews with Treatment Foster Parents and Group Home Staff for a NC state-wide sample of youth with psychiatric disorders and aggressive behavior. Findings indicated high rates of service use by youth in both settings. Analyses indicated significant differences in service types used by youth in each setting, yet similar volume of service use between settings. Clinical and demographic factors did not significantly influence types of services received. Differences in service patterns between the two groups indicated that youth in TFC were more likely to receive community-based, individualized services while youth in group homes were more likely to receive more restrictive services.