Objectives In the United States, more money is spent on treatment for children’s mental health problems than for any other childhood medical condition, yet little is known about usual care (UC) treatment for children. Objectives of this study were to a) characterize UC out-patient psychotherapy for children with disruptive behavior problems, and b) identify consistencies and inconsistencies between UC and common elements of evidence-based practices to inform efforts to implement evidence-based practices in UC. Methods Participants included 96 psychotherapists and 191 children ages 4–13 presenting for treatment for disruptive behavior to one of six UC clinics. An adapted version of the Therapy Process Observational Coding System for Child Psychotherapy – Strategies scale (TPOCS-S) was used to assess psychotherapy processes in 1215 randomly selected (out of 3241 collected) videotaped treatment sessions for up to 16 months. Results Most children received a lot of treatment (mean number of sessions=22, plus other auxiliary services), and there was great variability in amount and type of care received. Therapists employed a wide array of treatment strategies directed to children and parents within and across sessions, but all strategies were delivered at low average intensity. Several strategies conceptually consistent with evidence-based practices were observed frequently (e.g., affect education, positive reinforcement); however, others were observed rarely (e.g., assigning/reviewing homework, role-playing). Conclusion UC treatment for these youths reflected great breadth but not depth. The results highlight specific discrepancies between evidence-based care and UC, thus identifying potentially potent targets for improving the effectiveness of UC.

The American Academy of Pediatrics recommends comprehensive assessments for children entering foster care. These children may be placed with biological parents, kin, or in nonrelative foster care. It is not known whether health-related needs differ by placement. Chart abstractions were conducted of child welfare and medical records of 1542 children, ages 3 months to 5 years 11 months, admitted to San Diego's sole emergency shelter/receiving facility from April 1, 1998, through June 30, 1999, for investigation of alleged maltreatment. Children were discharged to three placement types: biological parents (28.5%), kinship caregivers (28.4%), or nonrelative foster parents (43.1%), Overall, 86.7% of children studied demonstrated physical, developmental, or mental health needs, with more than half displaying two or more problems. More than half of the children had a "Suspect" score on the Denver-II; 70.3% of children with "Suspect" scores were found to have delay on a development evaluation. Almost one tenth of the sample were diagnosed with one or more mental health conditions. Few differences were found for physical, developmental, or mental health concerns by placement. Results suggest that young children placed with biological parents or in kinship care have similar needs to those of children placed with foster parents. This study confirms the importance of comprehensive assessments for young children removed from their homes, regardless of placement. It also illustrates a need for standardized assessment criteria, particularly for developmental and mental health status, and for collaborative care models for all young children entering the child welfare system, regardless of their placement following investigation. Index termsfoster care; child welfare; developmental delay; mental health; physical healthThe estimated 826,000 children currently served by the child welfare/child protective services system 1 (hereafter termed child welfare) are more susceptible to poor health outcomes than any other subpopulation of youth in the United States. These children are removed from their homes when parents are unable to care for them due to prenatal drug/alcohol exposure, abuse, neglect, and/or violence. These background risk factors predispose these children to a myriad of physical, developmental, and mental health problems. Infants and toddlers, who are dependent on the care of others during a critical phase of brain development, 2-5 are especially vulnerable to both the experience and consequences of maltreatment 6-9 and are the most rapidly expanding age group entering child welfare. 3,10 Overall, the largest age group in child welfare (30%) is composed of children younger than 5 years of age. 1 Out-of-home placement can compound these problems if services are not provided effectively. Recent federal amendments to the Child Abuse Prevention and Treatment Act (CAPTA) in 2003 recommend that states enhance collaboration among public health agencies, child welfare, and community programs to address the comprehensive...

Publicly funded mental health programs play a significant role in serving children with autism spectrum disorder. Understanding patterns of psychiatric comorbidity for this population within mental health settings is important to implement appropriately tailored interventions. This study (1) describes patterns of psychiatric comorbidity in children with autism spectrum disorder who present to mental health services with challenging behaviors and (2) identifies child characteristics associated with comorbid conditions. Data are drawn from baseline assessments from 201 children with autism spectrum disorder who participated in a community effectiveness trial across 29 publicly funded mental health programs. Non-autism spectrum disorder diagnoses were assessed using an adapted Mini-International Neuropsychiatric Interview, parent version. Approximately 92% of children met criteria for at least one non-autism spectrum disorder diagnosis (78% attention deficit hyperactivity disorder, 58% oppositional defiant disorder, 56% anxiety, 30% mood). Logistic regression indicated that child gender and clinical characteristics were differentially associated with meeting criteria for attention deficit hyperactivity disorder, oppositional defiant disorder, an anxiety, or a mood disorder. Exploratory analyses supported a link between challenging behaviors and mood disorder symptoms and revealed high prevalence of these symptoms in this autism spectrum disorder population. Findings provide direction for tailoring intervention to address a broad range of clinical issues for youth with autism spectrum disorder served in mental health settings.

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Objectives-In the United States, more money is spent on treatment for children's mental health problems than for any other childhood medical condition, yet little is known about usual care (UC) treatment for children. Objectives of this study were to a) characterize UC out-patient psychotherapy for children with disruptive behavior problems, and b) identify consistencies and inconsistencies between UC and common elements of evidence-based practices to inform efforts to implement evidence-based practices in UC.Methods-Participants included 96 psychotherapists and 191 children ages 4-13 presenting for treatment for disruptive behavior to one of six UC clinics. An adapted version of the Therapy Process Observational Coding System for Child Psychotherapy -Strategies scale (TPOCS-S) was used to assess psychotherapy processes in 1215 randomly selected (out of 3241 collected) videotaped treatment sessions for up to 16 months.Results-Most children received a lot of treatment (mean number of sessions=22, plus other auxiliary services), and there was great variability in amount and type of care received. Therapists employed a wide array of treatment strategies directed to children and parents within and across sessions, but all strategies were delivered at low average intensity. Several strategies conceptually consistent with evidence-based practices were observed frequently (e.g., affect education, positive reinforcement); however, others were observed rarely (e.g., assigning/reviewing homework, roleplaying).Conclusion-UC treatment for these youths reflected great breadth but not depth. The results highlight specific discrepancies between evidence-based care and UC, thus identifying potentially potent targets for improving the effectiveness of UC.

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