Search

There is a lack of research on how mental health diagnoses are delivered and explained to children and the effectiveness of these strategies. This qualitative study examines how emerging adults recall the delivery of mental health diagnoses in childhood and how they suggest these diagnoses should be delivered to children. Semi-structured interviews were conducted with 42 emerging adults (aged 18-22) who were diagnosed with attention deficit hyperactivity disorder (ADHD), depressive disorders, generalized anxiety disorder (GAD), and/or bipolar disorder in childhood. Findings reveal that parents, rather than mental health professionals, often inform children of their diagnoses. The data suggest that parents often act as translators of diagnostic information, acting as liaisons between mental health professionals and their children. The paper explores ways in which parents and mental health professionals withhold diagnoses from children, and how this affects children's experiences. Drawing on their own experiences, participants offer suggestions regarding the best ways to deliver diagnoses to children. Findings suggest that adults should share mental health diagnoses openly with children. Implications for social workers and other allied health professionals who support families when children are diagnosed are discussed. [ABSTRACT FROM AUTHOR]

The significant number of annual US jail admissions is intricately tied to the increasing population of children with incarcerated parents. Some proportion of these children will visit their parents in jail, and the limited research linking visits to young children's well-being is mixed. Sesame Street developed multimedia educational materials to support young children with incarcerated parents, including specific messages around visiting. The educational materials have been found to positively shape how caregivers talk to children about parental incarceration, though a gap remains regarding young children's self-reported experiences. In a preliminary randomized efficacy trial of these educational materials, the current study examined 67 young children's (aged 3–8) self-reported feelings while at the jail following viewing of the video materials, including their feelings about their caregivers, incarcerated parents, families, and visiting in general. Data were collected when children arrived at the jail (before half were randomized to watch the intervention materials) and then again following the intervention. In the treatment group, the proportion of children reporting positive feelings increased from pre- to post-test, most saliently for feelings about families, while feelings decreased overall for those in the control group. The intervention was associated with positive feelings about family, especially for those children who were told developmentally appropriate information about the parent's incarceration prior to arrival at the jail. The exploratory findings shed light on young children's emotions when visiting parents in jail and the buffering role that intervention materials can have in offering support to help manage feelings during jail visits. Highlights: Exploratory findings suggest that the intervention was associated with positive changes in self-reported feelings for young children visiting parents at jail. Feelings about family were most significantly strengthened for young children following the multimedia intervention at jail. Strengthened feelings about family were most robust for children given developmentally appropriate information about the incarceration. [ABSTRACT FROM AUTHOR]

The Strengths and Difficulties Questionnaire (SDQ) is a screening tool widely used in both pediatric research and clinical practice. Few studies have examined the psychometric properties of the U.S. version of this measure, and none have examined the structure of the measure with children younger than 4 years of age. The goal of this study was to assess the psychometric properties of the parent informant version of the SDQ administered in a pediatric practice serving a low-income, predominately Black, urban population of children ages 2–5 years. Parents routinely completed the SDQ electronically during annual well-child visits from July 2016 to June 2017. Confirmatory factor analysis was used to test 3-factor, 5-factor, and modified 5-factor (with positive construal response style) models. Responses to age-appropriate SDQ forms were analyzed. There were N = 622 for the 4–12 year old version (only collected on 4–5 year olds) and N = 672 of the 2–3 year old version. In both groups, the modified 5-factor model was the best fitting model. The internal consistency for the modified 5-factor model was lower than the original 5-factor model with the alpha coefficient lower on the Conduct Problems, Emotional Problems and Peer Problems subscales. Measurement invariance testing found non-invariance due to gender among the 4–5 year olds on the emotional problems subscale. Our study found that the SDQ shows satisfactory psychometric properties in preschool-aged children in a low-income urban U.S. population. More research is needed to deepen our understanding of the measure's clinical utility. Highlights: Few studies have examined the psychometric properties of the Strengths and Difficulties Questionnaire in the US. No studies have examined the structure of the measure with children <4 years of age. Participants were recruited from a pediatric practice serving a low-income, predominately Black, urban population of children (2–5 years). A modified 5-factor (with positive construal response style) model fit the data best. Internal consistency was low for some subscales and non-invariance due to gender was found for the emotional problems subscale among 4–5 year olds. [ABSTRACT FROM AUTHOR]

Of the 40 million people living in poverty in the U.S., approximately 28% are single mothers and 18% are children. Low family income is linked with negative outcomes including higher rates of child mental health concerns. Due to limited public benefit availability, mothers often must rely on informal safety nets, or support from family or friends, to make ends meet. However, these informal safety nets are often coupled with burden, or obligations. To further increase their vulnerability, mothers living in poverty face higher levels of poor mental health. Also, both maternal mental health and safety nets can change over time. The purpose of this study was to examine informal safety nets, including informal support and burden, and maternal mental health and their longitudinal effects on mental health symptoms of children living in low-income families. Relying on data from the Welfare, Children, Families project, descriptive results showed change in informal safety nets, maternal mental health, and child mental health over time, with decline or multiple changes more common than improvement. Multilevel change models indicated safety nets and maternal mental health were associated with child outcomes such that mothers with minimal safety nets, higher psychological distress, and higher parenting stress had children with significantly higher mental health symptoms compared to children whose mothers had healthy safety nets and less distress. Findings speak to the importance of interventions that target both mothers and children in low-income families. Highlights: Low-income mothers' informal safety nets, or support from family or friends, change over time. Findings suggest the negative impact of weak informal safety nets and poor maternal mental health for child mental health. Findings suggest the increasing importance of informal safety nets for children's mental health as children age. [ABSTRACT FROM AUTHOR]

There is increasing recognition that young children's self-regulation provides a foundation for overall wellness later in life. Yet, infants reared in poverty may exhibit less-developed self-regulation compared to their more economically-advantaged peers. Factors associated with poverty that may influence early self-regulation include maternal depression and parenting self-efficacy. However, few researchers have examined how both parenting self-efficacy and maternal depression may affect young children's self-regulation. The purpose of this study was to investigate the associations among maternal depression, parenting self-efficacy, and infant self-regulation for a racially diverse sample of 142 mother–infant dyads living in low-income households in the United States. Maternal depressive symptomatology was determined with the Edinburgh Postnatal Depressive Scale. Parenting self-efficacy was determined with a self-report measure, reflecting caregivers' mindset or feelings reflecting competency as a parent of an infant. Infant self-regulation was measured by parental report of the Infant Behavior Questionnaire Short Form Effortful Control subscale. While maternal depressive symptomatology and self-efficacy were directly and significantly correlated with infant self-regulation, results of a mediation model suggested that parenting self-efficacy mediated the relationship between maternal depressive symptomatology and infant self-regulation. Lower maternal depressive symptomatology predicted better parenting self-efficacy, in turn predicting better infant self-regulation. This study increases our understanding of how early factors shape the self-regulation of infants reared in low-income homes—highlighting the potential role of targeting parenting self-efficacy for parenting interventions for mothers experiencing depressive symptoms. Highlights: We investigated infant self-regulation in low-income homes in the US. Maternal self-efficacy mediated depression and infant self-regulation relation. Lower maternal depression predicted better self-efficacy and better self-regulation. [ABSTRACT FROM AUTHOR]

Objectives: This study tested the separate and combined effects of father involvement and paternal incarceration on child internalizing and externalizing behaviors at 9 years of age. Methods: Our sample contains completed interviews of 2652 fathers, 3515 mothers, and 3377 children. The mean age of fathers was 28 at child age 9. Multiple regression analysis of secondary data was conducted from the Fragile Families and Child Wellbeing Study, a national study that followed a cohort of low-income married and unmarried parents and their young children living in 20 US cities. Results: Higher socioeconomic status and greater father involvement were associated with lower child internalizing and externalizing behaviors, while paternal incarceration for property crimes was associated with greater externalizing in boys and internalizing in girls. Incarceration for drug crimes was associated with lower father involvement. Conclusions: Multiple regression analyses confirmed the independent effects of father involvement on child internalizing and externalizing, but the incarceration for property crimes effects were attenuated and moderated by SES. [ABSTRACT FROM AUTHOR]

Bullying is a serious public health issue among children and adolescents in the United States. Existing national data sources provide limited current information about involvement in bullying among youth. The purpose of this study was to estimate the prevalence of parent-reported bullying victimization and perpetration among U.S. children and adolescents ages 6–17 years using nationally representative data, and to examine health-related factors associated with bullying experiences. We conducted secondary data analysis of the 2016 National Survey of Children's Health, and stratified the sample by age (6–11 years, 12–17 years). We performed bivariate analyses to examine prevalence of bullying experiences according to demographic characteristics, health conditions, health behaviors, health services, and family environment. Using multivariable logistic regressions, we assessed the association between these factors and bullying experiences. Results showed that 22.7% of U.S. children and adolescents were bullied by others and 6.4% bullied others. The rate of bullying victimization was slightly higher among 6–11 year olds than among 12–17 year olds (24.1 vs. 21.1%, p = 0.011). The rate of bullying perpetration was 7.2% among children and 5.6% among adolescents but the difference between age groups was not statistically significant (p = 0.086). Several health conditions and health services factors were associated with either bullying victimization or perpetration, including special health care needs, internalizing problems, behavior or conduct problems, speech or other language disorders, autism, and unmet need for mental health treatment or counseling. Bullying victimization was also strongly associated with bullying perpetration. [ABSTRACT FROM AUTHOR]

Exposure to early risks are linked with less optimal child development across domains. These contextual risks may display various configurations and each configuration could be linked to specific developmental outcomes. Based on 1364 mother-child dyads from the NICHD Study of Early Child Care, this study examined the different risk profiles children experienced in early development and how changes in these profiles over time predicted a wide range in their school adjustment. Using latent class analysis (LCA), we found that children's contextual risks could be characterized by one of the five risk typologies at each assessment from 6-months to first grade: low risk, high socio-cultural risk, high psychological risk, high socio-economic risk, and high risk across domains. Moreover, these risk profiles they experienced were fairly stable over time: children rarely moved in or out of certain risk classes from infancy through middle childhood. As a function of these risk typologies they experienced across time, children demonstrated different levels of academic and socio-emotional adjustment in first grade. These findings link configurations of risks children experience across infancy and early childhood to their first-grade adjustment observed by multiple informants. [ABSTRACT FROM AUTHOR]

Objective: Children and families enrolled in early childhood systems of care (SOC) present with various psychological and behavioral risk factors that may inhibit healthy development. Within a SOC, wraparound services are designed to increase families' access to numerous child-serving sectors in order to target those risk factors. This study examined whether child and family risk factors at enrollment in an early childhood SOC predicted dosage, service recommendation, and usage of recommended services. Method: Participants were 144 children ranging in age from 1.38 to 5.89 years and their caregivers. Families completed measures of child and caregiver functioning prior to participation in the SOC. Service recommendation and usage were measured at intake and three months, respectively. We used multiple regression analysis to examine the relationship between risk factors and dosage of services received. Logistic regression analyses identified the relationships between risk factors and service recommendation and usage according to specific service types within the SOC. Results: Children with greater behavior problems received more services overall (R2 = .103, β = .243, p = .033). Child risk factors predicted recommendation for child welfare (trauma exposure:  OR = 1.352, p = .052) and mental health services (behavior problems: OR = 1.061, p = .034; trauma exposure: OR = 1.316, p = .046), whereas families with substance use issues were less likely to be recommended for mental health services (OR = .229, p = .017). Conclusions: Findings highlight opportunities for improved service provision and service-level decision making in early childhood SOCs. [ABSTRACT FROM AUTHOR]

Family food routines are important contexts through which children develop math knowledge and skills. The Food For Thought (FFT) program teaches Latino parents strategies to develop their kindergarten children's math abilities during family food routines such as grocery shopping and cooking. We examined whether attendance to FFT was related to children's math outcomes at post-test (right after program completion). Sixty-eight low-income Latino parents and their kindergarten children (M = 71 months) participated in the four-week program taking place in schools. Children's math skills (counting, numeral recognition and cardinal understanding) were assessed at pre- and post-test. The association between parents' attendance to FFT meetings and children′s math outcomes at post-test depended on children's initial levels of math skills (i.e., math skills at pre-test). Children with lower initial math skills whose parents attended more FFT meetings had more advanced math outcomes at post-test, than children with lower initial math skills whose parents attended fewer FFT meetings. The effect size of this interaction was moderate, d = 0.46. Limitations and future directions of this early math intervention targeting Latino families are discussed. [ABSTRACT FROM AUTHOR]

Disordered eating in children is a major public health concern, as it is precursor to clinical eating disorders and obesity. However, little is known about the potential causes of child disordered eating. The current study examined marital conflict as a predictor of disordered eating in a sample of children aged 5-12 years, from the perspective of emotional security theory. Ninety five children and their parents in the Southeast United States participated in the study. We found that marital conflict was associated with higher levels of restrained eating, emotional eating and external eating behaviors controlling for demographics and parental feeding practices. Further, we examined the possible pathways between marital conflict and child disordered eating and found that marital conflict was related to greater child emotional insecurity about the family, which was associated with greater child anxiety, which were then related to disordered eating. In addition to serving as a secondary pathway linking emotional insecurity to child disordered eating, anxiety also significantly directly mediated the association between marital conflict and all three types of disordered eating: restrained eating, emotional eating and external eating in children. Next we examined if parental feeding practices (food monitoring, food restriction and parental pressure to eat) moderate the relation between marital conflict and child disordered eating. Parental pressure to eat was negatively associated with child disordered eating under higher marital conflict. The current study highlights the importance of marital conflict and child emotional security as precursors of child disordered eating. [ABSTRACT FROM AUTHOR]

Empirical evidence suggests maternal behavioral health problems are significant predictors of child behavioral health difficulties, but it is unclear of the specific relation of maternal alcohol use problems and depression symptoms with child internalizing and externalizing behavior problems. The purpose of the study is to examine the impact of maternal depression symptoms and alcohol use problems on children's internalizing and externalizing behavior problems over a period of 5 years. Implications for intervention may differ depending on which type of maternal behavioral health concerns predicts which child behavior problem. A total of 1874 families eligible for Early Head Start participated. Maternal depression symptoms and alcohol use problems were assessed when children were in preschool, and internalizing and externalizing behavior problems were assessed when children were in fifth grade. Clinical internalizing behavior problems was best predicted by maternal depression symptoms, whereas clinical externalizing behavior problems was best predicted by maternal alcohol use problems. Children were almost twice as likely to have clinical internalizing behavior problems when mothers exhibited very elevated depression symptoms compared to when mothers displayed minimal symptoms. A similar relation was found with maternal alcohol use problems and clinical externalizing behavior problems. Our findings highlight the importance of understanding and treating various kinds of behavioral health concerns in mothers of young children. [ABSTRACT FROM AUTHOR]

Despite prevalence rates as high as 9.4%, few studies have examined the applicability of cognitive-behavioral therapy for treatment of anxiety disorders in very young children (i.e., below the age of 7 years). The present study examined the preliminary efficacy of a parent-led exposure therapy protocol (PLET) designed for young children with anxiety disorders. Twenty-two youth aged 4-7 years and their parents participated in this pilot randomized control trial. Families of youth with significant anxiety concerns were randomized to either PLET ( n = 12), a 10 session/5-week family-based exposure therapy program designed to target anxiety in young children, or treatment as usual (TAU; n = 10). Children in the PLET condition demonstrated a greater reduction in anxiety symptoms compared to TAU ( d = 3.18), with 90.91% of PLET participants (active condition) being classified as treatment responders at post-treatment as opposed to 0 in the TAU condition. Gains were maintained at 1 month-follow-up. Although pilot in nature, these data suggest in a preliminary fashion that a parent led exposure therapy protocol that is adapted appropriately for developmental age and incorporates an active coaching component for parents may be efficacious for the treatment of young children with anxiety disorders. This clinical trial was registered through clinicaltrials.gov under the following identifier: NCT02051192. [ABSTRACT FROM AUTHOR]

This follow up study with 23 normal functioning 1st graders examined the long-term effectiveness of Child-Centered Play Therapy (CCPT) on academic achievement. Through the use of a one-way repeated measures analysis of variance, researchers examined the use of CCPT from pre-intervention to mid-intervention (16 sessions) to post-intervention (26 sessions). Results indicated that children who participated in 26 sessions of CCPT demonstrated statistically significant improvement on the Early Achievement Composite as measured on the Young Children's Achievement Test (YCAT), along with increases in the Reading, Mathematics, and Spoken Language subscales. Participants showed statistically consistent improvement in academic scores of the full duration of the study. Overall, the findings imply that CCPT as a long term method can support academic achievement in the school system with normal functioning 1st grade students. The outcome suggests long term CCPT is an intervention for elementary/primary school counselors to use with children who have emotional or academic needs. The findings open the door for school counselors or outside professionals to use play therapy with children in the school system as a way of providing academic support and thereby promoting the field of play therapy in the school system. [ABSTRACT FROM AUTHOR]

Cultural issues tied to race/ethnicity are important aspects in delivering medical home services to children with neurodevelopmental disabilities and their families. To better understand family satisfaction with family centered care (FCC) in medical homes of children with disabilities, this study investigated whether family race/ethnicity, in addition to parent and child characteristics, significantly influenced family perceptions of FCC in three areas: family-provider partnership, care setting practices and policies, and community coordination and follow-up. Based on the life course theory for optimizing children's developmental trajectories, examining connections between family race/ethnicity and satisfaction with health care allows for identification of strengths and weaknesses in medical home services delivery, and offers opportunities for family support and improvement in outcomes for children with disabilities. This study developed an original empirical survey using a structured questionnaire developed by Family Voices, a national advocacy organization dedicated to promoting the well-being of children with disabilities and their families. The study collected data for 122 families in a large urban area in the northeastern United States. Multivariate analyses revealed that family race/ethnicity significantly contributed to the prediction of parental satisfaction with medical homes of children with disabilities, and to families' perceptions of FCC in care setting practices and policies, and community coordination and followup, but not to family provider partnership. Non-White families reported significantly lower satisfaction. Discussion emphasizes that health care providers need to become more vigilant in providing culturally sensitive care. To enhance FCC practices and policies, the study advances a checklist of ten essential areas that promote culturally sensitive interactions between families of children with disabilities and their medical and non-medical health care providers. [ABSTRACT FROM AUTHOR]

A national picture of residential treatment centers (RTCs) for children is lacking and this situation may be complicated by differences between facilities in how RTCs are defined. This study uses data from a national survey of mental health facilities to supplement current knowledge about variation in the definition of RTCs nationwide. Descriptive analyses using 2012 National Mental Health Services Survey (N-MHSS) data were conducted on a standard definition of an RTC from the research literature and three different variations of it. Cohen's h was calculated to assess whether differences in proportions were meaningful. While nearly two-thirds of RTCs that serve children define themselves following a standard definition in the research literature, nearly a quarter served adults, 9% did not require that residents have a diagnosis of serious emotional disturbance (SED), and a small proportion offered inpatient care in addition to residential care. Of the 9% of RTCs that did not require an SED diagnosis, the majority of these facilities were located in the West. This finding suggests that some of these RTCs may be wilderness programs, and it may also be an indicator of lack of RTC availability. Lack of consensus in the research literature and in the field regarding the definition of an RTC makes it difficult to compare different RTC study findings with each other. Development of a consensus definition of RTCs is a necessary first step to collecting comprehensive data and assessing the current state of this important component of the mental health delivery system. [ABSTRACT FROM AUTHOR]

While recent research has documented a rapid increase in the use of new technologies such as touchscreen tablets early in life, little is known about how young children use tablets, what activities they engage in, and whether family demographic and maternal well-being are associated with early use. Guided by Bronfenbrenner's bioecological theory of human development, the current study addressed these questions with a cross-sectional, online survey of mothers with children between 12 and 48 months of age. Mothers reported on their child's tablet use as well as their own personal well-being (depressive symptoms and role overload) and relational well-being (relationship satisfaction, coparenting quality, conflict frequency). Nearly 63 % of all mothers owned a tablet. Approximately 46 % of children with access typically use a tablet in an average day, with the majority using for 15 min or less. For families who owned a tablet, child's frequency of use was positively associated with child's age and mother's use and negatively associated with mother's relational well-being. Despite the American Academy of Pediatrics recommendation that screen media be avoided for children under 24 months, children in our study used tablets, albeit infrequently. Our findings suggest that it is important for researchers to consider the relationship between contextual factors within the family and child media use. Refining their focus for families with particular needs may allow child advocates and policy makers to develop more beneficial media recommendations for families with a variety of circumstances. [ABSTRACT FROM AUTHOR]

Emotion knowledge contributes to emotion regulation and coping among adults, but few studies have investigated its role in children's coping development, especially in a cross-cultural context. We examine relations between children's emotion knowledge and coping in European American and Chinese immigrant families. One hundred and three 7- to 10-year-old children and their mothers from European American and Chinese cultural background participated in this study. Children's emotion knowledge was assessed using emotion-situation knowledge production task. This task examines their understanding of situational antecedents o discrete emotions. Children's use of coping strategies was reported by mothers using the Children's Coping Strategies Checklist. Results showed that Chinese immigrant children had greater emotion knowledge of fear and pride but were reported using less variety of coping strategies than European American children. The relationship between children's knowledge of self-conscious emotions and their use of distraction coping strategies was moderated by culture, whereby knowledge of self-conscious emotions was negatively associated with the parent-reported distraction strategies only for European American children but not for Chinese immigrant children. The importance of culture in both theory and practice related to emotion knowledge and coping is discussed. Findings in this study suggest that family intervention and children's emotion training programs may need to consider children's cultural background. [ABSTRACT FROM AUTHOR]

The feasibility of using acceptance and commitment therapy (ACT) to foster increases in congruence between values and behaviors pertinent to those values was evaluated with adolescents. Participants were nine, primarily African American, school aged children (11-15 years) with comorbid attention-deficit/hyperactivity disorder, learning disorders, and behavior problems who were enrolled at a charter school in an urban, South-central area of the United States. Despite some feasibility obstacles, several significant Reliable Change Index scores on the Behavior Assessment Scale for Children-second edition and the Bull's-Eye Values Assessment were found and other results approached statistical significance in the desirable direction. These findings suggest that ACT may be feasible for increasing congruence between values and behavior, and may have potential clinical utility with acceptance and mindfulness based treatments in youth with comorbid psychological and behavioral problems. [ABSTRACT FROM AUTHOR]

Children who possess less self-regulatory skill are at a disadvantage when compared to children who demonstrate greater skill at regulating their emotions, cognitions and behavior. Children with these regulatory deficits have difficulty connecting with peers, generating relationships with teachers, negotiating their social world, and succeeding academically. By understanding the correlates of self-regulatory abilities, interventions can be developed to ensure that children at-risk for poor self-regulation receive the support necessary to enhance their regulatory skills. Using data from a nationally representative survey of English-speaking American parents with children between the ages of two and eight ( n = 1,141), we evaluated a host of demographic and parenting variables to isolate the correlates of self-regulation. Older children were found to have fewer regulatory problems than younger children while children from low-income homes and male children were found to have greater problems with self-regulation. Minority status, household composition (single vs multi-parent), and parental education were not significant correlates of self-regulation. Findings also illustrate the powerful relationship between parenting style and self-regulation. Parents who rely on nurturing parenting practices that reinforce the child's sense of autonomy while still maintaining a consistent parenting presence (i.e., authoritative parenting) have children who demonstrate stronger self-regulatory skills. Parents who exert an excess of parental control (i.e., authoritarian parents) have children with weaker self-regulatory skills. And lastly, parents who have notable absence of control (i.e., permissive parents) are more likely to have children with considerable regulatory deficits. Results offer implications for both practitioners and scholars. [ABSTRACT FROM AUTHOR]

We review empirical studies on kinship foster care in the United States. We conceptualize kinship foster care within the context of Urie Bronfenbrenner's () most recent ecological systems theory. Because there are multiple levels of influences on the developmental outcomes of children placed in kinship foster home, understanding the interrelations between the individual (child) and his or her surrounding environments (e.g., biological families, social-support network) is important. We argue that Bronfenbrenner's most recent ecological systems theory is an appropriate theoretical framework for policy and practice implications in addressing complex issues surrounding kinship foster care system in the United States. This review integrates the empirical findings collectively on the factors associated with kinship foster care within and between five systems levels of the ecological systems theory: micro- (caregiver-child relationship, attachment, and kinship family environment), meso- (biological families), exo- (social-support network outside the family), macro- (race/ethnicity and policies), and chrono- (welfare reform) systems levels. Theories that are relevant to the ecological factors (e.g., attachment theory) are also discussed. Finally, we draw policy and practice implications from the ecological systems analysis. [ABSTRACT FROM AUTHOR]

The mental health histories of the 448 children 15 and 16 years of age who were admitted to state-operated children's psychiatric inpatient services in New York during 1982 were reviewed for the 11 year period through April 1993, Thirty-three percent were served as adults (after age 18) in the state-operated adult civil mental health system; 42% of these individuals were still receiving services at the end of the period. 113 of the 146 individuals served as adults were served only in the civil system. Thirteen percent of the cohort received some of their mental health services as adults in the state-operated adult forensic mental health system due to criminal law involvement. This includes nine percent who received mental health services while they were inmates in state prisons. Twenty four of the 57 forensic clients received services as adults only in the forensic system. Diagnostic, demographic, and service history characteristics of the groups were compared to foster an early understanding of policy and programmatic issues related to movement from the child mental health system to the adult system. Baseline (1982) information was used to identify predictors of later service utilization. [ABSTRACT FROM AUTHOR]

The number of children identified as mentally retarded by the special education system in the United States has declined dramatically over the past 15 years. Hypotheses regarding this decline have generally focused on changes in state definitions and social factors related to the stigma of the mental retardation classification. In the present study, we investigated differences in state definitions of mental retardation as well as demographic and economic variables as predictors of states' MR identification rates. Definition variables failed to relate significantly to identification rates while several race and per capita expenditure variables were significant predictors. Results are discussed in terms of the importance of investigating demographic and economic variables in understanding the variation in state MR identification rates. [ABSTRACT FROM AUTHOR]

Currently, over 4.3 million children are receiving special services within the nation's schools because of physical, developmental, and educational disabilities. It is estimated that twice this number would benefit from special education services. Public Law 94–142, the Education for the Handicapped Act, offered the first real opportunity for many children with disabilities to receive special health and educational services. Public schools have become a primary setting for provision of services to these children, however, many states have encountered difficulty in procuring funding. One federally mandated source of revenue is the Medicaid program. In the fall of 1991, all state Medicaid and special education programs were asked to provide information concerning current or planned use of Medicaid funds for special education services. Responses were received from 36 states. Only 19 states reported using Medicaid funding in any capacity, and of these, only four required schools to bill Medicaid for services rendered. The majority of these programs are in the pilot stages of development. Special education services covered by Medicaid vary widely, as do reimbursement mechanisms. All 19 states allow Medicaid coverage for speech, physical and occupational therapy. Only about half of those states provide allowances for diagnostic evaluation and assessment, while coverage for psychological services is provided by three-fourths of those states, and EPSDT screens by half of the states. Only two programs had been evaluated formally at the state and/or federal level. Medicaid remains a largely untapped source of revenue that could be used to help fund services for disabled children. [ABSTRACT FROM AUTHOR]