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1999 Annual Report to Congress on the Evaluation
of the Comprehensive Community Mental Health
Services for Children and Their Families Program
Back to Report
DATA HIGHLIGHTS
CHILDREN AND FAMILIES
CHILD CHARACTERISTICS
- Gender: 62% boys, 38% girls.
- Average age: 12.2 years. 21% were aged 8
years or younger, 17% were aged 9 to 11 years, 26% were aged 12
to 14 years, and 36% were aged 15 years or older.
- Race/Ethnicity: 55% were Caucasian, 15% African-American,
25% Hispanic, 2% American Indian or Alaskan Native, 2% Asian or
Pacific Islander, and 1% were of other ethnicities.
FAMILY CHARACTERISTICS
- Family Composition: 53% of children lived
in single-parent homes, 24% lived in two-parent homes, 7% lived
with a guardian, 10% were wards of the State, and 4% had other living
situations.
- Living Arrangements: At intake, 63% of children
were reported to have lived in just one living arrangement during
the previous 12 months; 37% were reported to have lived in two or
more different living arrangements.
- Poverty: 61% of the children's families
reported incomes below $15,000, which is below the poverty threshold
of $16,700 for a family of four according to DHHS's 1999 Poverty
Guidelines (U.S. Department of Health and Human Services, 1999).
- Family Composition and Poverty: 72% of children
in mother-maintained households lived in poverty, 47% of the children
in father-maintained households lived in poverty, and 43% of the
children in two-parent households lived in poverty.
- Child Risk Factors: 60% reported that their
child had at least one risk factor for serious emotional disturbance.
The most frequently reported child risk factors included history
of physical abuse (33%), previous psychiatric hospitalization (25%),
history of running away (25%), and sexual abuse (24%).
- Family Risk Factors: 79% identified at least
one family risk factor, 20% identified one family risk factor, 20%
identified two risk factors, and 39% indicated three or more family
risk factors. The highest reported family risk factors were history
of substance abuse (62%), history of violence (54%), and history
of mental illness (45%).
REFERRAL SOURCES and DIAGNOSES
- Referral Sources: Communities funded in
1993 and 1994: 21% were referred by a mental health agency, 21%
by schools, 15% by a social service agency, 14% through courts and
correctional institutions, and 11% by parents. Communities funded
in 1997: 21% were referred by a mental health agency, 20% by schools,
9% by a social service agency, 21% through courts and correctional
institutions, and 20% by parents.
- Primary Diagnosis: Communities funded in
1993 and 1994: 29% conduct-related, 13% ADHD, 26% depression, 8%
anxiety, and 23% other. Communities funded in 1997: 33% conduct-related,
28% ADHD, 21% depression, 4% anxiety, and 15% other. "Other"
includes diagnoses such as adjustment, substance abuse, developmental
disability/autism, psychosis, personality disorders, learning disability,
abuse/neglect, and diagnosis deferred.
- Multiple Diagnoses: 29% of children had two
distinct diagnoses. Among children with two diagnoses, a secondary
diagnosis of a conduct-related disorder (39%) or ADHD (18%) was
more common among children in communities funded in 1997 (i.e.,
Phase II) than among children in communities funded in 1993 and
1994 (i.e., Phase I). Among Phase I children, conduct-related disorders
and ADHD were prevalent at a rate of 18% and 10%, respectively.
EDUCATIONAL STATUS
- Individualized Education Plan (IEP): 55%
of school-aged children had an IEP; most of these children (62%)
had IEPs related to the emotional disturbance designation. Children
in grades 1 and 2 were less likely to have an IEP than children
in higher grade levels.
- Classroom Placement: 59% of children were
in regular classrooms, 20% were in special education classes, and
2% were suspended or had formally dropped out; 36% of children were
assisted by classroom aides, while 64% had no classroom aides.
JUVENILE JUSTICE STATUS
- Contacts with Youth Authorities: 29% of
children had experienced some contact with law enforcement during
the 12 months before they entered systems of care.
- Adjudicated Convictions: 13% of children
had one or more adjudicated misdemeanors, 6% reported an adjudicated
felony, and 15% had one or more arrests that led to convictions
during the 12 months before entering system-of-care services.
SUBSTANCE USE STATUS
- Cigarette, Alcohol, Marijuana Use: Based
on self-reports from youth aged 11 years or older receiving services
in communities funded in 1997, 54% had tried alcohol, 67% had tried
cigarettes, and 43% had tried marijuana at least once in their lifetimes.
CLINICAL OUTCOMES
- Behavioral and Emotional Problems Were Reduced:
After 2 years of receiving services, 42% of the children showed
a significant reduction in severe behavioral and emotional problem
symptoms as evidenced by a reduction in severe behavioral and emotional
symptoms, indicated by the total problem score on the Child Behavior
Checklist (CBCL). Symptoms of children who improved over the 2 years
that they were in services declined to below clinical levels for
70% of children.
- Clinical Functioning Improved: After 2 years
in services, the percentage of children who had scores below 40
on the Child and Adolescent Functional Assessment Scale (CAFAS)
more than doubled, from 13.5% to 29%. Scores below 40 indicate that
children are no longer considered to be clinically impaired in their
social functioning. Boys and girls entered services with similar
levels of functional impairment, and both made improvements. Girls
made faster and greater improvements in functioning than boys.
FUNCTIONAL OUTCOMES
- Residential Stability Improved: Single residential
living arrangements among children who remained in services for
1 year made a 20% gain.
- School Attendance Improved: The percentage
of children attending school regularly increased from 85.9% at entry
into system-of-care services to 89.4% after 1 year of services.
- School Performance Improved: Grades that
were Average or Above Average made a 20% gain among children remaining
in services up to 1 year. Children in special education programs
also showed improvement in their grades. Average or Above Average
grades improved by 14% over those at intake.
- Law Enforcement Contacts Were Reduced: The
number of children with any law enforcement contacts fell by 25%
among children who remained in services after 1 year.
- Children with Reduced Law Enforcement Contacts
Improved in Functioning: Children who had a decrease in contacts
with law enforcement and those whose contacts remained the same
after 1 year in services, made the greatest improvement in their
overall functioning. Children who had increased contacts did not
improve.
- Substance Abuse Diagnosis and Improvement in
Functioning: Among communities funded in 1993 and 1994, about
17% of the children had a secondary diagnosis of substance abuse
at entry into services. These children faced greater challenges,
yet made the greatest improvements in functioning after 1 year,
as indicated by a 29-point decrease in total CAFAS scores, as compared
to a 12-point decrease for children without a secondary diagnosis
of substance abuse.
FAMILY RATINGS OF SERVICES
- Caregivers were satisfied with services.
Over 75% of the caregivers rated services as "good or excellent."
- Caregivers were satisfied with their child's
progress. Over 66% of the caregivers were satisfied with their
child's progress after 1 year in services.
- Caregivers reported having a choice in making
service decisions. Over 75% of the caregivers felt that they
were always given a choice in decisionmaking related to their children's
services.
- Caregivers reported being asked their opinions
about their child's treatment. 75% of the caregivers indicated
that they were always asked for their ideas and opinions concerning
their child's treatment.
- Caregivers received unconditional, high-quality
care. Three-fourths of the caregivers felt they would receive
care unconditionally and believed that the quality of their care
would be high.
SYSTEM-OF-CARE SERVICE FEATURES AND FUNDING
- Communities Delivered Services Consistent with
System-of-Care Principles: The evaluation of service system
implementation was based on eight principles. The eight system-of-care
principles are family focused, culturally competent, interagency,
community based, accessible, collaborative/coordinated, individualized,
and least restrictive. Assessments revealed how communities with
developed systems of care differed from communities that provided
services in the traditional manner. In East Baltimore, a system-of-care
grant community, service delivery scores on each principle were
higher than in West Baltimore, a community that did not have a system-of-care
grant.
- Families Experienced Services Consistent with
System-of-Care Principles: Families who received services in
a community with a system of care in place experienced services
consistent with system-of-care principles. In Stark County, Ohio,
a system-of-care community, families found their service experiences
to be more child and family focused, community based, and culturally
competent than in Youngstown, Ohio, a community that did not have
a system-of-care grant. The families in Stark County also felt that
services they received had a greater impact: Their services were
more appropriate and their children showed greater improvement.
- Total Dollars Contributed to Children's Mental
Health Budget Increased: Evidence of change in funding for children's
mental health services comes in part from the evaluation of specific
communities. In Milwaukee, Wisconsin, expansion as well as changes
in funding are evidenced by the dramatic change in contributions
from sources other than the program grant. The total dollars contributed
to the children's mental health budget by sources other than the
CMHS grant rose by $28 million in one community (Wraparound Milwaukee).
CB-E199D
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