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2000 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: 12.1 years.
- Race/Ethnicity: 53% White, 24%
Hispanic, 14% African-American, 2%
American Indian or Alaskan Native, 3%
Asian American or Pacific Islander, and
4% other ethnicities.
Family Characteristics
- Family Composition: At intake, 47% of
the children lived with their biological
mother only, 26% lived in two-parent
homes, 5% lived with their father only, 8% lived with a guardian,10% were wards of the
State, and 4% had other living situations.
- Living Arrangements: Among all children with data at intake, 58% of children were
reported to have lived in just one living arrangement during the previous 12 months; 42%
were reported to have lived in two or more different living arrangements.
Risk Factors
- Poverty: At intake, 68% of the children's families reported incomes below the poverty level
of $17,050 for a family of four according to DHHS's 2000 Poverty Guidelines (U.S.
Department of Health and Human Services, 2000).
- Family Composition and Poverty: At intake, 76% of children in mother-maintained
households lived in poverty, 60% of the children in father-maintained households lived in
poverty, and 56% of the children in two-parent households lived in poverty.
- Child Risk Factors: At intake, 67% of caregivers reported that their child had at least one
child risk factor for serious emotional disturbance. The most frequently reported child risk
factors included history of physical abuse (31%) history of running away (25%), previous
psychiatric hospitalization (25%), and sexual abuse (23%), and drug or alcohol use (21%).
- Family Risk Factors: At intake, 84% of caregivers identified at least one family risk factor,
and 42% indicated three or more family risk factors. The most frequently reported family risk
factors were history of substance abuse (62%), history of mental illness (46%), and history
of family violence (53%).
Referral Sources
- Referral Sources: 22% of the children were referred to systems of care by a mental health
agency, 15% through juvenile justice agencies, 20% by schools, 14% by social service
agencies, and 16% by caregivers or youth themselves.
- Referral source differed significantly by ethnicity. More White families and fewer
Hispanic families referred themselves to services, however minority families were no more
likely to be referred to services from external sources (such as schools, mental health,
juvenile justice, or social service agencies) than White children.
Diagnoses
- Diagnosis: 29.4% of children had a DSM-IV diagnosis of conduct-related disorders, 25.8%
of depression, 13.8% of ADHD, 7.9% of anxiety disorders, 6.3% of adjustment disorders,
and 16.8% had a diagnosis of other disorders.
Educational Status
- Individualized Education Plan (IEP): 48% of children had an IEP; 53% of the children
with IEPs had IEPs related to the emotional or behavioral disturbance designation, 35% for
challenges due to learning disabilities, and the remaining 12% had IEPs for physical
disabilities and various other reasons. In addition, the majority of the children in special
education classes had an IEP.
Juvenile Justice Status
- Contacts with Youth Authorities: 62% of youth aged 11 years and older reported that
they had been accused of breaking the law, 50% had one or more arrests, and 54% had
been on probation.
Substance Use Status
- Cigarette, Alcohol, Marijuana Use: Based on self-reports from youth aged 11 years or
older, 58% of 345 youth had used alcohol, 67% had smoked cigarettes, and 50% had used
marijuana prior to intake. Of youth who had used marijuana, 65% had used marijuana in
the 30 days before entering services.
TO WHAT EXTENT DO CHILDREN AND FAMILIES' OUTCOMES IMPROVE OVER TIME?
Clinical Outcomes
- Behavioral and Emotional Problems Were Reduced: After 2 years of receiving services,
46% of the children showed a significant reduction in severe behavioral and emotional
problem symptoms as indicated by the total problem score on the Child Behavior Checklist
(CBCL). For 70% of these children, ratings of their problems fell below those that indicate
a need for clinical care at 2 years.
- Clinical Functioning Improved: After 2 years in services, children's social functioning
improved significantly. Girls made slightly greater gains than boys in the first 6 months.
- Behavioral and Emotional Strengths Improved: Six months after intake into the system-of-care programs, caregivers' ratings of children's strengths increased significantly in all
areas except school functioning, which improved slightly. Children diagnosed with conduct-related disorders had the greatest increases in overall strengths scores after 6 months to
above average strengths for children with behavioral and emotional disorders.
The child and family outcomes study examines how change occurs over time for a subsample of children and families enrolled in the descriptive study. Outcomes data are collected at intake and at subsequent intervals to assess change over time. Outcomes measures include, but are not limited to
- behavioral, emotional, and social functioning;
- educational performance;
- involvement with the law;
- stability of living arrangements; and
- family and child satisfaction with services.
Instruments typically used in the field of children’s mental health, including the Behavioral and Emotional Rating Scale (BERS; Epstein & Sharma, 1998), the Child Behavior Checklist (CBCL; Achenbach, 1991), and the Child and Adolescent Functional Assessment Scale (CAFAS; Hodges, 1990), were used to collect these data.
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Functional Outcomes
- Residential Stability Improved:
Overall, the stability of living
arrangements increased among children
in the system of care from intake to 2
years. The majority of children reported
only one living arrangement in the year
prior to intake (64%); however, there was
a decrease from intake to 2 years in the
percentage of children with multiple
living arrangements.
- School Attendance Improved Among
Girls: Among girls who remained in
services for 2 years, school attendance
improved. Among boys, school
attendance did not change.
- School Performance Improved: After 2
years in services, the percentage of boys
with average or above average grades
increased from 59% at intake to 71%.
The percentage of girls with average or
above average grades increased from
63% at intake to 73% after 2 years in
services.
- Children with Individualized Education Plans (IEP) Increased: At intake into services,
41.7% children in the outcomes study did not have an IEP. The percentage of children who
had an IEP increased from intake to 2 years. These statistics demonstrate an overall increase
in the use of IEPs of 19% from intake to 2 years.
- Law Enforcement Contacts Were Reduced: The percentage of children with law
enforcement contacts decreased from 23.9% at intake into services to 18.6% after 2 years
in services.
HOW ARE SERVICES DELIVERED IN SYSTEMS OF CARE?
- Children and families received a broad array of services. Among grant communities
funded in 1997 and 1998, children and families received an average of six services.
Children received both traditional and nontraditional services.
- System-of-care principles were implemented in infrastructure and service delivery.
Across the eight system-of-care principles, grant communities tended to score higher in the
service delivery domain than in the infrastructure domain.
Family Ratings of Services
- Caregivers were satisfied with services. Nearly 70% of the caregivers indicated that they
found services to be good or excellent after 2 years.
- Caregivers were satisfied with their child's progress. Over 70% of the caregivers were
satisfied or very satisfied with their child's progress after 2 years in services.
- Caregivers reported having a choice in making service decisions. Over 75% of the
caregivers reported being satisfied or very satisfied with their choice of services.
- Caregivers reported being asked their opinions about their child's treatment.
Nearly 70% of the caregivers indicated that they were usually or always asked for their ideas
and opinions.
- Caregivers received unconditional, high-quality care. Nearly 70% of the caregivers
felt they would receive care unconditionally and believed that the quality of their care would
be high.
Youth Rating of Services
- Youth were satisfied with services. Nearly 70% of the youth rated services as "good or
excellent" after 2 years in services.
- Youth were satisfied with their progress. Nearly 70% of youth were satisfied or very
satisfied with their progress after 2 years in services.
- Some youth reported having a choice in making service decisions. Less than half of
the youth reported having a choice in the services they received.
- Some youth reported being asked their opinions about their treatment. Less than
half of the youth reported that they were usually or always asked for their opinion or ideas.
- Youth received unconditional, high-quality care. Nearly 70% of the youth felt they
would receive care unconditionally and believed that the quality of their care would be high.
List of Grant Communities
REFERENCES
Achenbach, T. M. (1991). Manual for the Child Behavior Checklist and 1991 profile. Burlington,
VT: University of Vermont Department of Psychiatry.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders
(4th ed.). Washington, DC: Author.
Epstein, M. H., & Sharma, J. (1998). Behavioral and Emotional Rating Scale: A strength-based
approach to assessment. Austin, TX: PRO-ED.
Friedman, R. M., Katz-Leavy, J. W., Manderscheid, R. W., & Sondheimer, D. L. (1999).
Prevalence of serious emotional disturbance: An update. In R. W. Manderscheid & M. J.
Henderson (Eds.), Mental health, United States, 1998 (pp. 110-112). Rockville, MD: U.S.
Department of Health and Human Services.
Hodges, K. (1990). Child and Adolescent Functional Assessment Scale (CAFAS). Ypsilanti, MI:
Eastern Michigan University, Department of Psychology.
National Institute of Mental Health. (1969). Crisis in child mental health: Challenge for the 70's.
Report of the Joint Commission on Mental Health of Children. Bethesda, MD: Author.
U.S. Department of Health and Human Services. (2000). The 2000 HHS Poverty Guidelines: One
Version of the [U.S.] Federal Poverty Measure. Retrieved August 25, 2000, from
http://aspe.hhs.gov/poverty/00poverty.htm
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