• By Kevin Mount
  • Posted on Sunday 14th October, 2007

Might measuring the way that they do it be the way to get results?

SAMHSANOT RIGHT Mental illness might appear to be the most private of struggles. However, the US government is investing over $1 billion to make these private problems more of a public concern and to marshal resources in 125 communities to provide better care for children with mental health problems. The communities receiving the federal funds are developing coordinated “systems of care” which involve alternative approaches to out-of-home placements, family involvement, cultural sensitivity and inter-agency cooperation and coordination.Although the principles may be the same, each of the 125 communities decides on a combination of initiatives that is unique to its needs, with the inevitable result that it is difficult to know whether the “systems of care” philosophy, in general, is helpful to children with mental illness. The complicated task of assessing the impact of the effort, at the same time accounting for the distinctiveness of each community and its particular system, has lately fallen to E. Michael Foster of the University of North Carolina and colleagues at Macro International Inc.In their recent article in Children and Youth Services Review, Foster and his team acknowledge that the best way to assess the impact of the systems of care approach is to randomly assign mentally ill children either to a community that received funds to adopt the approach or to one that didn’t, and then to compare the psychological functioning of the two groups over time. So a familiar conflict was encountered – between the essential nature of the program and the requirements of reliable scientific evaluation: children and families could hardly be uprooted from their home communities for the benefit of a control group. Instead, the team had to compare the outcomes of children in funded communities to children in similar communities (in terms of geography and demographic and economic characteristics) which did not receive funds. They took the extra step of removing from the study any child who did not have a similar counterpart in the other community. In all, the study involved 573 children receiving psychological services in Alabama and Nebraska. Children and their parents were interviewed over the course of a year.In Alabama, children in "system of care" community showed substantially greater improvement in their mental health status than did their counterparts in the comparison community. In Nebraska, however, there was no significant difference in the outcomes for children who experienced system of care versus those who did not. The authors conclude that results from more of these types of comparisons are needed to assess the impact of the "system of care" philosophy. They also stress the unique circumstances of each community and suggest that a better of question than “does the system of care work in general or not?” might be “under what conditions does it work?”Summary of “Can system integration improve mental health outcomes for children and youth?” by E. Michael Foster, Robert Stephens, Anna Krivelyova and Phyllis Gamfi in Children and Youth Services Review, Volume 29, Issue 10, (October 2007), pp1301-1319

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