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The reliability of young children's self reports of psychiatric information is a concern of epidemiologists and clinicians alike. This paper explores the determinants of test-retest reliability in a sample of children from the general population using reliability coefficients constructed from a kappa statistic. Age, cognitive ability, and gender are related to consistency of reports in a test-retest paradigm. Controlling for age, cognitive ability and gender, children report more reliably on observable behaviors, and less reliably on questions involving unspecified time, reflections of one's own thoughts, and comparison of themselves with others. The reliability of reports of emotions lies between these two extremes. Surprisingly, sentence length of up to 40 words and psychiatric impairment of the child as measured by the Child Global Assessment Scale did not influence reliability. As might be expected, parents' reports of their children are more reliable than their children's reports.

The results suggest that highly structured diagnostic interviews such as the DISC-R may not be appropriate for use with younger children of elementary school age in community-based studies.

Psychotropic medication is an important factor in the care of children with serious emotional disturbance (SED) in community settings. In this article, we describe the use of medication in two sites that participated in the Robert Wood Johnson Foundation's Mental Health Services Program for Youth (MHSPY). Partaicipants included a total of 488 children and youth, enrolled at either the Cleveland, Ohio, or state of Vermont site. Forty percent of the study population received psychotropic medication during their enrollment in the program. Characteristics associated with use were analyzed using logistic regression. Although adolescent boys with conduct disorders appeared to be targeted by the MHSPY, younger children, girls, and those with attention-deficit/hyperactivity disorder (ADHD) or psychotic disorder diagnoses were more likely to receive medication. Stimulants, tricyclic antidepressants, and neuroleptics were the drug types most frequently prescribed. Rates of medication use in the MHSPY program were high but not unexpected, given the targeting of children with significant histories of emotional and behavioral challenges and imminent risk of restrictive placement. As new policies increasingly shift to community-based care for children with SED and to delivering such care through Medicaid managed care plans, careful evaluation of the risks and benefits of medication treatment is essential.

The Child and Adolescent Level of Care System/Child and Adolescent ServiceIntensity Instrument (CALOCUS/ CASII) is designed to help determine the intensity of services needed for a child served in a mental health system of care. The instrument contains eight dimensions that are rated following a comprehensive clinical evaluation. The dimensions are risk of harm, functionality, co-morbidity (psychiatric, substance abuse, development disability and medical), environmental stressors, environmental supports, the child's resiliency, and the child and family's willingness to engage in treatment. An algorithm connects the ratings to a level of care recommendation. The instrument specifies six levels of care defined flexibly enough to consider whatever services are available. The results of psychometric testing using raters with a broad range of clinical experience and training from four different systems of care around the country are presented. The testing demonstrates excellent reliability when rating vignettes. Using children and adolescents

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In an effort to bridge the gap between service need and service utilization, an urban based, university affiliated children's psychiatric outpatient clinic has implemented a program which provides mental health services in inner city schools. When compared with the central clinic populations (N = 304), the school sample (N = 44) was markedly socioeconomically disadvantaged, minority, and as psychiatrically impaired as the central clinic population. School based mental health services have the potential for bridging the gap between need and utilization by reaching disadvantaged children who would otherwise not have access to these services. Implications for such services are discussed.

Child development professionals, psychoanalysts among them, have learned more during the past century about child development, and about what optimizes and what derails it, than was known in the entire preceding history of civilization. As Freud envisioned, and spoke of a number of times for three decades, by bringing what we have learned in the clinical situation and in-depth psychological observational research (Hartmann, 1950) to bear on mental health prevention, psychoanalysts are contributing critically to optimizing the development and mental health of children. We share Freud's view that this is ". . . so exceedingly important, so rich in hopes for the future, perhaps the most important of all the activities of analysis. What I am thinking of [Freud said] is the application of psychoanalysis to education, to the upbringing of the next generation" (Freud, 1933, p. 146). Our own clinical and research experiences and findings have increasingly compelled us to apply what we have, and to continue to lean toward the prevention of experience-derived emotional disorders in children (Parens, 1993).Here we want to report the evolving steps we have taken over these past 30+ years, as one application of what we found once in progress led to another and yet another. Foremost, we want to report on how from our long-term direct observational (psychoanalytic-anthropologic) project, our "Early Child Development Program," we determined to develop parenting-optimizing educational materials as a means of preventing emotional and adaptive problems in children. We found opportunities and evidence to support the fact that we can optimize the work of parents as, day in and day out for years, they try to rear their children in growth-promoting ways. We will report on the fact that in the course of helping parents to understand their children's behaviors, needs, and