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The Health Care Reform Tracking Project is a 5-year national project to track and analyze state health care reform initiatives as they affect children and adolescents with emotional/behavioral disorders and their families. The study's first phase was a baseline survey of all 50 states to describe current state reforms as of 1995. Among findings of this survey were that 86 percent of states were involved in some type of health care reform activity. Nearly all health care reforms were focusing on Medicaid, and most involve medical waivers. The study's second phase involves an in-depth impact analysis of reforms over time in 13 states: Hawaii, Iowa, Massachusetts, North Carolina, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Washington, Wisconsin, Arizona, and California. Preliminary results of the impact analysis include: three states indicate that health care reforms have improved access to mental health services for children, although two states report access has become more difficult. Six states report new types of providers and programs included in service networks. States also identified areas to avoid in health care reform (such as splitting acute and long-term care responsibilities between the managed care entity and the public sector) and areas to include (such as providing a single system for children with serious and mild disorders). (DB)

This monograph explains the community-based systems of care approach to providing services for children and youth with emotional disorders and reviews data from 30 communities suggesting that children served in systems of care are less likely to receive services in restrictive environments or to be placed out of their homes, counties, and states. Preliminary information reviews the development of the systems of care approach, which emphasizes comprehensive and individualized services provided within the least restrictive environment with full participation of families and coordination among agencies and programs. Next, major goals of system development across various communities are identified and information on target population criteria and priorities is provided, noting that the largest percentage of children served at most sites is in the disruptive disorders category. A section on the array of services provided notes the expansion of "intermediate" services and use of case management approaches. Specific outcome indicators used in the review of the 30 community programs are then reported, including: out-of-home and community placements, utilization of restrictive service options, functional improvements, educational status, law enforcement status, family involvement, satisfaction with services, access to services, and cost comparisons. An appendix provides specific outcome data by community. (Contains 43 references.) (DB)

The case studies contained in this document were developed as part of a national project to identify communities that have made substantial progress toward developing comprehensive, coordinated, community-based systems of care for children and adolescents with serious emotional disturbances and their families. After initial identification, communities were further selected for site visits based on such criteria as providing a range of services, having interagency coordinating mechanisms in place, utilizing a child-centered and family-centered approach, and incorporating a community-based system of care. The service delivery systems described in this document are located in four communities: Northumberland County, Pennsylvania; Richland County, Ohio; Stark County, Ohio; and Ventura County, California. Each case study includes an introduction to the project as a whole and a profile of the service delivery system, including the community context, the background and history of the system of care development, philosophy and goals, target population, system organization, system care components, system-level coordination mechanisms, client-level coordination mechanisms, system of care activities, system financing, evaluation, major strengths and challenges, and technical assistance resources. Following the case studies, a paper by Judith W. Katz-Leavy and others, titled "Individualized Services in a System of Care," reviews philosophy, process, operationalization, and evaluation of individualized services and includes implementation examples. The final section of the document provides brief summary profiles of 11 additional community care systems. (DB)

This document is part of a series of monographs on community-based services for children and adolescents who are severely emotionally disturbed. The series is the product of a national study of community-based service approaches which identified over 200 programs serving emotionally disturbed children and included visits to several programs representing a variety of service delivery approaches. This volume begins with presentation of a model system of care, along with principles for service delivery. A literature- and program-based review of therapeutic foster care services is then presented, focusing on: definition and terminology; history; philosophy and goals; characteristics; variables such as treatment intensity and treatment approach; specific services such as preplacement, intervention, discharge, and follow-up; services to natural families; linkages; clients; staffing; treatment parents; resources; evaluation; and major advantages and challenges. Two programs are described in detail--the Family Network Program of the Lee Mental Health Center (Fort Myers, Florida) and Pressley Ridge Youth Development Extension (Pittsburgh, Pennsylvania.) One-page profiles of 32 therapeutic foster care programs are also provided. An appendix contains "The Story of Amanda," a case study of a 10-year-old emotionally disturbed child successfully treated in a therapeutic foster care home. (JDD)

This document is part of a series of monographs on community-based services for children and adolescents who are severely emotionally disturbed. The series is the product of a national study of community-based service approaches, which identified over 200 programs serving emotionally disturbed children and included visits to several programs representing a variety of service delivery approaches. This volume on home-based service approaches begins with a presentation of a model system of care, along with principles for service delivery. A literature-based discussion of home-based services is then provided, emphasizing their history, philosophy and goals, characteristics, service intensity and duration, service phases, linkages, clients, staff, resources, evaluation, and advantages and challenges. Detailed descriptions of three programs follow: Family Advocacy Project (Middlebury, Vermont); Homebuilders (Federal Way, Washington); and Satellite Family Outreach Program (Chicago, Illinois). A final section offers one-page profiles of 34 home-based service programs. References accompany the first two chapters. (JDD)