Substance Abuse and Mental Health Services Administration

System of Care: A Community-
Community
Based Approach to Address the
Mental Health Needs of Children,
Adolescents and Families
Findings and Lessons Learned:
National Evaluation Results
National Academy for State Health Policy
October 21, 2008
Gary M. Blau, Ph.D.
Chief, Child, Adolescent and Family Branch
Center for Mental Health Services

Evidence Based Practice: Definitions
and Resource Examples
New Freedom Commission Report on
Evidence Based Practices
SAMHSA EBP’s Implementation Resource
Kits
NASMHPD EBP Resource Guide
Hawaii EBP Service Initiative
Medicaid Support for Evidence-Based
Practices in Mental Health Program

MST
FFT
Incredible Years
EBP Examples
CBT/Trauma Focused CBT
PBIS
PCIT

• NREPP is intended to serve as a decision support
tool.
• NREPP is a voluntary, self-nominating system in
which intervention developers elect to participate.
• NREPP is a good place to start researching what
interventions might work for you.
http://nrepp.samhsa.gov

Guam
System of Care Communities of the Comprehensive Community
Mental Health Services for Children and Their Families Program
Lummi Reservation,
Passamaquoddy Tribe,
WA
ME
King County,
New Hampshire (3
Maine (4
WA
regions)
Sault Ste.
Vermont 1 (statewide)
Maine counties) (3
Clark County, WA Yakima County,
Marie Tribe, MI
Vermont 2 (statewide)
Worcester counties) County,
Northwest Portland
Blackfeet Tribe,
Minnesota
WA
Bismarck,
Vermont 3 (statewide)
Worcester, MA
Area Indian Health
MT
(6 counties)
Fargo, & Minot,
Albany County,
Rhode MA Island 1
Multnomah BoardCounty,
Mid-Columbia
Montana &
ND Minnesota
Monroe County, NY
Rhode (statewide) Island 2
Clackamas County, OR
Region
Crow Nation
(4 Wisconsin
NY
(statewide) Rhode Island 3
OR
Sacred Child Project,
Erie County,
(statewide) Bridgeport,
(4 counties),
counties) (6 counties)
New London County,
ND
Ingham
NY
CT
Lane County,
Westchester CT County,
OR
Orange
Willmar,
OR
Oglalla
County,
NY Nassau County,
Idaho
Yankton MN
Detroit Chautauqu County, NY Mott Haven,
Sioux
Kalamazoo County, MI
New
NY
Northern
Sioux
,
a
MI
Cuyahoga
Burlington
NYYork,
Tribe,
Iowa
County,
Arapaho Tribe,
Tribe, SD
NY
MI
United Indian Health Service,
County,
South NJ Philadelphia,
SD
(10 Milwaukee,
County, NY
Allegheny County 1,
CA
WY
counties) McHenry County, WI Chicago,
OH
PA
Lake County,
Allegheny PA County 2,
IL Lyons, IL
Beaver
Nebraska
IN
PA County,
Glenn County,
Wyoming
Riverside, Marion Southern Consortium
Delaware PA 1
CA Butte County, CA
(statewide
(22
& Proviso, IL County, & Stark County, OH
Delaware (statewide) 2
counties)
Montgomery County,
Placer County,
)
Lancaster St. Joseph,
IN
Alexandria (statewide)
Southeaster
Napa & Sonoma Counties,
MD
Baltimore,
Rural
Denver area,
CA Sacramento CA
County,
,
Maryland (statewide)
County,
MO St. Charles n IndianaNorthern
Charleston, WV
MD
Contra CA Costa County,
Frontier, CO
NE
VA
Washington,
Southeaster County, St. Kentucky Kentuck
DC
Urban
CA
UT
Clark
Sedgwick n Kansas MO
y
San Francisco,
Colorado (4
Eastern Kentucky
Edgecombe,
Alamance County,
Louis, (112
Nash, & Pitt Counties,
Trails,
CA
County,
counties)
County,
Oakland, CA
Southwes Nashville, TN
North North
NC
NC
MO counties)
Carolina Carolina (11 (11
California 5 (Riverside, San Monterey, Mateo,
NV
KS
t Missouri Maury
Mecklenburg counties) counties) County,
Santa Cruz, Solano, & Ventura CA
Navajo
Creek
Mississipp County,
South NC Carolina (3 counties & Catawba
Counties)
Nation
Northwest
Oklahoma
Santa Barbara County,
i
TN
Nation)
Oklahoma Nation
Shelby
Seven
Greenwood,
Georgia
(statewide) (5
CA Generations
River Delta County, TN
Charleston, SC
Los Angeles County,
Choctaw
System of
counties)
Pascua
area, AR
Gwinnett & SC
CA
Nation,
Hinds
Care, CA Yaqui
Texas
Birmingham Rockdale
San Diego County,
OK
County,
Tribe, AZ
(11
Las Cruces,
, Counties,
CA
Ft. Worth,
MS
Pima County,
counties)
NM
TexasTX
AL GA
Mississippi
AZ
(5
(3 counties)
El Paso County, counties)
TX
Travis Harris Southeaster
County, County,
n
Hillsboroug
TX
TX Louisiana
h
County, Sarasota FL
County,
FL
West Palm Beach,
FL Broward County,
FL
Wai'anae &
Leeward, HI
Honolulu, HI
Yukon
Kuskokwim
Delta Region, AK
Fairbanks
Native
Association, AK
Puerto
Rico
Funded Communities
Date Number
1993–1994 22
1997–1998 23
1999–2000 22
2002–2004 29
2005–2006 30
2008 18

Evidence both Ways!
Groundbreaking new
language in RFA. The focus
of Evidence-based Practice
has been enhanced with
the addition of Practicebased
Evidence in our
System of Care Program.
National initiative to create
“Community Defined
Evidence,” which will allow
communities to define for
themselves the concept of
acceptable evidence

Transformation Resources
Got a question about how to develop a
family-driven, youth-guided system of care?
Start here
www.systemsofcare.samhsa.gov

Children in 2002-04 2002 04 Grant Communities:
Demographic Characteristics
Gender (n = 15,813)
Male 63.6%
Female 36.4%
Age Group (n = 15,699)
Birth to 3 years 5.8%
4 to 6 years 10.4%
7 to 11 years 26.7%
12 to 14 years 26.8%
15 to 18 years 29.2%
19 to 21 years 1.1%
Average Age at Intake (n =15,715) 11.5 years

Demographic Characteristics (cont.)
Of the children in the study:
38% were Caucasian alone
25% were African American alone
26% were Hispanic
Race/Ethnicity (n = 15,542)
American Indian or Alaska Native 4.6%
Asian 1.3%
Black or African American 24.9%
Native Hawaiian or Other Pacific Islander 1.9%
White 37.8%
Hispanic/Latino 25.9%
Multi-Racial 3.3%
Other 0.3% 9

DSM–IV DSM IV Axis I and Axis II Diagnoses
Diagnosis (n = 12,398) %
Mood Disorders 33.6%
Attention-Deficit/
Hyperactivity Disorders
Oppositional Defiant
Disorder
29.7%
22.5%
Adjustment Disorders 13.8%
Other 10.4%
PTSD and Acute Stress
Disorder
8.5%
V code 7.8%
Conduct Disorders 6.6%
Disruptive Behavior Disorder 6.5%
Anxiety Disorders 6.4%
Substance Use Disorders 5.9%
Diagnosis (Continued) %
Learning, Motor Skills, and
Communication Disorders
3.7%
Impulse Control Disorders 2.8%
Mental Retardation 2.6%
Pervasive Developmental
Disorders
Schizophrenia and Other
Psychotic Disorders
2.6%
2.4%
Personality Disorders 1.0%
Substance Induced
Disorders
0.3%

DSM–IV DSM IV Axis I and Axis II Diagnoses
The four most common diagnoses for
children and youth included:
Mood disorders (33.6%)
Attention-Deficit Attention Deficit / Hyperactivity Disorder
(ADHD) (29.7%)
Oppositional defiant disorders (22.5%)
Adjustment disorders (13.8%)
11

Older Children and Youth:
Presenting Problems
For children and youth with available
information on presenting problems, the
most commonly reported problems upon
entry into systems of care were:
Conduct / Delinquency (58%)
Hyperactivity and Attention (38%)
Depression (37%)
Adjustment (34%)
School Performance (32%)
12

Juvenile Justice History at
Intake, 6, 12 , 18 and 24 Months
Youth self-report (age 11 and above) of arrest fell by
half, dropping from 19% upon entering systems of
care to 9% at 24 months.
The percentage of youth who were questioned by
police decreased from 19% following entry to
systems of care to 12% at 24 months.
Youth self-report of appearance in court dropped
from 16% at intake to 10% at 24 months after
entering systems of care services.
13

Rates of Suicide Attempts Among Youth
from Intake to 24 Months
The percent of youth aged 11 and older with suicide attempts
were reduced by nearly half within 6 months after entering
systems of care (from 11.4% to 6.7%), and was further
reduced by more than two thirds after 24 months (to 2.5%).
14

Decreased Costs
Improved child and family outcomes
resulted in cost savings due to decreases:
decreases
in inpatient hospitalizations ($1,735.50 per child served)
TOTAL COST SAVINGS 1 : $16,796,169.00
in the number of arrests ($829.80 ( $829.80 per child served)
TOTAL COST SAVINGS 1 : $8,030,804.40
1
Based on estimated number of children served in FY 2008 of 9,678
15

System of Care RFA Released on
October 3, 2008
- Due 1/15/09
- www.samhsa.gov/Grants
www.samhsa.gov/Grants

Systems of Care Build
Resilience…