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

Executive Summary

The Comprehensive Community Mental Health Services for Children and Their Families Program provides grants to States, communities, territories, and Native American Tribes and tribal organizations to improve and expand local systems of care designed to meet the individualized needs of the estimated 4.5 to 6.3 million children and adolescents with a serious emotional disturbance and their families. The program is administered by the Child, Adolescent and Family Branch of the Center for Mental Health Services (CMHS) within the Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. It was first authorized by Congress in fiscal year 1992 under section 561 of the Public Health Service Act, as amended. This volume is the fourth annual report to Congress mandated under the act.

The Comprehensive Community Mental Health Services for Children and Their Families Program promotes the provision of mental health services within the context of a system of care that weaves mental health and other supports into a coordinated fabric of services to meet the diverse, highly individual, and changing health, educational, and supportive needs of children and adolescents with severe emotional disturbance. The system-of-care model is based on a philosophy built on three hallmark tenets: (1) mental health service systems are driven by the needs and preferences of the child and family; (2) services are community based; their management is built on multi-agency collaborations; and (3) the services offered, the agencies participating, and the programs generated to meet the mental health needs of the children are both responsive and sensitive to the cultural context and other characteristics of the populations being served.

To develop a system of care consistent with the theoretical model described above, a community must focus its developmental and program activities at two distinct levels: (1) infrastructure to house, organize, coordinate, and manage the integration and conduct of program elements; and (2) service delivery to undertake the services and interventions that directly serve and involve children and families.

The tasks required of grantees under this program are not insignificant in magnitude, complexity, or scope. To that end, the program provides grantees up to 5 years of funding. As a grantee reaches its third year of Federal support, it begins to focus on how to sustain its system-of-care approach without Federal assistance.

The Federal contribution to this program through annual appropriations by Congress has led to increased attention to accountability. The foremost method to demonstrate program effectiveness is through evaluation. Beyond serving as a fiscal watchdog, evaluation—both of individual grantees’ programs and of the cumulative effect of the Comprehensive Community Mental Health Services for Children and Their Families Program itself—can inform CMHS about what works for whom, and under what conditions. As such, it helps guide new directions for current program grantees and sets a benchmark for future generations of program grantees.

This report presents data from the third year of the evaluation of the children’s services program, based on information collected through August 1998 from 22 grantees that were funded for their first of 5 years of support in either FY 1993 or FY 1994. In more human terms, the evaluation focuses on programs that established systems of care for approximately 34,377 children and their families.

This Executive Summary presents two types of evaluation data, described in brief in the next two sections, and examined in greater depth in the body of the report:

Outcome data based on project site evaluations of a selected group of 200 to 400 children assessed at intake, 6 months, 1 year, and annually thereafter for as long as they remained in the program. Outcome measures examined in the evaluation included—but were not limited to—an assessment of the child’s clinical and social functioning, educational performance, and stability of living arrangements, coupled with an examination of family and child ratings of the services provided; and,
Descriptive data (e.g., demographic information, diagnostic status, functional characteristics, and referral sources) obtained at the time that children entered services.

This Executive Summary concludes with a list of the grantees from the 1993, 1994, 1997, and 1998 grant cycles under this congressionally mandated and highly successful program.

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