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This study employed a randomized controlled trial with pre- and post-intervention measurement to investigate the impact of the Speaking to the Potential, Ability, and Resilience Inside Every Kid (SPARK) Teen Mentoring program on knowledge of the principles of mind, thought, and consciousness; communication, decision making, and problem-solving skills; emotional regulation; and resilience. The SPARK program is a resilience-focused social-emotional learning program designed to promote youth resilience, emotional well-being, and academic success. Study participants included 396 9th through 12th grade students from four high schools. Random assignment occurred at the classroom level and resulted in 12 classes (n = 200 students) in the intervention condition and 12 classes (n = 172 students) in the comparison condition. Students in the intervention condition received the SPARK intervention while students in the comparison condition continued with the regularly scheduled school curriculum. Results revealed that levels of knowledge of the principles of mind, thought, and consciousness; communication, decision making, and problem-solving skills; emotional regulation; and resilience increased for students who received the intervention and either decreased or remained unchanged for students who did not receive the intervention. Results from this study provide initial evidence for the efficacy of the SPARK program with high school age youth and demonstrate the positive effects of the program on the development of emotional and interpersonal capacity required for pro-social behavior and academic success. Considerations for future program development and evaluation efforts are discussed.

Social and Emotional Learning (SEL) programs seek to enhance social and emotional competencies in children, including self-awareness, self-management, social awareness, relationship skills, and responsible decision-making. By means of direct instruction regarding social and emotional competencies, SEL programs have the potential to strengthen resilience in children and thus their capacity to effectively cope with life’s challenges. Strengthening resilience in children who are repeatedly exposed to adverse experiences, particularly those from economically disadvantaged minority backgrounds, is of particular importance and has implications for the prevention of a multitude of problems later in life. Our study reports the result of an investigation of the SPARK Child Mentoring program, a resilience-focused SEL program designed to reduce risk factors, uncover innate resilience, promote natural emotional well-being, and facilitate school success. We employed a randomized controlled trial comprising 94 elementary school students that included pre- and post-intervention measurements. After controlling for pre-intervention levels, we found a significant difference between students’ understanding of underlying program principles; communication, decision making, and problem-solving skills; emotional regulation; and resilience for students who received the intervention compared to students who did not receive the intervention. These results provide initial evidence for the efficacy of the SPARK Child Mentoring program with a diverse sample of elementary school students and adds to the existing literature base concerning positive outcomes associated with SEL programs. We discuss implications for future research focused on long-term preventive effects of the program and the characteristics of students most likely to benefit from it.

There is evidence to suggest the level of caregiver strain experienced by parents and other caregivers may have implications for engagement in their child’s mental health and education services. This is particularly important for caregivers of youth with emotional and behavioral disorders in special education, as these caregivers tend to be less involved than other caregivers. The purpose of this study was to understand caregiver strain and theoretically-related constructs in caregivers of youth with emotional and behavioral disorders. The sample included 112 caregivers of youth receiving special education services for Emotional Disturbance (ED). Using structural equation modeling and the Modified Double ABCX Model as a theoretical framework, the relationships among caregiver strain, stressors, resources, and perceptions were examined. Consistent with findings from previous studies, results indicated that more problems with youth functioning were related to higher levels of caregiver strain. Resources were found to be positively related to both perceptions and caregiver strain. The strongest relationship was observed between caregiver perceptions and caregiver strain, with more negative perceptions associated with higher levels of caregiver strain. Findings reveal the nature of the relationships among caregiver strain and related constructs, as well as the potential importance of perceptions as a target for interventions for families and youth. An understanding of caregiver strain as it relates to stressors, resources, and perceptions provides insight into how we might leverage these factors in order to increase caregiver engagement in services, ultimately improving outcomes for youth and their families.

Suicide is the third leading cause of death among youth. It’s Time to Talk about It: A Family Guide for Youth Suicide Prevention is a consumer-driven, easy to read educational print resourc...

Children stand to lose if the federal government follows through on threats to cut funding for critical safety-net programs that have long supported families and communities. Although cuts directly targeting children's mental health are a great concern, cuts to policies that support health, housing, education, and family income are equally disturbing. These less publicized proposed cuts affect children indirectly, but they have direct effects on their families and communities. The importance of these services is supported by an extensive body of social learning research that promotes collective efficacy-neighbors positively influencing each other-shown to have positive long-term effects on children's development and adult outcomes. In this article, the authors describe two federal programs that by virtue of their impact on families and communities are likely to promote collective efficacy and positively affect children's mental health; both programs are facing severe cutbacks. They suggest that states adopt a cross-system approach to promote policies and programs in general medical health, mental health, housing, education, welfare and social services, and juvenile justice systems as a viable strategy to strengthen families and communities and promote collective efficacy. The overall goal is to advance a comprehensive national mental health policy for children that enhances collaboration across systems and strengthens families and communities, which is especially critical for children living in marginalized communities.

BACKGROUND Suicide is the second leading cause of death for adolescents. Whereas school-based prevention programs are effective, obtaining active consent for youth participation in public health programming concerning sensitive topics is challenging. We explored several active consent procedures for improving participation rates. METHODS Five active consent methods (in-person, students taking forms home, mailing, mailing preceded by primers, mailing followed by reminder calls) were compared against passive consent procedures to evaluate recruitment success, as determined by participation (proportion who responded yes) and response (proportion who returned any response) rates. RESULTS Participation acceptance rates ranged from 38 to 100% depending on consent method implemented. Compared with passive consent, active consent procedures were more variable in response and participation rates. In-person methods provided higher rates than less interpersonal methods, such as mailing or students taking consents home. Mailed primers before or reminder calls after consent forms were mailed increased response but not participation rates. Students taking consents home resulted in the lowest rates. CONCLUSIONS Although passive consent produces the highest student participation, these methods are not always appropriate for programs addressing sensitive topics in schools. In-person active consent procedures may be the best option when prioritizing balance between parental awareness and successful student recruitment.

This study provides a description of caregiver strain in a sample of caregivers of students with emotional and behavioral disorders receiving school-based services. Few studies have examined caregiver strain in school-based samples. Given poor outcomes for these youth, as well as the potentially influential role of caregiver strain in service use and engagement, understanding the caregiving experience in this population is important. The current study sought to: (1) examine the levels of the different types of caregiver strain reported by caregivers in the sample; (2) describe the level of the different types of caregiver strain reported by different groups of participants; and (3) examine the relationship between caregiver strain and various student and caregiver characteristics. This study is a secondary analysis of data collected from 243 students and their caregivers enrolled in one of two larger studies examining the effectiveness of a parent support intervention. Overall, results suggest that caregivers of students with emotional and behavioral disorders may experience strain as a result of their child’s problems that goes beyond usual daily life stressors. Internalized strain directed inward toward caregivers themselves appears to be of particular importance in this population. Conclusions and recommendations for future research are discussed.

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.

Abstract. Background: Although gatekeeper training is effective at increasing knowledge, some question the effectiveness of these programs due to high pretraining knowledge levels. However, knowledge scores may be artificially inflated when students guess answer options correctly but lack information needed to assist suicidal peers. Aims: To use free-recall questions to evaluate suicide prevention knowledge and compare levels of knowledge using this methodology with established assessment methods in the literature. Method: Free-recall knowledge questions were examined before and after participation in a student gatekeeper training program. Focus groups with students enriched interpretation of quantitative results. Results: Unlike in studies using forced-choice assessment, students’ baseline knowledge was markedly low using free-recall questions and, despite making significant improvement from pretraining levels, posttraining knowledge barely approached passable levels. Focus group findings suggest that training sessions may need to be more engaging and interactive in order to improve knowledge transfer. Conclusion: Free-recall questions may provide a less inflated measure of accessible knowledge learned from school-based suicide prevention curricula. Evaluators and programmatic partners should be cognizant of this methodological issue and consider using a mix of assessment methodologies to determine students’ actual levels of knowledge after participation in gatekeeper training.

Parent education and support has been identified as a potential resource to help improve outcomes for youth who have emotional disturbances (ED). The current study builds on promising results from Parent Connectors (PCs) (Kutash et al. in Adm Policy Ment Health Ment Health Serv Res 38:412–427, 2011), a peer-to-peer program aimed at increasing the engagement of families in the education and treatment of their children who have ED. A total of 128 parents of students identified as having ED and enrolled in special education programs in 23 middle schools or special centers were randomly assigned to a treatment (had a PC) or comparison group. For parents who had a PC, results indicated positive program effects including increased perceived benefit of engagement, more engagement in their child’s services, and a more positive response to social norms. Students received more mental health services, were enrolled more days in school, and were suspended fewer times and for fewer days. The moderating effects of parent strain and child emotional functioning were examined, and implications for practice are discussed.

It is well documented that youth with or at-risk for emotional and behavioral disorders (E/BD) have severe deficits in their academic functioning. To begin to address these deficits, we focus on the need to close the opportunity gap by providing access to multi-tiered systems of academic prevention, maximiz- ing academic learning time, and providing explicit instruction for youth with E/BD. We offer recommended positive behavior interventions and supports necessary to improve engagement in instruction. Closing the achievement gap using multi-tiered academic supports requires best practices for universal screening and diagnostic assessment to understand youth academic needs. We detail the key elements of explicit instruction directly linked to improved academic performance. We conclude with alterable instruction factors for in- tensifying instruction and emphasize the need for intensive language instruc- tion for the majority of youth with E/BD.

Using data from the Special Education Elementary Longitudinal Study, we describe parent involvement and support activities in schools educating a nationally representative sample of students with emotional disturbances (EDs). We describe the extent to which programs aimed at encouraging family involvement are offered by schools and received by families and their relationship to child, family, and school characteristics. Student-level information was obtained from students, teachers, and parents, whereas school-level information was obtained from school administrators. Although schools attended by 71% of the students reported offering at least one type of family involvement activity, teachers reported only 17% of families of children with ED received a parent support service. Compared with families who did not receive support services, those who did were more involved in their school, and their children received more services in the community and had higher achievement levels. The need and potential methods for increasing parent engagement are discussed.

The purpose of the current study is to contribute to the knowledge base on the use of family education and support (FES) services by examining the longitudinal trajectories of FES receipt and multiple domains of child and family functioning. Using an extant data set of more than 9,000 youth and their caregivers, results indicate that families who received FES on entry into services had greater caregiver strain, and their children experienced greater emotional challenges than families who did not receive FES services. Furthermore, for families who received FES, the longitudinal results revealed an immediate effect of seeking additional services, decreasing caregiver strain 6 months after receipt of FES services, and improving child emotional functioning 6 to 18 months after initial receipt of FES services. The complex, lagged effects in the results are discussed in the context of the theorized cyclical course of family stress as exemplified by the Double ABCX model of adjustment and adaptation. Implications for future research of FES services are discussed, especially the need to develop a functional logic model and an operational definition of FES and its components.

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.

Most schools offer some type of school-based mental health service to students, and there is a growing body of empirically rigorous studies examining the effects on academic and mental health outcomes for students. However, students classified as having emotional disturbances are under-represented in these studies. Using a convenience sample of four different types of school-based mental health programs, changes in achievement levels and social and emotional functioning in youth with emotional disturbances served in special education (n = 148) were examined. Longitudinal results reveal there was improvement in either the emotional or social functioning of these youth in all four programs, while results for improvement in achievement levels were less consistent. Results reveal that in the targeted sample of programs with intensive or multifaceted services, there was improvement in academic as well as social and emotional functioning in these youth. Implications for school-based mental health services are discussed.

How are characteristics of communities associated with the implementation of the principles of systems of care (SOC)? This study uses multilevel modeling with a stratified random sample (N = 225) of US counties to explore community-level predictors of the implementation factors of the System of Care Implementation Survey. A model composed of community-level social indicators fits well with 5 of 14 factors identified as relevant for effective SOCs. As hypothesized, community disadvantage was negatively and residential stability positively associated with the implementation of SOC principles. Designation as a mental health professional shortage area was positively related to some implementation scores, as was the percentage of minority residents, while rurality was not significantly associated with any of the factors. Given the limitations of the study, the results should be interpreted with caution, but suggest that further research is merited to clarify these relationships that could inform efforts directed at promoting SOCs.

A major impediment to obtaining national information on systems of care implementation has been the lack of a psychometrically sound large-scale survey instrument. The present study provided information on the factorial and concurrent validity of the Systems of Care Implementation Survey scales. Multilevel confirmatory factor analysis and multilevel regression analysis were used to test these indicators of internal and external validity. Two hundred twenty-five counties were randomly selected and stratified by population size and poverty level. Nine hundred ten informants responded to the survey questionnaire, M = 4.04 informants per county (SD = 3.17). Results indicated that all models had at least adequate fit to the data, with nine of the 14 factor models having excellent fit. Overall, 11 of the 14 factors had some indication that receiving federal funding to create systems of care was associated with higher scores on the factors. Implications for future research were discussed.

The results of a survey to measure the implementation of the systems of care (SOC) approach in a nationally representative sample of counties are presented. The results from 910 informants within 225 counties reveal a moderate level of implementation of SOC factors, with the level of poverty and population size influencing implementation. Furthermore, mental health informants generally tended to rate the implementation of systems of care greater than administrators associated with the school system, other family serving agency personnel or family members. Family members and school personnel tended to rate the implementation lowest, while staff from the other child serving agencies tended to rate the implementation closer to mental health administrators. A quarter of the counties (26%) surveyed rated themselves as having adequate levels of implementation on 11 or more of the 14 factors, while 75% rated themselves as having adequate levels of implementation on six or more of the 14 factors measured. Implications for federal policies regarding systems of care implementation are discussed.

Education and mental health integration will be advanced when the goal of mental health includes effective schooling and the goal of effective schools includes the healthy functioning of students. To build a solid foundation for this reciprocal agenda, especially within the zeitgeist of recent educational reforms, a change in the fundamental framework within which school mental health is conceptualized is needed. This change involves acknowledging a new set of priorities, which include: the use of naturalistic resources within schools to implement and sustain effective supports for students' learning and emotional/behavioral health; inclusion of integrated models to enhance learning and promote health; attention to improving outcomes for all students, including those with serious emotional/ behavioral needs; and strengthening the active involvement of parents. A strong research agenda to support these new priorities is essential.

The lack of effective training and an inability to maintain fidelity are two major barriers to implementing evidence-based practices in schools. This study examined the level of implementation of evidence-based practices by teachers after they participated in a unique training program aimed at enhancing the use of evidence-based practices. The results indicate that five months posttraining, 62% of the evidence-based strategies had been implemented and these levels were maintained 13-months posttraining. While the level of exposure to students of the evidence-based practices was low, significant longitudinal improvements in reading and levels of inclusion were documented.

The inverse relationship between economic status and mental illness is well established. Less is known, however, about the nature of this relationship. A comparison of poor suburban and rural youth receiving services for their emotional and behavioral problems revealed more similarities than differences. Family income increased during the first year of service for a small percentage of families. A small but significant relationship was found between increased income and caregiver strain as well as child outcomes. For families who are poor and have a child with a disability, highly individualized services and support that reduce caregiver strain are necessary to improve child outcomes.

Evaluating school-based mental health services for children and youth with emotional disturbance (ED) has been a challenge for researchers. One particular challenge is the study design of using the student as the statistical unit of analysis, which in certain cases may lead to a violation of the “independence of error” assumption. However, the alternative to this nested design, including fewer students and more schools, can be costly and administratively complex. This study examines data from two national studies including 314 students with ED and served in special education programs and their caregivers from 24 schools in the US to identify the extent to which nesting or design effects occur in this population. The results show that variables focusing on psychopathology are less affected by nesting but school-related variables such as academic functioning are more affected. Design effects varied by grade level, suggesting that grade should be considered when designing such evaluations.

This article describes a process developed to increase the use of evidence-based instructional strategies by teachers of students in special education programs in a middle school and high school. The project developed a working partnership between university researchers and parents, teachers and administrators of students in special education programs. The partnership produced manuals for the teachers that outlined effective strategies for teaching reading, encouraging family involvement, providing academic feedback, and engaging in positive behavior support in the classroom. The results of assessing implementation fidelity, implications of the study, and future research issues are presented.

This article provides a national perspective on the schools and school programs for students with emotional disturbances (ED) who are served in special education, using nationally representative data from the Special Education Elementary Longitudinal Study (SEELS) and the National Longitudinal Transition Study-2 (NLTS2).The authors describe school characteristics and resources; educational programs, services, and supports; and students' experiences in general education academic classes and note differences among students with ED at the elementary, middle, and high school grade levels. Based on available data, the authors were able to make some comparisons with students with disabilities other than ED who received special education services and with students without disabilities. For example, findings suggest that (a) students with ED attend larger schools with higher proportions of students who receive special education services than is true for U.S. schools as a whole; (b) although most of these students spend some time in general education classrooms, they are included in such classes less often than students with other disabilities and are likely to have teachers who feel unprepared to work with them; and (c) they are likely to receive accommodations in those classes but are unlikely to receive academic support services, such as tutoring, to help them succeed. Mental health and family support services are not commonly provided for these students, and most academic and behavioral supports are less common at the high school level than at the elementary or middle school levels.The authors conclude with implications for mental health and special education communities and for their collaboration.

This article provides a national perspective of children and youth with emotional disturbances (ED) served in special education using data from the Special Education Elementary Longitudinal Study and the National LongitudinalTransition Study—2. Data sources comprise teachers,school records, the students, and their parents. Results indicate that children and youth with ED live in households in which multiple risk factors exist for poor life outcomes. As a group, these children and youth have serious and multiple impairments that include an array of emotional disabilities, poor communication skills, and low academic achievement. There is a considerable gap between initial identification of problems and the onset of service delivery, a high rate of suspension and expulsion, and an unstable school environment. Parents of children and youth with ED work harder to secure services for their children and are less satisfied with services than parents of children in other disability groups. Implications of the findings point to a need to emphasize programs that address both the academic and the behavioral needs of these children and youth.

The purposes of this article are to (a) describe the design features of two longitudinal studies,the Special Education Elementary Longitudinal Study (SEELS) and the National Longitudinal Transition Study—2 (NLTS2) and (b) outline their potential implications for policy, practice, research, advocacy, and system development for children and youth with emotional disturbances (ED). We begin by reviewing the role of longitudinal research and its importance in building the knowledge base regarding these children and youth. A review of illustrative longitudinal studies conducted on children and youth with ED points to the potential of a longitudinal design for providing much needed information but also reveals the limitations and inconsistencies in both the samples and methods of existing studies that hamper development of policy and practice. SEELS and NLTS2 are offered as exemplars of the type of studies needed to supply critical information to the field. We describe key features of these studies and how they will extend the research knowledge base.We conclude by outlining the implications of the two studies for key issues in improving outcomes for children and youth with ED.

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.

Methodological and practical challenges present formidable barriers to conducting empirical evaluations of school reform initiatives. Systematic information about school reform and improvement, and its relationship to special education, is even more difficult to obtain. In this study, the authors developed a reliable and valid method to (a) systematically describe and assess the school improvement process and (b) examine its relationship to special education by including in the investigation programs for students with emotional disturbance. A rigorous case-study design was used with 20 schools that varied in their levels of improvement activity. Results indicated that the School Improvement Index (SII) could reliably and validly discriminate between schools engaging in high levels of school improvement activities and those schools engaging in low levels. The use of the SII as a research tool and an aid to local schools engaged in school improvement is discussed.

Research and evaluation of the wraparound process has typically focused on outcomes, service providers, and costs. While many of these studies describe a process that is consistent with the wraparound approach, few studies have reported attempts to monitor or measure the treatment fidelity of the wraparound process. The purpose of this study was to assess the fidelity of the wraparound process in a community-based system of care using the Wraparound Observation Form-Second Version. Results from 112 family planning meetings indicated some strengths and weaknesses within the current system. Families and professionals were frequently involved in the planning and implementation of the wraparound process. However, informal supports and natural family supports were not present in a majority of the meetings. Given the significant number of youth served in wraparound programs, the benefits of using the Wraparound Observation Form-Second Version as an instrument to monitor the fidelity of the wraparound approach should not be ignored.

In this article, the rationale, development, implementation, and evaluation of a school-based program for students with emotional disturbances who are served in a special education setting is described. The essential features of this program included a training program for professionals from the school and community agencies, the development and implementation of a strengths-based plan in which students and families are included as partners, and a method for evaluating the fidelity of program implementation. Results indicated a reduction in discipline referrals, better retention of students with emotional disturbances in their community schools, and a trend toward improved emotional functioning. In addition, fidelity was positively related to higher reading achievement.The findings are discussed in terms of their implications for policy, training, and future research efforts.

In this article, we present findings from a study that compared academic progress over 5 years for students with emotional and behavioral disorders (EBD) and students with learning disabilities (LD). Additionally, a set of factors related to academic achievement (attendance, behavior offenses, type of special education setting, school mobility, and early retention) were examined as to their contribution to achievement over time for these two groups of students. Findings indicated that students with LD made significant progress over time in reading, and this progress was associated with receiving less full-time special education services. Similar findings, however, were not found for students with EBD. For both groups of students, early retention was associated with lower achievement over time.

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.

The development of comprehensive and collaborative service systems for children with serious emotional disturbance and their families from the advocacy of the 1960s to its current status is reviewed. These systems represent a coalition of the child-serving agencies (education, mental health, child welfare, and juvenile justice), health care, the practitioners in these agencies, and the families that they serve. A detailed description of an empirically supported model system operating in Vermont is presented along with other state models. Challenges in creating and maintaining comprehensive and collaborative systems along with recommended strategies for overcoming these challenges are described.

The current study examined the organizational social context in 21 community-based programs serving youth at-risk for out-of-home care due to emotional or behavioral disorders and their families and program performance on five quality indicators of team functioning in teams that included a family support specialist. Results indicate that programs with higher performance on structures to facilitate teamwork, informal communication mechanisms among team members, and the ability to integrate family support specialists as equal members of the team showed more positive organizational functioning. Implications for the role of quality indicators in health care reform efforts are discussed.

Quality measurement is an important component of healthcare reform. The relationship of quality indicators (QIs) for parent-delivered family support services to organizational social contexts known to improve quality is unexamined. This study employs data collected from 21 child mental health programs that deliver team-based family support services. Performance on two levels of QIs —those targeting the program and staff -- were significantly associated with organizational social context profiles and dimensions. High quality program policies are associated with positive organizational cultures and engaging climates. Inappropriate staff practices are associated with resistant cultures. Implications for organizational strategies to improve service quality are discussed.

Quality indicators for programs integrating parent-delivered family support services for children’s mental health have not been systematically developed. Increasing emphasis on accountability under the Affordable Care Act highlights the importance of quality-benchmarking efforts. Using a modified Delphi approach, quality indicators were developed for both program level and family support specialist level practices. These indicators were pilot tested with 21 community-based mental health programs. Psychometric properties of these indicators are reported; variations in program and family support specialist performance suggest the utility of these indicators as tools to guide policies and practices in organizations that integrate parent-delivered family support service components.

The specific purpose of the study was to compile descriptive data on children with serious emotional disturbance (SED), including (a) demographic and family characteristics, (b) level of psychological and adaptive functioning, (c) services received, and (d) outcomes or how the children fared over time. The sample consisted of 812 children, ages 8 to 18 years (M = 13.89 years, SD = 2.35), who had been identified as having SED and were being served by either mental health (46%) or public school (54%) systems in accordance with P.L. 94–142. Data were collected annually during a 7-year period. Results indicated that, at entry into the study, the children already had serious problems in many domains and the problems remained serious for these children at the end of the study.

The recent history of research on the service delivery system for children and adolescents who have serious emotional disabilities and their families is summarized. The article provides an overview of the changes in the response by the children's mental health system to this population, with an emphasis on developments in service delivery system and service demonstration research and evaluation efforts. The role of research is examined in terms of its critical importance in improving the system of care for these children and their families.

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 children’s system of care framework has been extensively implemented in the U.S. Since its inception in 1993, the Comprehensive Community Mental Health Services for Children and Their Families Program has invested in excess of $1 billion supporting the development of systems of care in 164 grantee sites across the country. Despite these efforts to implement children’s systems of care nationally, little is known about the extent to which the principles and values actually have been put into practice outside of the funded grantee sites. This paper describes the development of the Systems of Care Implementation Survey, a measure designed specifically for the first ever study assessing the level of implementation of factors contributing to effective children’s systems of care in a nationally representative sample of counties throughout the U.S.

The results of a survey to measure the implementation of the systems of care (SOC) approach in a nationally representative sample of counties are presented. The results from 910 informants within 225 counties reveal a moderate level of implementation of SOC factors, with the level of poverty and population size influencing implementation. Furthermore, mental health informants generally tended to rate the implementation of systems of care greater than administrators associated with the school system, other family serving agency personnel or family members. Family members and school personnel tended to rate the implementation lowest, while staff from the other child serving agencies tended to rate the implementation closer to mental health administrators. A quarter of the counties (26%) surveyed rated themselves as having adequate levels of implementation on 11 or more of the 14 factors, while 75% rated themselves as having adequate levels of implementation on six or more of the 14 factors measured. Implications for federal policies regarding systems of care implementation are discussed.

A model is presented for developing an evaluation of community mental health systems of care for children. This model is divided into three stages. The first, the Program Stage, examines the clients served, service components received, and level of consumer satisfaction. The second, the Effectiveness Stage, analyzes the impact of the service system on the clients it serves, and the Impact Stage, the system changes that may occur due to the operation of a community-based system of care. Several measures and instruments are suggested for use.

The Alternatives to Residential Treatment Study (ARTS) was initiated to investigate the efficacy of several innovative, community-based, child- and family-focused service programs that serve children with serious emotional disorders and their families. This article describes the methodology developed for the study and reports the preliminary findings from a sample of subjects in the first wave of a longitudinal outcome study. The data focus on the children and their families in terms of history of problems and services, cognitive and academic levels, clinical and social functioning, impact of the youth's disability on the family, and general family functioning.

Poor outcomes for youth who have emotional disturbances (ED), especially for those youth who are placed in special education programs, are well documented. Parent Connectors is a parent-to-parent support program delivered through weekly telephone calls to families of youth with ED in special education programs, with the aim of increasing the engagement of parents in their child’s education and treatment and improving the academic and emotional functioning of the child. Findings from a proof of concept study using random assignment of participants yielded encouraging support for the clinical efficacy of the intervention. Results demonstrated enhanced outcomes for parents who were highly strained at the beginning of the study. Implications for future research in the area of parent support are provided.

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.

The authors present a multi-level framework for conceptualizing and designing measurement systems to improve decision-making in the treatment and prevention of child and adolescent mental health problems as well as the promotion of well-being. Also included is a description of the recommended drivers of the development and refinement of these measurement systems and the importance of the architecture upon which these measurement systems are built. The authors conclude with a set of recommendations for the next steps for the field.