This Web site is a component of the SAMHSA Health Information Network

Enter Keywords Choose Website This Site Mental Health at HHS All Mental Health

Online Publications Order Publications National Library of Medicine National Academies Press Publications Homepage

printer friendly page e-mail this page bookmark this page shopping cart  current or new account

This Web site is a component of the SAMHSA Health Information Network.

2000 Annual Report to Congress on the Evaluation
of the Comprehensive Community Mental Health
Services for Children and Their Families Program

Home | Summary | Table of Contents | Figures | Tables | I | II | III | IV | V | VI | VII | VIII | IX | Appendix

VIII. ACTIVITIES AND ACCOMPLISHMENTS OF THE GRANT PROGRAM

The Child, Adolescent and Family Branch of the Center for Mental Health Services undertook many activities in FY 2000 to support the Comprehensive Community Mental Health Services for Children and Their Families Program and expand the knowledge and application of systems of care. The following sections summarize these initiatives and their FY 2000 accomplishments.

SUPPORTING THE GRANT COMMUNITIES

To ensure that the 45 currently funded grant communities operate as efficiently and effectively as possible, the Child, Adolescent and Family Branch supports technical assistance conferences and activities that disseminate information about best practices to the grant communities; generate new knowledge based on the experiences of the grant communities; and offer group, peer-to-peer, and individualized assistance. The primary components of support for the grant communities in FY 2000 included the Technical Assistance Partnership for Child and Family Mental Health, the National Indian Child Welfare Association, the Caring for Every Child's Mental Health Campaign, and the national evaluation. A Council for Coordination and Collaboration helps coordinate these various components, which are described below.

COUNCIL FOR COORDINATION AND COLLABORATION

The Child, Adolescent and Family Branch established the Council for Coordination and Collaboration as a result of a recommendation from its national partners at a meeting held in November 1999. The purpose of the meeting was to create an efficient interrelationship among the key partners of the grant program. The goals were to align the efforts of the partners in such ways as to be helpful to the grant communities and to each other, and to form a cohesive system of communication that would provide all the partners with information and knowledge to sustain this work. Three meetings of the council were held in FY 2000 with all partners participating in the planning of the agenda.

The council includes representatives from multiple organizations:

• The Center for Mental Health Services, the Child, Adolescent and Family Branch
• COSMOS Corporation
• The Federation of Families for Children's Mental Health
• IQ Solutions, Inc.
• The National Indian Child Welfare Association
• The National Mental Health Association
• The National Technical Assistance Center for Children's Mental Health at Georgetown University
• ORC Macro (formerly Macro International Inc.)
• The Research and Training Center for Children's Mental Health at the University of South Florida
• The Research and Training Center on Family Support and Children's Mental Health at Portland State University
• The Technical Assistance Partnership for Child and Family Mental Health
• Vanguard Communications

In addition to these partners, four grant communities participated in the council's second and third meetings. The grant communities included West Virginia (12 counties); Clark County, Washington; Travis County, Texas; and Oglala Sioux Tribe, Pine Ridge, South Dakota.

Although the council is in its beginning stages of development, innovations have already been realized. Most notably, communication and collaboration among the partners has increased. For example, the Research and Training Center for Children's Mental Health at the University of South Florida and the Research and Training Center on Family Support and Children's Mental Health at Portland State University have joined efforts to produce Data Trends, a publication that disseminates current research findings in the field of children's mental health services. In addition, the council formed a work group charged with developing a Web site so that partners can coordinate meeting and site visit schedules to lessen the burden for the grant communities.

Grant communities are supported through a variety of technical assistance activities, including meetings, peer mentors, learning clusters, consultants, a Web site, and e-mail networks.

TECHNICAL ASSISTANCE PARTNERSHIP FOR CHILD AND FAMILY MENTAL HEALTH

The Technical Assistance Partnership for Child and Family Mental Health, funded by the Child, Adolescent and Family Branch and implemented in partnership by the American Institutes for Research and the Federation of Families for Children's Mental Health, supports the 45 grant communities in their efforts to develop and implement local systems of care successfully. The goals of the Technical Assistance Partnership are to

• assist grant communities with the development of technical assistance plans that are based on locally identified needs for establishing a system of care;
• promote accountability through continuous information feedback mechanisms;
• design and implement technical assistance in a manner that promotes family-professional partnerships;
• promote plans to develop a system of care that fully and directly involves families who represent the target populations and community and includes families as full partners in all levels of the planning and implementation of service organization, management, and delivery; and build capacity in local systems of care in the areas of skills, knowledge, and resources that will reduce the need for similar technical assistance in the future.

In this first year of operation, the Technical Assistance Partnership conducted a number of activities to support the grant communities. These included the activities and mechanisms discussed below.

Meetings

• An orientation meeting for the grant communities newly funded in 1999 was held in Little Rock, Arkansas. This meeting provided an overview of the grant program, guidance regarding fulfillment of program requirements, and opportunities to network with people from other grant communities facing similar challenges.
• A meeting of all newly funded and current grant communities introduced a "new way of doing business," with an emphasis on family involvement and cultural competence in practice. In addition, grant communities were introduced to the national partners in the grant program--the groups responsible for providing evaluation, social marketing, technical assistance, and other resources.
• A training meeting for grant community technical assistance contractors and peer mentors took place. The purpose of this training was to provide an overview of the program and to initiate the technical assistance process. This included provision of mechanisms for communication between grant communities and peer mentors, introduction to available technology and its uses, and introduction to and selection of learning clusters (see below).
• All grant communities participated in a meeting at the close of this year's biennial training institute sponsored by the National Technical Assistance Center for Children's Mental Health where updates about technical assistance activities and the grant program were provided.

Peer Mentors

Peer mentors work in pairs consisting of one family professional and one provider professional, providing technical assistance to between one and six grant communities. There are 13 family professionals and 28 provider professionals working in this capacity. The peer mentors largely come from leadership positions in graduated grant communities. Peer mentors serve as the primary link between the grant communities and the Technical Assistance Partnership. As such, they are trained to perform two primary functions: (a) problem solving, or implementing processes for effecting change, and (b) connecting to the knowledge base, which includes accessing research-based solutions from the Technical Assistance Partnership's Web site and other sources. Peer mentors work closely with the Technical Assistance Partnership's site technical assistance coordinator and other members of the grant community to develop technical assistance plans, provide technical assistance, and to assess the technical assistance process and strategy.

Learning Clusters

Technical assistance is also delivered to groups of grant communities through learning clusters. Learning clusters consist of six to nine grant communities that elect to focus on a particular topic in a given year. The specific topic is appropriate to each grant community's stage of growth and fits with their technical assistance priorities. A family professional and a mental health service professional lead each learning cluster. Learning clusters for FY 2000 are Culturally Competent Practices and Services, Leadership, Partnership/Collaboration, Strategic Planning, Wraparound Planning, and Sustainability of Tribal Grantees.

Consultant Pool

The Technical Assistance Partnership has built a database of expert consultants to assist communities in the development and implementation of systems of care. These consultants bring expertise in approximately 30 topical areas, including child welfare, clinical treatment issues, service system infrastructure, youth and family involvement, public policy, managed care, and others. The database includes the name, biographical data, and a resume for each consultant by each topical area. The Partnership provides support to help defray the costs of the consultant and is available to help the community make a decision about which consultant to use. After the consultation is completed, the community provides feedback to the Partnership on the usefulness of the consultation.

Communication Through Technology

The Technical Assistance Partnership created and continually adds to its Web site. This site contains information about the Federal grant program as well as information about each grant community and helpful resources. Additionally, the Technical Assistance Partnership has established e-mail networks for each learning cluster and for all of the peer mentors. This facilitates communication among groups with common interests, goals, and challenges.

Through on-site consultation, meetings, and learning clusters, NICWA provides technical assistance to American Indian grant communities.

TECHNICAL ASSISTANCE FOR AMERICAN INDIAN GRANT COMMUNITIES

The National Indian Child Welfare Association (NICWA) provides technical assistance to all of the Tribal grant community staff and parents. A weekly in-house mental health team meeting and a quarterly mental health team retreat provide the strategic planning for much of the technical assistance activities.

On-site Technical Assistance

Thirteen on-site technical assistance events were provided to the American Indian grant communities during FY 2000. Each grant community was provided tools for assessing their technical assistance needs for the year.

Meetings

Several meetings were organized to offer technical assistance to the American Indian grant communities. For example, all American Indian grant communities participated in a meeting that focused on parent involvement, and other technical assistance meetings for these grant communities took place at the grant community meetings described above. Technical assistance was offered as part of a "Native American Track" at the Florida Research and Training Center research conference. At the "Building Community Capacity for Cultural Competence" meeting in New Orleans, NICWA provided training sessions for American Indian grant communities focused on infrastructure development, sustainability, and building new coalitions to address cultural competence. Also, at a joint Native American Service and Circles of Care grant community meeting, NICWA provided technical assistance on sustainability. In addition, NICWA staff participated in the First National Native American Wraparound Conference in Albuquerque, New Mexico, where they assisted with planning, offered technical support to the grant communities that arranged the conference, and distributed materials resulting from the conference discussions.

Learning Clusters

NICWA staff provided learning cluster technical assistance at grant community meetings focused on the issues of sustainability and parent involvement.

The Caring for Every Child’s Mental Health Campaign uses an integrated social marketing/communications approach to help increase a community’s understanding of the mental health needs of children and adolescents.

THE SOCIAL MARKETING CAMPAIGN: CARING FOR EVERY CHILD'S MENTAL HEALTH CAMPAIGN

The Caring for Every Child's Mental Health Campaign is the communications component of the Comprehensive Community Mental Health Services for Children and Their Families Program. Now in its second phase, the mission of the Campaign is to facilitate change in the behavior of stakeholders and decisionmakers in order to support and sustain systems of care through the use of an integrated social marketing/communications approach. Vanguard Communications helps the grant communities increase community understanding of children's and adolescents' mental health needs and garner support for these issues. Their approach coordinates many different communication tactics, including public relations, education, advertising, marketing, coalitions, technology (Internet), and traditional media, all within a social marketing planning and management framework. In FY 2000, the Campaign provided technical assistance to grant communities upon request, helping them make the best use of campaign tools and strategies. Accomplishments include the following:

• Situational analysis/Needs assessment. A situational analysis/needs assessment with 23 grant communities provided information for strategic and local planning to all grant communities as well as the Center for Mental Health Services and partner organizations.
• Marketing plan. The Campaign produced a marketing plan that sets out a triple-sector communication approach: (a) providing technical assistance to grant communities regarding their local social marketing efforts, (b) participating in national public education programs to reduce stigma associated with serious emotional disorders, and (c) implementing a social marketing campaign with one stakeholder group.
• Workshops. The Campaign designed and implemented two major workshops for grant community participants. A 3-hour workshop on "How to Speak 'Data-eze' or How to Communicate Evaluation Results with Ease" was held during the University of South Florida's annual Research and Training Center Conference. The other, "Using Social Marketing to Influence Children's Mental Health Policy and Practice," was presented at the biennial training institute sponsored by the Georgetown University Technical Assistance Center for Children's Mental Health.
• Communications Academy. The Campaign provided a 2-day regional Communications Academy on social marketing for approximately 40 grant community representatives made up of family representatives, communication contacts, and project directors to assist them in planning and carrying out their own local social marketing initiatives.
• Materials. The Campaign produced two tabletop exhibits that were loaned to grant communities for use in health promotion and community outreach efforts such as tribal gatherings, community forums, and meetings in locales as diverse as Alaska, Delaware, and Arkansas. An educational exhibit was displayed at national conferences in Oregon; Florida; Washington, DC; Louisiana; and other States. The Campaign also designed colorful computer screensavers that promote public awareness of children's mental health in both Spanish and English. These can be downloaded for free and used by grant communities and others. Finally, the Campaign created an innovative children's poster and workbook for children. Pre-tested with children and teachers in grant communities, these materials are intended for children in grades 1 through 3 and are being provided to the grant communities for wide dissemination.
• Communication through technology. A system of bimonthly conference calls and an electronic listserv enhanced and promoted networking and information-sharing among all grant communities as well as Campaign staff.

STRENGTHENING FAMILY INVOLVEMENT

Steadfast in its commitment to involve families, the Child, Adolescent and Family Branch supports a number of activities that are designed to promote families as equal partners in the promotion of children's mental health. Not only are these activities resulting in increased family involvement in local programs and the establishment of family organizations in States and communities, they have also influenced other Federal agencies and federally funded programs to engage families more systematically as partners in planning, implementation, management, and evaluation of programs. The primary components of the Child, Adolescent and Family Branch's efforts to strengthen family involvement in FY 2000 included technical assistance and training provided by the Federation of Families for Children's Mental Health, InterTribal Voices of Children and Families, and the Evaluation Skills for Families Initiative.

TECHNICAL ASSISTANCE ON FAMILY INVOLVEMENT

Family involvement is one of the core principles of the grant program. The Federation of Families for Children's Mental Health supports the evolution of this principle through technical assistance to the grant communities, national partners, and the Center for Mental Health Services so that families who are raising children with mental health needs can participate fully in the design, implementation, and evaluation of services and supports.

In FY 2000, activities supporting family involvement provided by the Federation included

• providing technical assistance to grant communities in partnership with the Technical Assistance Partnership for Child and Family Mental Health;
• developing family involvement strategies;
• developing family leadership;
• training families in evaluation skills, advocacy skills, and system-of-care principles;
• enhancing family-professional relationships; and
• improving interagency collaboratives to include families in an equitable, dignified, and respectful way.

The Federation received funding from the Child, Adolescent and Family Branch to conduct a focus group of American Indian family members to understand better their technical assistance needs and to develop a report for other technical assistance providers and American Indian grant communities. InterTribal Voices of Children and Families (described below) was formed as a result of these discussions.

INTERTRIBAL VOICES OF CHILDREN AND FAMILIES

As a result of the growing partnership between the Federation and NICWA, the annual Federation conference included an American Indian track designed to support children in American Indian communities and to increase the voice of American Indian parents. The dialogue that began at this meeting about whether to form an organization of American Indian parents and caregivers who have children with serious emotional disturbance led to further discussion at the American Indian parent organization meeting held in March 2000 and at the April research conference organized by Portland State University. It was at this meeting that focus groups on parent involvement were held and InterTribal Voices, the American Indian organization for parents of children with serious emotional disturbance, was established. NICWA provided technical assistance and support during the organization's first meeting.

In addition to supporting InterTribal Voices, NICWA assisted the Yuut Calilriit Ikaiyuquulluteng project in Bethel, Alaska, in designing a family retreat. The family retreat focused on educating family members about wraparound services and the children's mental health initiative.

Increasing the evaluation skills of families is an important avenue for strengthening family involvement in systems of care.

THE EVALUATION SKILLS FOR FAMILIES INITIATIVE

With support of the Child, Adolescent and Family Branch and in collaboration with the Research and Training Center on Family Support and Children's Mental Health at Portland State University and the national evaluation team at ORC Macro, the Federation of Families launched the Evaluation Skills for Families Initiative in FY 2000. The purpose of the initiative is to provide families with information and skills in evaluation. The initiative consists of a variety of workshops and training courses individualized to meet participant needs in particular projects, communities, and conferences. Courses are taught in a three-level series by a family-professional team that focuses on both the practical application of evaluation for families and family-run organizations as well as the technical aspects of conducting an evaluation.

At the core of the initiative is a curriculum entitled "Families as Evaluators," which teaches family members how to understand evaluation, how to work in evaluation, and how to lead evaluation. Each level is described below.

• Level I. The World of Evaluation: How to Understand It. The goal of this course is to give families the skills necessary to understand and use evaluation results to inform and enhance their advocacy. The training provides information about the major types of evaluation, key terms used in evaluation, steps in the evaluation process, and components of a research report. The training also includes visual displays of data.
• Level II. The World of Evaluation: How to Work in It. The goal of this course is to help families make decisions about when and how to become involved in an evaluation project. The training covers the critical issues in each of the following steps: the research question, evaluation design, measurements, data collection, data analysis and interpretation, and dissemination of findings.
• Level III. The World of Evaluation: How to Lead It. This course is intended to take participants to a skill level that will make it possible for them to lead an evaluation. The Federation of Families envisions family organizations contracting with evaluators and technical consultants to assist with family-run evaluation projects.

The Research and Training Center on Family Support and Children's Mental Health at Portland State University is providing evaluation services for the training and is developing a companion curriculum for evaluators from communities that are participating in the grant program.

The Level I training has been offered in three cities with 50 family members receiving graduation certificates. Plans are underway for additional Level I trainings and the piloting and refinement of the Level II curriculum.

PROMOTING SYSTEMS OF CARE FOR THE BROADER COMMUNITY

While the primary focus of the Child, Adolescent and Family Branch efforts is on supporting the grant communities, leadership within the Branch and the Center for Mental Health Services recognizes that the value of systems of care transcends the specific population and communities served by the grant program. A number of opportunities were created in FY 2000 to reach out to people and communities (including those beyond mental health) to build the leadership skills, policies, and understanding of research essential for developing and supporting systems of care. In addition, the Child, Adolescent and Family Branch created opportunities to nurture relationships with other Federal agencies; to help spread information about the value of systems of care; and to forge partnerships that will benefit children, their families, and communities.

COMMUNITIES CAN! LEADERSHIP ACADEMY

The Leadership Academies offer an opportunity for families and professionals to take a step back from their day-to-day responsibilities and explore the nature of leadership, their role as leaders in the process of systems change, and strategies to support continued growth and development as leaders. Further, they learn about effective leadership behavior amidst conflict and how to strengthen their own skills to mobilize community involvement and to adapt to change effectively.

Specifically, the Leadership Academy is designed to help community leaders

• develop a consciousness about the nature and practice of leadership and a commitment to the leadership role,
• gain a greater understanding of individual leadership strengths and opportunities for improvement that promote success,
• broaden individual skills and tools for greater effectiveness in leadership activities, and
• understand that leadership is the ability to mobilize people for change and the capacity to make a difference.

The Leadership Academy is much more than a one-time meeting. Sessions include a variety of interactive, individual, and didactic activities to help participants understand and build upon their personal leadership capacity as they strive to meet the challenges of developing systems of care in their communities. Three stages of learning help Leadership Academy participants and graduates continue to build, deepen, and apply leadership concepts:

• Stage I. A 3-month preparatory period in which individuals begin to understand and identify their leadership strengths and challenges.
• Stage II. A 4½-day intensive training and learning institute that employs a variety of learning methods to give leaders a supportive environment in which they can explore their own leadership strengths and opportunities for improvement.
• Stage III. A continuous learning framework in which Academy participants apply and deepen the leadership concepts in their home environments through the use of a peer-driven National Learning Community of Leaders. Academy graduates return to the Leadership Academy to enroll in more intensive courses on facilitation, negotiation, and measurement of the success of community-based efforts. Additional support and coaching by Academy staff and faculty is available on a fee basis.

During FY 2000, the Child, Adolescent and Family Branch funded three Leadership Academies designed and implemented by Communities Can! of the Georgetown University Child Development Center. More than 150 people participated, including representatives of the grant communities as well as family members and professionals from other communities who are committed to building systems of care. In addition, 120 people who graduated from the Leadership Academies in FY 1999 were part of the continuous learning framework during FY 2000, and 75 graduates participated in the intensive courses on facilitation, negotiation, and measurement offered at the July 2000 Academy.

THE POLICY ACADEMY ON DEVELOPING SYSTEMS OF CARE FOR CHILDREN WITH MENTAL HEALTH NEEDS AND THEIR FAMILIES

The first of a series of Policy Academies on Developing Systems of Care for Children with Mental Health Needs and Their Families was held in December 1999. The Policy Academies, funded by the Child, Adolescent and Family Branch and designed and implemented by the National Technical Assistance Center for Children's Mental Health at Georgetown University, represent a major national initiative to assist in the creation of public policy frameworks to further the development of systems of care in States, federally recognized tribes, and territories. The Policy Academies assist each participating delegation to

• define concrete objectives for a major child policy initiative (e.g., establishing cross-agency collaboration and financing for community services, putting in place local administrative and direct services coordinating structures, instituting family involvement in policy and direct services, developing culturally competent local service systems, and developing criteria and steps for program evaluation);
• design a major policy initiative and determine the type of policy strategy (such as legislation, an executive order, or memoranda of understanding) that will accomplish the identified objectives and expand interagency approaches to funding and service delivery in communities across the State, federally recognized tribe, or territory;
• strategize the next steps for gaining the political support and moving the proposed child policy initiative through the governmental process;
• develop an implementation plan for the child policy initiative; and
• form strategic partnerships to facilitate the successful implementation of the policy initiative.

The Policy Academies are designed to be more than just a 3-day conference. Participating delegations receive technical assistance prior to the 3-day academy and are expected to complete pre-work that includes defining the goals and objectives of the proposed policy initiative and determining the technical expertise and information wanted at the meeting. The actual academy is then tailored to meet the needs of the participating delegations. During the year after the academy, delegations can access ongoing consultation and technical assistance in implementing the initiatives they have proposed.

Six delegations participated in the 1999 Policy Academy. The delegations represented Kentucky, New Jersey, South Carolina, Oregon, Utah, and the jurisdiction of Guam. Delegations included representatives from the Governor's office or the highest official for the jurisdiction, cabinet secretaries, human services and budget agency directors and key staff, State legislators and key staff, family organizations, and advocates.

The FY 1999 delegations are currently using the skills they developed at the meeting and are actively working on system-of-care issues in their homes. For example, Guam developed legislation on systems of care that was recently signed by the Governor. The new law states that children on Guam with or at risk of serious emotional disturbance shall be provided access to a comprehensive system of care. Utah is working on a home- and community-based waiver to prevent parents from having to relinquish custody of their children in order to qualify for mental health services. Kentucky is developing interagency agreements with their education system. The Governor of New Jersey announced a children's initiative that would pool service dollars across the Divisions of Youth and Family Services, Mental Health Services, and Medical Assistance and Health Services. The Governor's office in Oregon established a work group that meets monthly to assess and recommend how best to align existing programs, policies, and resources into a statewide mental health system for children and adults. Finally, South Carolina is developing memoranda of agreement with State agencies to increase interagency collaboration in providing community services to support children with complex mental health needs.

WORKSHOP ON EVALUATION FOR STATES AND COMMUNITIES

An evaluation workshop entitled "The Evaluation of Children's Mental Health Services within Systems of Care" was sponsored and organized by the Department of Mental Hygiene at the Johns Hopkins School of Public Health in collaboration with the National Technical Assistance Center for Children's Mental Health at the Georgetown University Child Development Center and the Maryland Coalition of Families for Children's Mental Health. The purposes of the workshop were to (a) review recent developments in the evaluation of system-of-care services for children and adolescents with mental disorders or behavioral problems; (b) disseminate lessons learned from the evaluation of the program beyond the grant-funded communities to local communities and programs not currently funded; and (c) develop within policymakers, clinicians, family members, children's advocates, and local program evaluators the capacity to participate in, use, and sustain local evaluations of child and adolescent services and systems of care. The workshop provided sessions that offered practical information about developing logic models, identifying evaluation collaborators, choosing instruments, and disseminating information.

More than 100 people attended the workshop conducted April 3-5, 1999. Most attendees were individual representatives from community-based programs across the country, including family members, providers, administrators, and evaluators. Representatives of all major child-serving agencies were present. Participants left with new insights and innovative approaches to building and maintaining family-friendly, culturally competent, and collaborative evaluation and monitoring efforts.

THE FEDERAL INTERAGENCY COORDINATING COUNCIL

The Federal Interagency Coordinating Council (FICC) is an interagency body responsible for mobilizing available resources to assure appropriate services for the nation's infants and young children with disabilities and their families. It was statutorily mandated with the reauthorization of Public Law 99-457, which became the Individuals with Disabilities Education Act Amendments. Membership of the FICC includes the Federal Departments of Education, Health and Human Services, Interior, Agriculture, and Defense; State representatives from Education and non-Education Part C Lead Agencies; State preschool coordinators; and parents of children with disabilities aged 12 and under.

Throughout FY 2000, Gary De Carolis, chief of the Child, Adolescent and Family Branch of the Center for Mental Health Services, participated as a representative from the Federal Department of Health and Human Services on the FICC. As such, he was able to share information about the grant program and systems of care with other Federal and State partners. In December 1999, Mr. De Carolis, along with Dr. Wayne Holden, director of the national evaluation team at ORC Macro, and Dr. Rolando Santiago from the Child, Adolescent and Family Branch, unveiled the system-of-care assessment tool to the FICC. This presentation provided detailed information about how the tool is used to measure the fidelity of the intervention. The presentation was well received and provided important information to communities outside the grant program about building community-based systems of care.

SYSTEM-OF-CARE TRAINING INSTITUTES

The year 2000 biennial Training Institutes, sponsored by the National Technical Assistance Center for Children's Mental Health at Georgetown University in partnership with the Child, Adolescent and Family Branch, focused on improving policies and practices. The institutes provided specialized training and in-depth, practical information on how to develop and operate community-based systems of care for children and families and how to provide high quality, effective clinical interventions and supports within them. In attendance were more than 1,500 individuals from across the country representing State and local policymakers, program planners, administrators, providers, clinicians, families, youth, advocates, researchers, educators, students, managed care companies, and others involved in improving services for children and their families.

The faculty for the Training Institutes was comprised of representatives of communities that have made substantial progress toward developing systems of care and state-of-the-art clinical interventions as well as national experts. The opening session by Dr. Bernard Arons, director of the Center for Mental Health Services, examined Mental Health: A Report of the Surgeon General and included a panel discussion highlighting issues related to children and adolescents and cultural competence. The second segment of the opening session explored youth violence. A public health perspective on the problem of violence was presented by Dr. Deborah Prothrow-Stith of the Harvard School of Public Health, followed by a panel including a clinician, a youth, and a parent who have been involved in a school-based intervention program. On the second day, a general session focused on public policy and its critical role in system-of-care development. Congressman Bernard Sanders of the U.S. House of Representatives, along with Gary De Carolis, chief of the Child, Adolescent and Family Branch, discussed how Federal, State, and local policy could be used to develop and sustain local systems of care.

THE FEDERAL NATIONAL PARTNERSHIP

Since 1994, the Child, Adolescent and Family Branch has organized regular meetings of the Federal National Partnership. This is an ad hoc group consisting of representatives from multiple Federal agencies as well as individuals representing national research, professional, technical assistance, and advocacy organizations. The focus of this year's meeting was on the importance of communication strategies for disseminating messages about children's mental health. Representatives from several communications campaigns at the Federal level were asked to share what they were doing and to identify how they might work together more purposively to increase messages about children's mental health. As a result of this meeting, the National Communications Coalition on Children's Mental Health is being organized. The Coalition will include public, private, and foundation representatives who together will identify how they might develop a more coordinated system for disseminating key messages. In addition, as a result of the Federal National Partnership, a cross-agency communications campaign is being developed for the Federal Safe Schools/Healthy Students program.

FACILITATING KNOWLEDGE DEVELOPMENT

The Child, Adolescent and Family Branch is committed to facilitating the development of knowledge about systems of care and interventions for children with serious emotional disturbance and their families. Motivated by a desire to learn more about effective practices and collaboration for these children and their families, the Branch undertook a number of efforts in FY 2000 to examine and improve practice, to develop new models for evaluation, and to investigate areas where additional research beyond the national and local evaluation of the grant communities was needed. These are described below.

GOVERNMENT PERFORMANCE AND RESULTS ACT

The Government Performance and Results Act (GPRA) of 1993 (Public Law 103-62) requires all Federal departments and agencies to develop strategic plans that specify what they will accomplish over a 3-5-year period, to set annual performance targets related to their strategic plan, and to report annually the degree to which the targets set in the previous year were met. In addition, agencies are expected to conduct regular evaluations of their programs and to use the results of those evaluations to help understand their successes and failures based on the performance monitoring data. The Child, Adolescent and Family Branch developed six measures to identify areas of program improvement, develop action plans for program improvement, and provide information to establish program benchmarks and standards. These measures address interagency collaboration, utilization of inpatient and residential treatment programs, functional outcomes, family satisfaction, stability of living arrangements, and clinical outcomes after 6 months of service delivery.

Table 38 provides a summary of results on the key indicators of the six measures for FY 2000. Performance targets for FY 2000 were met or exceeded, with the exception of the following three indicators: (a) percent referred from non-mental health agencies, (b) percent with no law enforcement contact, and (c) percent satisfied with services received. Interested readers may refer to earlier sections of this report for more information and findings on these indicators.

Dr. Rolando Santiago, program director for evaluation at the Child, Adolescent and Family Branch, presented the GPRA-related efforts of the Comprehensive Community Mental Health Services for Children and Their Families Program to the deputy secretary of the Department of Health and Human Services. The presentation focused on findings using two of the performance measures and associated program responses. For example, data on referral sources revealed a gap in referrals from the primary care system. The evaluation data from grant communities funded in 1999-2000 will provide additional information on health measures. Furthermore, the Branch plans to convene meetings with staff from the Maternal and Child Health Bureau of the Health Resources Services Administration and the American Academy of Pediatrics to develop collaborative strategies and mechanisms to integrate further systems of care and the primary care system.

SERVICES EVALUATION WORK GROUP

The fourth meeting of the Services Evaluation Work Group took place in March 1999. The Work Group is composed of researchers, program evaluators, public policymakers, and families whose task is to provide understanding, planning, guidance, and support to the national evaluation. The meeting agenda included (a) overviews of the comparison and evidence-based practice studies provided by Dr. Wayne Holden, principal investigator for the national evaluation; (b) a demonstration of the Interactive Collaborative Network, the Web-based data collection system that has been designed by ORC Macro to improve the efficiency, accuracy, and timeliness of data collection at the grant communities; (c) a presentation by Dr. Ronald Mandersheid, chief of the Survey and Analysis Branch, CMHS, on the Decision Support 2000 management information system developed for State mental health agencies; (d) a presentation by Dr. Leonard Bickman and Dr. Anne Doucette of Vanderbilt University on a proposed measurement system for community-based mental health systems; and (e) a panel discussion by representatives of the American Indian grant communities on how to enhance the relevance of the national evaluation to American Indian grant communities. In addition, work groups addressed three other topics: (a) direction and design of the evaluation of grant communities funded in 1999-2000; (b) update on the system-of-care assessment and the redevelopment of the system-of-care assessment tool; and (c) adequacy of the grant communities' management information systems.

LOGIC MODEL DEVELOPMENT

The University of South Florida (USF) has taken the lead on developing a logic model that can help anchor the national evaluation in a theory of change. The model is a theory-based framework to help the program and the grant communities make explicit the linkages between whom they are serving, their strategies, and their desired outcomes. It was developed with the assistance of a small work group made up of key stakeholders of the program, and it was reviewed by the Child, Adolescent and Family Branch. USF has conducted three trainings for grant communities at national meetings and provided individual assistance to grant communities on developing a model that expresses their unique theory of change within their local systems of care.

CROSS-AGENCY RESEARCH COLLABORATION

The Center for Mental Health Services, the National Institute of Mental Health, and the Agency for Healthcare Quality and Research formed a cross-agency research collaborative in 1997 to study the effectiveness of behavioral health treatments in primary care practice. The collaborative is supporting five research projects. One study, sponsored by the Center for Mental Health Services, will determine the effectiveness of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) delivered through school-based health clinics and aimed at decreasing depressive symptoms and improving social functioning and school performance. The study also is assessing the direct costs and the cost-effectiveness of IPT-A. Dr. Laura Mufson of Columbia University is conducting the study in two middle schools and two high schools in urban, largely impoverished areas of metropolitan New York. If proven to be effective, this treatment model could become another tool available to grant communities funded by the Comprehensive Community Mental Health Services for Children and Their Families Program to use in addressing the needs of adolescents experiencing depression.

LINKAGE WITH THE JUVENILE JUSTICE SYSTEM

The Child, Adolescent and Family Branch recognizes that linkages between the Comprehensive Community Mental Health Services for Children and Their Families Program grant communities and local juvenile justice systems vary considerably. Given the number of youth in the juvenile justice system who have mental health needs, the Branch entered into a contract with the American Institutes for Research (AIR) to understand better the principles and elements that should guide collaboration between the two systems. AIR commissioned Dr. Ted Fallon of the American Academy of Child and Adolescent Psychiatry to design and conduct a study of communities with particularly strong collaborative efforts in place. The final product will be a document that describes the successful collaborative elements found between the mental health and juvenile justice systems, and it will provide a guide to promising practices for a system of care for youth with serious emotional disturbance involved in the juvenile justice system. Such practices may include early identification protocols, models of diversion, and activities that lead to increases in early identification and reduced recidivism.

OUTREACH AND DISSEMINATION OF INFORMATION

New information is being generated continually as a result of the efforts of the grant communities, the work of the national evaluation team, and the work of the research and training centers affiliated with the program. In FY 2000, efforts to disseminate information included the publication of a second collection of Promising Practices monographs, conferences and symposia, data newsletters, and presentations and publications.

PROMISING PRACTICES SERIES

The second collection of monographs of the Promising Practices series was published in June 2000. The goal of the Promising Practices series is to add to the national knowledge base on how best to serve and support children with serious emotional disturbance and their families.

The 2000 Promising Practices series includes the following volumes:

• Volume I - Cultural Strengths and Challenges in Implementing a System-of-Care Model in American Indian Communities.This monograph examines the promising practices of five American Indian children's mental health projects that integrate traditional American Indian helping and healing methods with the system-of-care model.
• Volume II - Using Evaluation Data to Manage, Improve, Market, and Sustain Children's Services.This monograph explores promising practices in the use of evaluation data, and it shares a wealth of ideas and experiences from grant communities about using local data in ways that can impact the delivery, management, and sustainability of community-based services for children and families.
• Volume III - For the Long Haul: Maintaining Systems of Care beyond the Federal Investment.This monograph examines the fundamental strategies grant communities should consider in order to maintain long-term financial stability, with an emphasis on non-Federal funding sources.

The information contained within these monographs was gathered largely from the grant communities through site visits, focus groups, the national program evaluation, and interviews with professionals and parents. Data collection methods were designed to be family driven, community based, culturally competent, and inclusive.

RESEARCH AND TRAINING CENTERS

The Child, Adolescent and Family Branch supports two research and training centers that engage in outreach and facilitate the dissemination of knowledge about the grant communities and systems of care in general.

The Research and Training Center for Children's Mental Health at the University of South Florida conducts an integrated series of research, training, consultation, and dissemination activities to achieve its mission of improving service delivery systems for children with serious emotional or behavioral disabilities and their families. As part of its work, the Research and Training Center for Children's Mental Health held its 13th annual research conference, "A System of Care for Children's Mental Health," which was attended by more than 600 people. During this conference, two 90-minute symposia were offered on the national evaluation, one 90-minute symposium was offered on research from the local grant communities, and a discussion hour addressed evaluation issues in funded American Indian communities. The information presented was designed both to summarize current findings of the national evaluation and to identify issues to be addressed in the future. Issues addressed included the need for additional data to answer evaluation questions better, fully involving families in the evaluation, measures under development or in need of development, and evaluation design.

The Research and Training Center on Family Support and Children's Mental Health at Portland State University is dedicated to promoting effective community-based, culturally competent, family-centered services for children and their families who are, or may be, affected by mental, emotional or behavioral disorders. This goal is accomplished through collaborative research partnerships with family members, service providers, policymakers, and other concerned persons. As part of its work, the Research and Training Center on Family Support and Children's Mental Health held a national conference titled "Building on Family Strengths: Research and Services in Support of Children and their Families." The conference was attended by more than 450 people, including researchers and evaluators, service providers, family members, and others such as legislators and judges. Activities that highlighted the work of the services program were woven into the conference in several ways:

• An American Indian track, in collaboration with the National Indian Child Welfare Association and the Federation of Families for Children's Mental Health, provided an opportunity for American Indian families to learn about system-of-care principles, with an emphasis on family participation in all phases of services planning, implementation, and evaluation. Many of the family members who attended represented American Indian communities involved in the services program.
• A plenary session, "Cultural Diversity and Research in Children's Mental Health," provided an opportunity to address issues related to cultural competence and the national evaluation of the services program.
• A variety of workshops provided opportunities for the services programs to present their research findings.
• A poster session also included presentations from community-based systems of care, many using data from the national evaluation or the local evaluations of the services program.

In addition to the conference, the Research and Training Center on Family Support and Children's Mental Health produced an issue of Focal Point (Volume 14, Number 1; Spring 2000) on early intervention in children's mental health. The issue specifically addressed "Early Childhood Mental Health Systems of Care" and included a section entitled "Partnership News" that highlighted information about the services program.

SYSTEM-OF-CARE EVALUATION BRIEF

Each month, the national evaluation team produces a four-page publication that reports findings from the national evaluation. The evaluation brief is intended to succinctly capture information on various dimensions of the evaluation that may be of interest to a variety of audiences (e.g., grant communities, policymakers, other children's mental health researchers, families, program administrators). In FY 2000, the following evaluation briefs were published:

• Measuring and Evaluating Change
• Strengths of Systems of Care
• Studying System-of-Care Implementation: Findings from the Comparison Study
• Family-Centered Interviews in Systems of Care
• Characteristics of Children Receiving Special Education and Those in Regular Classrooms
• Intake Characteristics of Girls Enrolled in System-of-Care Services
• Referral Source Differences in Behavior and Functioning
• Understanding the Role of Families in Children's Mental Health Services Research
• Chronic Physical Illness and Children's Mental Health
• Poverty and Children in Systems of Care

DATA TRENDS

Data Trends is a publication produced by the Research and Training Center for Children's Mental Health at the University of South Florida and the Research and Training Center on Family Support and Children's Mental Health at Portland State University. Data Trends, first produced in 1999, disseminates current research findings in the area of children's mental health services. Each issue summarizes, in a single page, a current publication in the children's mental health area to alert the field to recent findings and activities. A particular focus is on articles pertaining to the development or evaluation of systems of care and articles presenting results from either the national evaluation or work conducted by local grant communities. Data Trends is disseminated both electronically and in hard copy, and it also is posted on the Web sites of both research and training centers. Data Trends Alerts are e-mail announcements of current policy developments or information directed to interested parties.

TOOLKIT FOR POLICY BRIEFINGS FOR ELECTED OFFICIALS

A toolkit for grant communities that provides practical advice to plan and carry out briefings for elected officials was developed by a consultant, Rhoda Schulzinger. The toolkit was developed because the Child, Adolescent and Family Branch believes that policy briefings are one of many strategies critical for broadening an understanding of how elected officials can support policies to develop and sustain community-based, family-centered systems of care. The toolkit outlines each step for planning, preparing, and conducting a policy briefing for elected officials and contains worksheets for grant communities to use. For example, the toolkit describes how to establish policy objectives, develop community support, understand target audiences, design briefings, arrange details, develop materials, work with reporters, and conduct follow-up activities.

KEY PRESENTATIONS

Presentations were made throughout FY 2000 highlighting findings of the national and local evaluations, unveiling the system-of-care assessment tool, and promoting opportunities for collaboration that would benefit the children and families served by the programs. The most prominent of the presentations included the following:

The Inaugural Presentation of the System-of-Care Assessment Tool
Presentation to the Federal Interagency Coordinating Council, Washington, DC (December 1999)
Presenters: Gary De Carolis, M.Ed., E. Wayne Holden, Ph.D., and Rolando Santiago, Ph.D.

Findings from the National Evaluation
Presentation to the National Mental Health Association, Alexandria, VA (April 2000)
Presenters: Gary De Carolis, M.Ed., E. Wayne Holden, Ph.D., and Rolando Santiago, Ph.D.

Use of Data to Inform Policy Development
Presentation to Directors and Data Managers of Local Community Mental Health and Substance Abuse Programs, and State Administrators, organized by the Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services; the University of Virginia, Southeastern Rural Mental Health Research Center; and the Mid-Atlantic Technology Transfer Center
Presenter: Rolando Santiago, Ph.D.

Cultural Competency in Evaluation
Presentation at the Workshop on "The Evaluation of Children's Mental Health Services within Systems of Care," organized by The Johns Hopkins School of Public Health, Department of Mental Hygiene
Presenter: Rolando Santiago, Ph.D.

Findings from the National Evaluation
Presentation to the American Psychological Association, the Children's Defense Fund, the Association of School Psychologists, and the School Board Association, organized by the Federation of Families for Children's Mental Health, Alexandria, VA (May 2000)
Presenters: Gary De Carolis, M.Ed., E. Wayne Holden, Ph.D., and Rolando Santiago, Ph.D.

Outcomes Related to Child Welfare Issues Surfaced by the National Evaluation
Presentation to Child Welfare Providers and State Legislators in New York, organized by Fordham University
Presenter: Gary De Carolis, M.Ed.

Co-morbidity of Mental Health and Substance Use Conditions: Findings from the National Evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program
Presentation at a retreat on "Preventing Substance Abuse among Children with Emotional Disturbances," organized by the Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services
Presenter: Rolando Santiago, Ph.D.

The System-of-Care Assessment Tool and Accountability in Human Services
Presentation at "Achieving Results for Children," organized by The Maryland Partnership for Children, Youth and Families
Presenter: Gary De Carolis, M.Ed.

Outcomes from the National Evaluation
Presentation to Professionals Involved in a Managed Care Provider Network, organized by Hillside Behavioral Health System
Presenter: Gary De Carolis, M.Ed.

The System-of-Care Assessment Tool: Testing the Fidelity of the Intervention
Presentation to California Technical Assistance Conference on Children's Mental Health, organized by California Children's Mental Health Advocates
Presenter: Gary De Carolis, M.Ed.

How the Grant Programs Are Influencing Policy Changes at the State and Community Levels
Presentation at the Year 2000 Training Institutes, organized by Georgetown University Child Development Center
Presenter: Gary De Carolis, M.Ed.

KEY PUBLICATIONS

Findings from the grant program as a result of the national evaluation and local evaluations were published throughout the year. Some of the most important publications include the following:

Catalano, R. A., Lind, S. L., Rosenblatt, A., & Attkisson, C. C. (1999). Unemployment and foster home placements: Estimating the net effect of provocation and inhibition. The American Journal of Public Health, 89(6), 851-855.

Hodges, K., Doucette-Gates, A., & Liao, Q. (1999). The relationship between the Child and Adolescent Functional Assessment Scale (CAFAS) and indicators of functioning. Journal of Child and Family Studies, 8(1), 109-122.

Holden, E. W. (1999, Winter). Sustainability and evaluation. Family Matters, 11-12.

Holden, E. W., & Santiago, R. (1999, Spring). Measuring and evaluating meaningful change. Family Matters, 9-10.

Nabors, L. A., Weist, M. D., Holden, E. W., & Tashman, N. A. (1999). Quality service provision in children's mental health care. Children's Services: Social Policy, Research, and Practice, 2, 57-59

Rosenblatt, A., Attkisson, C. C., Baize, H., Rosenblatt, J., Thornton, P., Chamberlain, N., Barry, S., & Freedman, J. (2000, January). The California Comprehensive System of Care Evaluation Report: January 2000.

Rosenblatt, J. A., & Rosenblatt, A. (1999). Youth functional status and academic achievement in collaborative mental health and educational programs: Two California care systems. Journal of Emotional and Behavioral Disorders, 7, 21-30.

Santiago, R., Holden, W., Yang, Z., & Pahinui, K. (1999, Summer). Trends and analysis. Family Matters, 10-12.

Tebes, J. K., Helminiak, T. W., Kaufman, J. S., & Ross, E. (2000). A cost outcome study of Project REACH Rhode Island. New Haven, CT: The Consultation Center, Yale University School of Medicine.

Table of Contents | Previous | Next

Back to Top