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Throughout the country, there is considerable inconsistency in how states regulate residential treatment programs for youth. In states with little oversight, the health and safety of youth are unprotected and they may be subject to substandard treatment, rights violations, and/or abuse. Three initiatives to address this issue are reported: (1) an Internet survey of youth who are former residents, (2) a four-state pilot study of how states regulate and monitor residential programs, and (3) a bridge-building conference between residential treatment providers and mental health leaders. Recommendations address the next steps for lawmakers, lawyers, judges, mental health and education professionals, and parents.

Much of today's psychological trauma can be identified as resulting from sudden and seemingly random events, and particularly from events that involve the loss of human life. This article presents a perspective on how behavioral health providers may approach the design, development, and implementation of community-based psychological trauma interventions. These interventions allow those community members most affected by the trauma to play a central role in the resolution of, and community adaptation to, traumatic losses. After a brief discussion of "critical incident stress debriefing"--a common form of psychological "first aid" that is sometimes used following traumatic events that affect a community--the article turns to the description of a community-based trauma-response program that provides a continuum-of-care model for the care and management of individual and group reactions to shared, traumatic events. A recent evaluation of that program, which was developed by the Community Services Program of the Trauma Center in Boston, is presented as an important first step toward determining the types of community-based responses that show promise in our efforts to ameliorate the impact of traumatic events in communities nationwide and internationally.

(2003). Further Psychometric Evaluation of the Eyberg and Behar Rating Scales for Parents and Teachers of Preschoolers. Early Education and Development: Vol. 14, No. 1, pp. 67-82.

Establishing a system of care requires communities to identify ways to successfully implement strategies and support positive outcomes for children and their families. Such community transformation is complex and communities vary in terms of their readiness for implementing sustainable community interventions. Assessing community readiness and guiding implementation, specifically for the funded communities implementing a system of care, requires a well-designed tool with sound psychometric properties. This scale development study used the results of a previously published concept mapping study to create, administer, and assess the psychometric characteristics of the System of Care Readiness and Implementation Measurement Scale (SOC-RIMS). The results indicate the SOC-RIMS possesses excellent internal consistency characteristics, measures clearly discernible dimensions of community readiness, and demonstrates the target constructs exist within a broad network of content. The SOC-RIMS can be a useful part of a comprehensive assessment in communities where system of care practices, principles, and philosophies are implemented and evaluated.

A new approach to services for children with serious emotional disturbance and their families calls for the development of systems of care. Family members participate in all aspects of service delivery, including designing, developing, and delivering services. Training and technical assistance are essential, as service providers need new skills in working with children, family members, service providers, and others in the community; and a new understanding of integrated, community-based services. Technology offers new possibilities for delivering such training. In North Carolina, the Internet is used to share information, plan training events, provide training, and exchange materials among training coordinators located around the state. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Reports on a randomized trial of case management carried out in conjunction with the Robert Wood Johnson Foundation's Mental Health Services Program for Youth in North Carolina (RWJ MHSPY). Youths with serious emotional disturbance (n = 167) were randomized to either a multiagency treatment team led by a case manager or a multiagency team led by the youth's primary mental health clinician. They were followed for 1 year after entry into the RWJ demonstration. Results show that the addition of an experimental case manager to a youth's treatment team resulted in longer participation in services, use of a wider variety of services, fewer inpatient days, and more community-based services.

As the concept of the system of care is implemented in states and localities across the country, it is important to define the kinds, the volume, and the cost of services necessary to address the needs of children and adolescents with mental health problems. This article focuses on the services that are usually the responsibility of the mental health system and provides a model for planning based on experiences in one state.

This paper focuses on nine overlapping topics dealing with improving mental health and substance abuse services for adolescents and their families. Depending on the state of knowledge of each topic, the authors either highlight the importance of the area or offer a specific position statement. It is intended that these statements be reviewed for possible endorsement by the American College of Mental Health Administration (ACMHA) and for transmission to other professional organizations, federal and state governmental agencies and the field in general.

We describe an evaluation of an innovative mental health system for children and adolescents. The Ft. Bragg Demonstration was developed to provide a complete continuum of care to children receiving health care benefits through CHAMPUS. The evaluation, jointly funded by the State of North Carolina and the NIMH, is designed to evaluate the implementation, service quality, clinical outcomes, and costs of this new system of care. Over a 5-year period, approximately 1,100 children and families will be studied in a four-wave longitudinal study at Ft. Bragg and two comparison sites. This project should provide important information about whether these new systems work better than the traditional array of services.

Developing systems of care for children with emotional disorders requires changes in the organization and delivery of services. Using concept mapping, the authors conducted a study to define factors of a community’s readiness to make such changes. Participants were from 25 of 27 federally-funded, advanced sites, plus a panel of experts. The participants completed three tasks: brainstorming, rating, and sorting. This process produced eight factors: Leadership, Network of Local Partners, Shared Goals, Collaboration, Families and Youth as Partners, Accountability, Evaluation, and Plans to Expand Services. Understanding factors that contribute to successful implementation should help communities identify and make needed changes.

Over the past decade in the United States, the number of private residential facilities for youth has grown exponentially, and many are neither licensed as mental health programs by states, nor accredited by respected national accrediting organizations. The Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (A START) is a multi-disciplinary group of mental health professionals and advocates that formed in response to rising concerns about reports from youth, families and journalists describing mistreatment in a number of the unregulated programs. This article summarizes the information gathered by A START regarding unregulated facilities. It provides an overview of common program features, marketing strategies and transportation options. It describes the range of mistreatment and abuse experienced by youth and families, including harsh discipline, inappropriate seclusion and restraint, substandard psychotherapeutic interventions, medical and nutritional neglect, rights violations and death. It reviews the licensing, regulatory and accrediting mechanisms associated with the protection of youth in residential programs, or the lack thereof. Finally, it outlines policy implications and provides recommendations for the protection of youth and families who pursue residential treatment.

The completion of four studies that constitute the evaluation of the Fort Bragg Child and Adolescent Mental Health Demonstration Project 19 now requires serious consideration of the meaning of the findings and the implications for changes in policy and practice. The studies, which addressed the impact of services delivered in a large, comprehensive and coordinated system of care, were designed and completed using accepted, state-of-the art methodology. The service system incorporated both the currently accepted principles of the federal Child and Adolescent Service System Program (CASSP) and features of managed care. Thus the results should be considered meaningful and be considered in the shaping of future directions in children's mental health services. However, the results must also be considered within several contexts and must be recognized as the results of a single, albeit high-quality and comprehensive, study. The first two studies completed, the Implementation Study 2 and the Quality Study, 3 provide a foundation or a basis for "trusting" the findings of the second two studies, the Cost Study 8 and particularly the Outcome Study. 5 These studies offer support that the Demonstration Project was implemented according to plan and that the services delivered were of high quality. The development of this foundation through the fast two studies represents a design strength that is sometimes missing in program evaluation, and its absence leaves confusion about the meaning of the results. In this evaluation, the findings of the Outcome Study can be less likely attributed to a faulty implementation of the service system or to the delivery of services of questionable quality. The Implementation Study, through the network analysis, uses an interesting evaluation strategy to assess the breadth of the service system and its integration with other services in the community. The results of the network analysis indicate strongly that (1) the system of care approach does create an expanded and organized network of service providers, and (2) the network is seen as having a positive impact on service delivery. The positive impact is reported to be derived from improved and organized access to timely care and expansion of the volume, types, and mix of services available. This part of the evaluation study contributes to validation of the principles on which service system development has been based, namely that service delivery is improved through an integrated and organized approach. The Outcome Study includes an assessment of family and client satisfaction that indicates that the consumers of services rate these integrated and organized services more highly and that they value their inclusion in the decision-making process regarding service planning. Thus additional system of care principles are supported, namely that an integrated and organized delivery system is more appealing to those using the system and that the opportunity for parents to participate as partners with professionals results in increased satisfaction with services.

Over the past two decades, there has been an increasing focus on the needs of children with mental health problems. Although there has been a commitment to developing a continuum of child mental health services by mental health professionals and others involved in the treatment, education, and care of children, progress has been remarkably slow. The state of North Carolina, in response to litigation, has established a precedent by developing integrated systems of services for seriously behaviorally disturbed children and adolescents that may serve as a model for others. The North Carolina mental health system, primarily through the community mental health centers, has served as the lead agency in this initiative. After 4 years o f program development, it appears to be well established that seriously disturbed youngsters can be served in community based systems, especially in a strong and expansive case management function is in place.

The increase in the number of children attending preschools or day care centers has provided an opportunity for early detection of emotional problems. However, few screening instruments have been standardized for children in this age group. A modification of Rutter's Children's Behaviour Questionnaire was standardized on a sample of 496 normal and 102 disturbed preschool children. The modified questionnaire (renamed the Preschool Behavior Questionnaire) was found to possess criterion validity and high interrater and test-retest reliabilities. Three factors were extracted and were labeled Hostile-Aggressive, Anxious-Fearful, and HyperactiveDistractible. The data indicated that the Preschool Behavior Questionnaire may be valuable in either clinical or research settings for the first step in early detection of emotional problems.

Using a technical assistance model, the authors developed a University-based program to facilitate staff development among direct care personnel in a network of community-based residential treatment programs serving emotionally disturbed children and adolescents in North Carolina. The process used and the results are described, followed by the implications of this program for child and youth services professionals.

Over the past 15 to 20 years, there has been a growing concern for the well-being of children among the professionals, parents, advocates, policymakers, and lawyers concerned with civil rights. There has been an increasing emphasis on deinstitutionalization, normalization, parent participation, and integration of the services of all agencies into a more systematic and comprehensive approach to the handicapped child. In comparison to earlier time periods, more positive change has taken place from the late 1960s to the present; however, given the concern and awareness that have emerged during that time period, change overall has been extremely slow.

A follow-up of 46 youthful clients discharged from a therapeutic camp between its inception in 1972 and September 1975 indicates an overall improvement in functioning, especially in the areas of school performance, interpersonal relationships, and household behavior. The one area in which no overall improvement was found was delinquency.

A sample of 26 adult male hemophiliacs was divided into two groups on the basis of their psychosocial adjustment. The poorly adjusted group rated their mothers as significantly higher in tendencies toward dominating, overprotecting, and ignoring their children. In studying the psychosocial adjustment of hemophiliacs, it was observed that these Ss frequently were exposed to similar patterns of child rearing. Support was found in earlier studies (Agle, 1964; Browne, Mally, & Kane, 1960) that mothers of hemophiliacs tend to overprotect and infantilize their sons. In fact, studies of juvenile diabetics (Swift, Seidman, & Stein, 1967) and of other children considered to be physically vulnerable (Green & Solnit, 1964) also revealed the mothers' tendencies to protect, infantilize, and dominate their children. These attitudes seemed initially based on the realistic possibility of physical danger to the child; however, even when the children in these studies were old enough to fend for themselves, the mothers continued their protective roles. The mothers' attitudes in these studies seemed to reflect feelings of inadequacy as a childbearer and guilty feelings of having burdened a child with a chronic illness. Although feelings of guilt and responsibility were also apparent in mothers of diabetics and other chronically ill children, they may be more salient in mothers of hemophiliacs, for in this disease the defects in blood clotting are transmitted as sex-linked, recessive genetic traits by the carrier mother to the son. That is, the mother passes on a genetically determined condition which she herself does not have. Hemophilia is a life-long, serious condition, found almost exclusively in males and usually