Predicting Functional Improvement over Time in a System of Care

Abstract

troul and Friedman (1986) defined a system of care as "a comprehensive spectrum of mental health and other necessary services which are organized into a coordinated network to meet the multiple and changing needs of children and families." During the past 2 decades, the system of care movement has brought about the creation of a variety of innovative approaches to service provision for young people involved in multiple child-serving systems (e.g., mental health, child welfare, juvenile justice, education) and their families. These reform efforts, which are designed to overcome the traditionally fragmented nature of the children's mental heath system (U.S. Department of Health and Human Services [USDHHS], 1999), have initiated political, philosophical, and practical transformations in services provision that are child and family focused, community based, and culturally competent (Stroul & Friedman, 1986). A primary goal of systems of care is to establish mechanisms for circumventing his-torical barriers to interagency collaboration, such as separate funding streams and often competing agency mandates, so that partnerships can be created both across systems and among families and professionals (Handron, Dosser, McCammon, & Powell, 1998). The objective is that children's educational, social, and therapeutic services, along with informal family and community supports, will be organized and coordinated to better meet the multiple and complex needs of children with multisystem needs and their families (Stroul & Friedman, 1986).While the system of care concept continues to gain in popularity, research and evaluation findings from studies of these approaches also are beginning to emerge (e.g.

Predicting Outcomes Among Adolescents With Disruptive Disorders Being Treated in a System of Care Program

“…It could also be that involvement of a large percentage of adolescents in the juvenile justice system indicated that these adolescents might have been in the traditional mental health system for a significant amount of time and had had poor responses to treatment. Previous studies suggest that exposure to a deficit-based treatment approach requires a considerable amount of time to undo psychological damage (or hardening) from previous unsuccessful approaches and to allow the adolescents and their families to trust the strengths-based system and have hope that the system can help them succeed (Anderson et al, 2006). …”

“…This age group was selected because studies show a doubling of the prevalence of SED, including disruptive disorders, between ages 12 and 13 years (Arnold, Walsh, Oldham, & Rapp, 2007; Costello et al, 1996), with significant functional impairment noted about the age of 12 years (Costello et al, 1996). The average length of involvement in the Dawn Project was 14 months (Anderson et al, 2006). The 12-month end time point was chosen because it was close to the average point at which participants exited treatment and thus provided the best opportunity to examine relationships of interest.…”

“…In addition, youth demographics such as age, gender, and race have been implicated in differential response to mental health treatment. For example, adolescents may have greater functional impairments than younger children (Anderson, Effland, Kooreman, & Wright, 2006; Manteuffel et al, 2002), and African American youths may respond to treatment at a slower rate than their Caucasian counterparts (Anderson et al, 2008; Walrath et al, 2006). With respect to gender, males and females tend to respond to treatment at similar rates (Anderson et al, 2008; Walrath, Mandell, & Leaf, 2001).…”

Disparity of SED Recovery

“…Three of these are related to our analysis. Anderson et al (2006) found that demographic characteristics, referral source, Medicaid status, presenting problems, or place of residence (i.e., facility) did not predict improvement over time in a SOC. Only baseline age predicted functional improvement after six months of SOC involvement—Younger youth tended to improve, whereas older youth tended to deteriorate.…”

“…Studies of other SOC communities have been published to date (Anderson et al 2006; Anderson et al 2007; Barksdale, Azur, and Daniels 2010; Barksdale, Azur, and Leaf 2009; Cook and Kilmer 2010; Gyamfi, Keens-Douglas, and Medin 2007; Miech et al 2008), among others. Three of these are related to our analysis.…”