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Group homes are a frequently used but controversial treatment setting for youth with mental health problems. Within the relatively sparse literature on group homes, there is some evidence that some models of treatment may be associated with more positive outcomes for youth. This article explores this possibility by examining differences across time for youth served in group homes utilizing the Teaching Family Model (TFM) and geographically proximate homes using more eclectic approaches. Data come from a longitudinal quasi-experimental study that included 554 youth. Results suggest that youth showed, on average, significant and rapid improvement during initial months in a group home. Improvement did not differ for TFM and non-TFM homes during this initial period. Post-discharge results, though, show that TFM was associated with continued improvement after discharge and significantly better outcomes by 8 months post-discharge. Results also discuss youth-level factors that may influence outcomes as well as need for additional work to more fully understand processes and practices that are key for maximizing and maintaining youths' positive outcomes during and after group home placements.

This study examines the use of family education and support (FES) services within community-based mental health systems. Using data from the national evaluation of the Children's Mental Health Initiative (CMHI), 2,853 caregivers and their children ages 6 to 18 years from 39 communities participated in this study. The findings indicated that during the first 6 months of entry into services, one third of families received FES services, and the clinical characteristics of children whose families received FES services were found to be more severe at intake into services with significantly higher internalizing and externalizing problems and significantly lower strengths than those families who did not. Similarly, caregivers who received FES services entered services experiencing more strain. The findings have implications for the impact of FES services on children. (Contains 5 tables and 1 figure.)

Between one-half and three-fourths of children entering foster care exhibit behavioral or social-emotional problems warranting mental health care. This paper, condensed and updated from a technical report prepared for Casey Family Programs in 2005, reviews evidence-based and promising interventions for the most prevalent mental conditions found among children in foster care. This paper also makes several recommendations regarding increasing access to mental health care and effective psychosocial interventions for foster care children. (Contains 2 footnotes.)

Recent work suggests that out-of-home placements continue to be relatively common for youth with mental health problems, even within systems of care. The current work examines rates and predictors of movement back home and stability of reunifications. During the focal period, 1,778 youths experienced out-of-home placements; 61% moved back home, and 22% of those reunited were placed out of home again. Race was related to likelihood of reunification and instability: American Indian youth were least likely to return home, whereas Hispanic youth were at increased risk of unstable reunifications. Older youth and boys were more likely to return home, whereas youth from families with higher incomes were slightly more likely to be placed out of home but also most likely to be stably reunited. Higher (i.e., worse) total "Child Behavior Checklist" score was related to moving back home, whereas decreased strengths and more child-level risk factors predicted instability of reunification. (Contains 4 tables.)

Major depressive disorder is common in adolescence and is associated with significant morbidity and family burden. Little is known about service use by depressed adolescents. The purpose of this article is to report the patterns of services use and costs for participants in the Treatment for Adolescents with Depression Study sample during the 3 months before randomization. Costs were assigned across three categories of payors: families, private insurance, and the public sector. We examined whether costs from payors varied by baseline covariates, such as age, gender, insurance status, and family income. The majority (71%) of depressed youth sought services during the 3-month period. Slightly more than one-fifth had contact with a behavioral health specialist. The average participant had just under $300 (SD = $437.67, range = $0-$3,747.71) in treatment-related costs, with most of these costs borne by families and private insurers. (Contains 6 tables.)

This study examined outcomes for 320 youth in a Center for Mental Health Services system-of-care demonstration site. Youth received wraparound-only (n = 213), MST-only (n = 54), or wraparound + MST (n = 53). Participants were 12 years old on average and mostly White (90%), and 75% were Medicaid-eligible. Service use and functional and clinical outcomes were examined at 6-month intervals out to 18 months. All three groups improved over the study period. The MST-only group demonstrated more clinical improvement than the other groups. Functional outcomes did not differ significantly across groups. Youth in wrap + MST had higher baseline severity and experienced less clinical and functional change than the other two groups, despite more mental health service use. Targeted, evidence-based treatment may be more effective than system-level intervention alone for improving clinical symptoms among youth with serious emotional disorders served in community-based settings. New or amended approaches may be needed for youth with the most severe disorders.

Objective: This study was designed to assess the relationship between mental health service utilization and heavy episodic drinking (HED) after controlling for demographic and student-level variables. Participants: A national sample of college undergraduate respondents to the 2017–2018 Healthy Minds Study survey (n = 67,427). Methods: Hierarchical logistic regression entering all variables on a single step. Subsequent logistic regression was used to assess interactions between mental health service variables and select demographic and student level variables. Results: Twenty-two demographic and student-level variables were associated with current HED (9 protective and 11 risk factors). Current mental health therapy was associated with a lower risk of current HED while mental health medication use in the past 12 months (but not currently) was associated with a higher risk of HED. Conclusions: Findings provide guidance to college/university community professionals given the responsibility of designing and implementing programs for mitigation of alcohol misuse on their campus. [ABSTRACT FROM AUTHOR]

This article proposes and examines a parsimonious framework for assessing quality in therapeutic residential care. The synthesized conceptual framework includes four potentially critical domains of quality: setting, staffing, safety, and treatment. Data from a recently completed quasi-experimental study of group homes were used to examine prevalence of various key indicators within each of these domains and to explore relationships between these indicators and youth-level outcomes. Findings suggest that, among this sample of licensed homes in a southeastern state, licensure may be an initial indicator of baseline quality. Beyond this most basic level, utilization of an evidence-informed model (in this case, the teaching family model) was associated with better outcomes. Net of model, findings suggest that positively focused motivational systems, youth’s perceptions of staff’s fairness and helpfulness, provision of age/interest-appropriate toys/books/games, more preservice training, and prohibition of physical restraint were all associated with better outcomes for youth. Additional work is needed to assess the generalizability and utility of this framework for assessing quality in group homes. [ABSTRACT FROM AUTHOR]

Despite their widespread use as a placement option for youth with mental health problems, there is relatively little research on group homes for youth. Available data highlight concerns with practices and treatment within group homes and mixed results on youth-level outcomes. However, existing research appears to collapse a wide range of group residential settings into a single amorphous category. This article explores potential variations among group homes to examine whether different programs are systematically serving different types of youth. It examines, in particular, placement in homes using the teaching family model (TFM) versus homes that do not. Findings suggest that demographics are not significantly associated with TFM placement. However, custody status, types of mental health problems, and use of psychotropic medications are. Homes appear to be serving distinct niches within a geographic area. Implications for future research and policy/practice are discussed. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

We conducted a review of empirically based prevention programs to identify prevalence and types of family support services within these programs. A total of 238 articles published between 1990 and 2011 that included a family support component were identified; 37 met criteria for inclusion. Following the Institute of Medicine's typology, prevention programs were categorized as universal, selective, or indicated; programs containing more than one prevention level were characterized as multi-level. Family support types included those led by a mental health professional, led by a peer, or team-led. Among the 37 prevention programs reviewed, 27% ( n = 10) were universal, 41% ( n = 15) were selective, 16% ( n = 6) were indicated, and 16% ( n = 6) were multi-level. The predominant model of family support was professionally led (95%, n = 35). Two ( n = 5%) provided team-led services. None were purely peer-led. In terms of content of family support services, all (100%, n = 37) provided instruction/skill build. Information and education was provided by 70% ( n = 26), followed by emotional support ( n = 11, 30%) and instrumental or concrete assistance ( n = 11, 30%). Only 14% ( n = 5) provided assistance with advocacy. The distribution of models and content of services in prevention studies differ from family support within treatment studies. As family support is likely to be an enduring component of the child and family mental health service continuum, comparative effectiveness studies are needed to inform future development. [ABSTRACT FROM AUTHOR]

Using longitudinal data on 1,813 children and parents from a nationally representative child-welfare sample, National Survey of Child and Adolescent Well-Being (NSCAW), this study investigated physically abusive and neglectful parenting as mediating the effects of parent depression on child mental health by developmental stage. Findings from latent growth models indicated that parental depression had a significant impact on child outcomes for all youths, but of the 2 types of parenting behaviors, only neglectful parenting mediated the relationship for preschool and school-aged children. Neither parenting behavior mediated the effects of parental depression for adolescents. [ABSTRACT FROM AUTHOR]

A comprehensive review of structured family support programs in children’s mental health was conducted in collaboration with leadership from key national family organizations. The goals were to identify typologies of family support services for which evaluation data existed and identify research gaps. Over 200 programs were examined; 50 met criteria for inclusion. Programs were categorized by whether they were delivered by peer family members, clinicians, or teams. Five salient components of family support were identified: (a) informational, (b) instructional, (c) emotional, (d) instrumental, and (e) advocacy. Clinician-led programs were heavily represented ( n = 33, 66%), followed by family-led ( n = 11, 22%), and team-delivered ( n = 6, 12%) programs. Key differences between programs delivered by clinicians or by peer family members were found in the degree of emphasis, research methodology, and outcomes. However, the content of the components was similar across all three program types. There are both important differences in emphasis across typologies of family support provided by clinicians, family members, or teams as well as important similarities in content. Family-delivered support may be an important adjunct to existing services for parents, although the research base remains thin. A research agenda to promote more rigorous evaluations of these services especially those delivered by peer family members is critical. [ABSTRACT FROM AUTHOR]

This article examines out-of-home placements for youth with mental health problems in community-based systems of care. Longitudinal data come from the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program. One third of youth residing at home when they enrolled in the system of care were placed out of home during the 2-year follow-up period. As expected, youth who were placed out of home displayed more problems, fewer strengths, and more risk factors than youth who remained at home. However, results suggested few differences between youth placed in foster care and those placed in more restrictive settings. In addition, there was increased placement instability for Hispanic and older youth. Findings suggest that out-of-home placements remain a common component in systems of care. This suggests the immediate need for additional work on effectiveness of these settings for youth within systems of care. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study of the predictors of workforce turnover in a transported treatment program. The study showed that the 20 percent annual turnover was lower than in the national mental health workforce. It revealed that clinician demographic, professional background and perceptions of the treatment model and demands did not predict turnover.

Despite a decline in the incidence of child abuse over the last decade, victimization rates remain troubling. This study used a subset of data from the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program to investigate and compare the demographic, psychosocial, and service use characteristics and outcomes of children with varying abuse histories referred into community-based mental health services. The lifetime estimate of abuse histories—physical, sexual, or both—among these children is 36.5%. A high level of clinical need across abuse subtypes and a gradient of increasing child and family risk factors differentiated children with and without an abuse history. Children with a reported history of both physical and sexual abuse consistently presented a more troublesome picture of personal and family challenges. Implications for the assessment of clinical needs and the identification of evidence-based interventions to meet the unique needs of these children are discussed. [ABSTRACT FROM AUTHOR]

Little is known about what additional services youth receive while they reside in out-of-home treatment settings. However, such information may be crucial for explaining effectiveness and variation in outcomes for youth in such settings. Our research examines patterns of multi-sector service use for youth in two settings—Therapeutic Foster Care and group homes. Data come from in-person interviews with Treatment Foster Parents and Group Home Staff for a NC state-wide sample of youth with psychiatric disorders and aggressive behavior. Findings indicated high rates of service use by youth in both settings. Analyses indicated significant differences in service types used by youth in each setting, yet similar volume of service use between settings. Clinical and demographic factors did not significantly influence types of services received. Differences in service patterns between the two groups indicated that youth in TFC were more likely to receive community-based, individualized services while youth in group homes were more likely to receive more restrictive services. [ABSTRACT FROM AUTHOR]

Background Children involved with child welfare systems are at high risk for emotional and behavioral problems. Many children with identified mental health problems do not receive care, especially ethnic/minority children. Objective To examine how patterns of specialty mental health service use among children involved with child welfare vary as a function of the degree of coordination between local child welfare and mental health agencies. Design Specialty mental health service use for 1 year after contact with child welfare was examined in a nationally representative cohort of children aged 2 to 14 years. Predictors of service use were modeled at the child/family and agency/county levels. Child- and agency-level data were collected between October 15, 1999, and April 30, 2001. Setting Ninety-seven US counties. Participants A total of 2823 child welfare cases (multiple informants) from the National Survey of Child and Adolescent Well-being and agency-level key informants from the participating counties. Main Outcome Measures Specialty mental health service use during the year after contact with the child welfare system. Results Only 28.3% of children received specialty mental health services during the year, although 42.4% had clinical-level Child Behavior Checklist scores. Out-of-home placement, age, and race/ethnicity were strong predictors of service use rates, even after controlling for Child Behavior Checklist scores. Increased coordination between local child welfare and mental health agencies was associated with stronger relationships between Child Behavior Checklist scores and service use and decreased differences in rates of service use between white and African American children. Conclusions Younger children and those remaining in their homes could benefit from increased specialty mental health services. They have disproportionately low rates of service use, despite high levels of need. Increases in interagency coordination may lead to more efficient allocation of service resources to children with the greatest need and to decreased racial/ethnic disparities. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the relationship between the need for and use of mental health services among a nationally representative sample of children who were investigated by child welfare agencies after reported maltreatment. Method: Data were collected at study entry into the National Survey of Child and Adolescent Well-Being and were weighted to provide population estimates. Results: Nearly half (47.9%) of the youths aged 2 to 14 years (N = 3,803) with completed child welfare investigations had clinically significant emotional or behavioral problems. Youths with mental health need (defined by a clinical range score on the Child Behavior Checklist) were much more likely to receive mental health services than lower scoring youth; still, only one fourth of such youths received any specialty mental health care during the previous 12 months. Clinical need was related to receipt of mental health care across all age groups (odds ratio = 2.7-3.5). In addition, for young children (2-5 years), sexual abuse (versus neglect) increased access to mental health services. For latency-age youths, African-American race and living at home significantly reduced the likelihood of care. Adolescents living at home were also less likely to receive services, whereas having a parent with severe mental illness increased (odds ratio = 2.4) the likelihood of service use. Conclusions: Routine screening for mental health need and increasing access to mental health professionals for further evaluation and treatment should be a priority for children early in their contact with the child welfare system. [ABSTRACT FROM AUTHOR]

Adolescents’ functional impairment has become increasingly important as a criterion for diagnosis and service eligibility as well as a target of therapeutic intervention in mental health settings. This study examines three critical issues in measuring functioning: 1) agreement between parent and adolescent reports of functioning, 2) explanations for disagreement, and 3) clinicians’ ratings of functioning compared with parent and adolescent reports. Agreement between parent and adolescent reports of functioning was estimated using the kappa statistic and conditional agreement in a sample of 258 adolescents. Rates of and reasons for expected disagreements between informants were explored in semi-structured interviews ( n = 43). ANOVA was calculated for clinician ratings for parent–adolescent pairs categorized on the basis of their agreement or disagreement on impairment. Finally, the independent contribution of parents’ or adolescents’ reports of impairment on clinician ratings of functioning was examined. From 12% to 97% of problems reported by one informant were denied by the other. Agreement was particularly poor for questions about relationships with friends, peers’ delinquent behaviors, and leisure activities. On average, parents and adolescents were more likely to expect the other would agree with their ratings rather than disagree. Reasons for disagreement included: 1) differences in how parents and adolescents interpreted questions; 2) lack of parental awareness of adolescents’ behaviors; and 3) different thresholds for what is considered problematic. Results also demonstrated that clinicians perceive problems reported only by parents as somewhat more serious than problems reported only by adolescents. Implications for diagnosis, treatment planning and outcomes measurement are discussed. [ABSTRACT FROM AUTHOR]

This study took preliminary steps to explore the relationship between involuntary outpatient commitment (OPC) and the risk of homelessness among individuals with severe mental disorders. Involuntarily hospitalized patients were randomly assigned to be released or maintained under OPC following hospital discharge. Multivariate analyses demonstrated that involuntary OPC was associated with a significant decrease in the risk of homelessness during the first 4 months following hospital discharge for participants with severe functional impairment at baseline. OPC did not appear to affect risk of homelessness among participants with mild-to-moderate functional impairment. Co-occurring substance abuse, treatment nonadherence, and outpatient services intensity were found to be strongly associated with episodes of homelessness. This study suggests that involuntary OPC may provide a short-term reduction in the risk of homelessness among a subgroup of treatment-reluctant individuals with severe mental disorders combined with severe functional impairment. [ABSTRACT FROM AUTHOR]

We examined Treatment Foster Care (TFC) in residential trajectories for youth with. psychiatric disorders and aggressive behavior. We analyzed residential placements of a statewide sample of youth during the 12 months preceding and following admission to TFC. Prior to TFC, the majority of youth were residing in more restrictive settings (group homes or residential treatment). Two-thirds of youth remained in TFC throughout the follow-up year. Of those who left, nearly half returned home, and slightly fewer were discharged to group homes. By the end of the 12-month follow-up period, rates of group home use were similar to those seen in the pre-TFC period. Movement out of TFC during the year was associated with being older at placement and with increased problem behavior (particularly externalizing behaviors). TFC serves as a step-down placement for a substantial number of youth. However, this is not the only way it is used, and models based on short-term transitioning or reunification with families may not be widely implemented or relevant in practice. Additional research is needed to understand current functions of TFC in residential trajectories and to maximize its utility in systems of care. [ABSTRACT FROM AUTHOR]

Case-mix adjustment methods are needed to account for differences between providers when the youth they treat have characteristics that adversely affect treatment success. This study explores variables for adjusting mental health treatment outcomes for adolescents and the differential effects of case-mix adjustment on providers' performance. Linear regression modeling was used to identify case-mix variables for five outcomes. Predictive equations for each outcome were developed for models based on intake clinical data alone, clinical data plus administrative data, and clinical data plus data describing youth history and family environment. Variance explained by intake clinical data alone did not increase appreciably with the addition of administrative data or data describing youth history and family environment. Adjusting outcomes changed the relative performance of certain individual providers substantially, but had a more moderate impact on the overall interpretation of providers' performance. [ABSTRACT FROM AUTHOR]

Background: Violent behaviour among persons with severe mental illness (SMI) causes public concern and is associated with illness relapse, hospital recidivism and poor outcomes in community-based treatment.Aims: To test whether involuntary out-patient commitment (OPC) may help to reduce the incidence of violence among persons with SMI.Method: One-year randomised trial of the effectiveness of OPC in 262 subjects with psychotic or major mood disorders and a history of hospital recidivism. Involuntarily hospitalised subjects awaiting OPC were randomly assigned to release or court-ordered treatment after discharge. Those with a recent history of serious assault remained under OPC until expiry of the court order (up to 90 days); then OPC orders were renewed at clinical/court discretion. Control subjects had no OPC. Four-monthly follow-up interviews with subject, case manager and collateral informant took place and service records were collected.Results: A significantly lower incidence of violent behaviour occurred in subjects with > or = 6 months' OPC. Lowest risk of violence was associated with extended OPC combined with regular out-patient services, adherence to prescribed medications and no substance misuse.Conclusions: OPC may significantly reduce risk of violent behaviour in persons with SMI, in part by improving adherence to medications while diminishing substance misuse. [ABSTRACT FROM AUTHOR]

As pressure increases for the demonstration of effective treatment for children with mental disorders, it is essential that the field has an understanding of the evidence base. To address this aim, the authors searched the published literature for effective interventions for children and adolescents and organized this review as follows: (1) prevention; (2) traditional forms of treatment, namely outpatient therapy, partial hospitalization, inpatient treatment, and psychopharmacology; (3) intensive comprehensive community-based interventions including case management, home-based treatment, therapeutic foster care, and therapeutic group homes; (4) crisis and support services; and (5) treatment for two prevalent disorders, major depressive disorder and attention-deficit hyperactivity disorder. Strong evidence was found for the treatment of attention-deficit hyperactivity disorder, depression, anxiety, and disruptive behavior disorders. Guidance from the field relevant to moving the evidence-based interventions into real-world clinical practice and further strengthening the research base will also need to address change in policy and clinical training. [ABSTRACT FROM AUTHOR]

Ninety-six per cent of mentally ill elderly persons who are not in the community reside in nursing homes, yet the mental health care they receive there is minimal or unavailable. Data are presented from the 1984 pretest of the National Nursing Home Survey. Five hundred and twenty-six patients in 112 nursing homes in four US metropolitan areas were sampled. Overall, the prevalence of mental disorder was found to be 68%; 39% of the patients had a diagnosis of organic brain syndrome (OBS) and 29% had other mental disorders (OMD). Only about one-third (31%) or residents had no mental disorder. These three patient groups, those with OBS, those with OMD, and those with no mental disorder, were compared on demographic, clinical, and treatment characteristics. The authors conclude that the balance between the Federal and State roles in financing care for the mentally ill in nursing homes needs to result in a more equitable system of care which does not discriminate against the mentally ill. Further, the mental health service system needs to assume greater responsibility for this populations. While significant attention is given to residents physical needs, behavioural and emotional problems are seriously neglected. [ABSTRACT FROM AUTHOR]

This paper examines the relationships between insurance coverage, need, and mental health services in a community-based sample of 1,015 youths who were 9, 11, and 13 years old at the beginning of the study. They were followed over a two-year period. A strong measure of need based on a standardized diagnostic interview was available and repeated over three annual waves. Data on service use was collected quarterly across two years. Major findings included: (a) high need (serious emotional disturbance [SED]) was strongly related to use of any mental health services; (b) services use was much more likely to occur with public (Medicaid) insurance coverage than either private or no insurance; (c) considerable unmet need was observed even for youths with SED; (d) school-based mental health services potentially substituted for professional mental health services; and (e) there was little unnecessary use of mental health services in the low need group. The major policy implication of these findings is that the regulation of insurance benefits should be based on level of need, rather than on arbitrary limits which are likely to either reduce the probability of or appropriate amount of care for youths who most need mental health services. [ABSTRACT FROM AUTHOR]

Mental health coverage generally limits benefits for high use, which is assumed to be discretionary. The authors present data from the National Medical Care Utilization and Expenditure Survey. Of the individuals who made mental health outpatient visits in 1980, 9.4% made 25 or more visits and accounted for 50% of mental health visits and expenditures. These high users were compared with low users and with high users of other health care. One-third of the mental health high users were highly disabled and had multiple medical disorders. The authors point out the heterogeneity of this population and suggest that psychiatric benefits be differentiated according to patients' needs and services offered. [ABSTRACT FROM AUTHOR]

Data from the National Survey of Child and Adolescent Well-Being show that approximately 1 in 8 (12.5%) children who are subjects of reports of maltreatment investigated by child welfare services (CWS) agencies have parents who were recently arrested. Compared with other children who come to the attention of CWS agencies, those with arrested parents are younger, disproportionately African American, and significantly more likely to be in out-of-home care. Approximately 2 in 5 children age 2 and older with arrested parents had a clinically significant emotional or behavioral problem, yet only 1 in 10 received mental health care. Although parent characteristics varied by race, rates of substance abuse, serious mental illness, domestic violence, and problems meeting basic needs were higher among arrested parents than among other parents. [ABSTRACT FROM AUTHOR]

Abstract: This article uses data from the National Survey of Child and Adolescent Well-Being (NSCAW) to examine multi-sector service use for mental health problems by youth in contact with social service agencies. At 18-months post-investigation for abuse/neglect, 24% was receiving some service for a mental health problem. Among served youth, 33% received services from multiple sectors. Likelihood of service use was higher for youth who were older, male, in non-kin foster care, had more severe mental health problems, and more parental risk factors. Among service users, few factors differentiated youth who used multiple sectors from those served in only one sector. [Copyright &y& Elsevier]

Objective: To compare detection rates, service use, and outcomes of substance use disorder (SUD) in adolescents seeking mental health treatment. Method: Adolescents (n = 237) and their parents or caregivers completed parallel, self-administered versions of the Adolescent Treatment Outcomes Module (ATAM) at intake and 6-month follow-up. SUD was asseseed using the Diegnostic Interview Schedule for Children (DISC). Results: Although 42 (16.6%) adolescents seektng mental health treatment met DISC critaria for any SUD at baseline, clinicians detected only 19 of these (κ = 0.51). Sensitivity and specificity were high for a screening tool for adolescent SUD (95.2 and 82.0, respectively). Adolescents with undetected SUD were less likely to receive SUD services and to have more legal problems at 6-month follow-up compared to adolescents with detected SUD. Conclusions: SUD rates may be high in adolescents seeking mental health treatment, confirming the need for routine screening in this population. Results confirm that a large gap exists between the need for and accese to SUD treatments, which may contribute to poorer outcomes for all adolescents with SUD. Key Words: Adolescent Treatment Outcomes Module; substance abuse; mental health; adolescents. [ABSTRACT FROM AUTHOR]