Evaluating children's mental health service systems: An analysis of critical behaviors and events

A lack of studies which evaluate system change by tracking client outcomes is noted in the children's mental health area. This deficit may be a result of the inability of researchers to define outcomes and to draw conclusions about which measures reflect the efficacy of services and service delivery systems. This paper reviews five social validation surveys which examined children's mental health outcome measures. Based on the results of the five surveys, a model of critical behaviors and events is presented. This model will assist evaluators and researchers in understanding which critical events and behaviors should be measured to assess the impact of community-based mental health services for children.     

The School and Community Study: Characteristics of Students Who Have Emotional and Behavioral Disabilities Served in Restructuring Public Schools

We present selected initial results from a study investigating the effects of school restructuring and reform activities on outcomes for students who are identified as having serious emotional and behavioral disabilities. A review of the literature revealed six key areas of reform for investigation: accountability, governance, parent involvement, includedness, curriculum and instruction, and pro-social discipline. Ten schools (five elementary, two K-8, one middle, and two high schools) actively engaged in school restructuring and reform efforts were selected to participate in the study, and their status related to these six areas is presented. Characteristics of the students identified as having emotional and behavioral disabilities and served in these schools in special education settings (N = 116) are described. Results from the administration of standardized assessments revealed that these students have significant levels of emotional and behavioral disabilities that impair their functioning at school and at home. Further, school staff are providing the majority of counseling services to these students during the school day, with non-school professionals providing services to 25% of the students.     

Effects of the SPARK Teen Mentoring Program for High School Students

Journal of Child and Family Studies - This study employed a randomized controlled trial with pre- and post-intervention measurement to investigate the impact of the Speaking to the Potential,...     

The Mental Health Needs of Youth with Emotional and Behavioral Disabilities Placed in Special Education Programs in Urban Schools

We describe the psychosocial characteristics of youth with an average age of 11.8 years served in special education due to emotional disturbances in urban communities (N = 158). Data were also collected describing service utilization, academic functioning, and family characteristics. Ten schools in three mid-size urban cities participated. Results from the administration of standardized assessments revealed that the majority of students scored in the clinical range on the parent version of the Child Behavior Checklist and the Columbia Impairment Scale, indicating significant levels of emotional and behavioral impairment. Further, behavior problems began at an early age with 80% of the youth using outpatient services beginning at the average age of 7.5 years and 29% of the youth using inpatient services beginning at an average age of 8.4 years of age. Most of the youths' school careers (67%) have been in a special education setting. The most common services currently being supplied by school personnel was individual counseling and this was provided for 63% of the students while child-serving agency personnel were providing individual counseling for 17% of the youth. Implications for the development of multi-agency collaborative services are presented.     

Description of a Fidelity Implementation System: An Example from a Community-Based Children’s Mental Health Program

Public policy initiatives to deliver evidence-based practices in community settings have increased the need to develop implementation feedback systems to assist program administrators adopting the practices as well as researchers who wish to continue the line of research. This paper contributes to the efforts to reduce the implementation gap in the children’s mental health services field by exploring the concept of fidelity and highlights its importance to the adoption of evidence-based practices. Fidelity, or the degree to which interventions are implemented as originally designed, is generally conceptualized as a system of five unique and interrelated components including adherence, dosage, participant responsiveness, quality of delivery, and program differentiation. Definitions and a critical analysis of each of the component’s strengths and weaknesses are offered while discussing the integrated nature of each component. An example of the development and use of the five components of fidelity within a community-based evidence-based program is described.     

A comparison of children with serious emotional disturbance served in residential and school settings

The National Adolescent and Child Treatment Study (NACTS) was designed to study children identified and served by the public mental health and special education systems as seriously emotionally disturbed. Children (N=812) and their parents (N=740) participated in the first wave of data collection in this longitudinal study. Subjects lived in six states, with approximately half in psychiatric residential treatment centers and the other half in public school special education programs. A multi-method, multi-source methodology was employed. The sample is characterized by externalizing problems, poor adaptive functioning, and substantial academic deficits. Residential children were more likely to have blended families, were more likely to have previously received residential treatment, and had higher rates of conduct disorder, anxiety, and attention deficit disorder, as measured by the Diagnostic Interview Schedule for Children. The two groups did not differ on intelligence, age of onset, or rates of schizophrenia or depression. The data suggest the presence of greater at-risk factors in the residential group and different paths of entry into special education and residential treatment programs.     

Psychoanalysis in groups: Creativity in diegophrenia

This paper illustrates the value of psychoanalysis in groups in promoting the creative potentials of diegophrenics. The concepts in diegophrenia and creativity are defined and described, with two types of creativity postulated: ego alien or oppositional and ego syntonic. Illustrations of how 12 major ego functions can be enhanced in therapy in order to allow the diegophrenic to recover his or her suppressed ego and free it from the ambivalence of subordination and revolt inherent in his/her prevailing pseudo-egos is provided.     

Evaluation of a Community-Based Peer-to-Peer Support Program for Parents of At-Risk Youth with Emotional and Behavioral Difficulties

Parents of children with emotional and behavioral needs frequently experience difficulty navigating community-based services for their child, as well as experience increased stress and parental strain. Peer-to-peer support programs are an emerging approach to assist these parents, and evidence suggests that they are effective in increasing parents’ perceptions of social support, self-efficacy, and well-being. However, these programs often focus on parents of youth with diagnosed mental health disorders, despite the potential benefit for parents of youth who are at-risk for significant emotional and behavioral problems. In the current study, we used a pre-post design to evaluate a community-based, peer-to-peer support prevention program delivered via telephone to parents (N = 139) of youth with emerging behavioral and emotional difficulties. We evaluated (1) whether the intervention was delivered as designed, (2) the pre- and post-intervention gains in social support and concrete support, and (3) whether parents’ level of participation in the intervention and program adherence predicted outcomes. Results indicated that the intervention was delivered as intended and resulted in increased parental perceived social support and concrete support over time. Furthermore, higher levels of parental participation and intervention adherence were associated with increases in perceived social support. Thus, findings suggest that it may be beneficial for parents of at-risk youth with significant emotional and behavioral difficulties to engage in a peer-to-peer phone support prevention program.