Evaluation Findings - SAMHSA Store - Substance Abuse and Mental ...

child’s mental health needs are met. Family
support, informal supports, transportation and
recreation activities, and flexible funds were
among the most used nontraditional services.
Residential services are utilized at low levels
and in a system of care are intended to be
utilized when appropriate and when less
restrictive alternatives may not be appropriate.
The use of inpatient hospitalization declined
dramatically from 6 months to 24 months after
service intake, with less than one-third of
children or youth using these services from 18
to 24 months after service intake than in their
first 6 months.
Youth and caregivers generally reported high
levels of satisfaction with the services they
received. A consistent finding among
systems of care is that youth are more
satisfied with their own progress than are
their caregivers. Youth are least satisfied with
their participation in treatment planning, a
finding that has been consistent over many
years. As systems of care increase their
implementation of efforts to address the need
for youth-guided care, it is anticipated that
this finding will improve.
Communities report broad support for
evidence-based practices (EBPs) and employ
diverse approaches to the use of EBPs.
Communities also report adaptations to EBPs
for reasons related to culture, racial/ethnic
diversity, socioeconomic status, geographical
location, literacy, individualization, and time
constraints.
Systems of care improved in their
implementation according to the principles
that serve as the guide to system change.
Improvement occurred at both the
infrastructure and service delivery levels,
with the greatest improvements occurring for
individualized, least restrictive, and
community-based services in the
communities assessed twice. Culturally and
linguistically competent service delivery and
interagency service delivery are the most
challenging areas for systems of care.
The average and per child costs of services
and the type of services associated with the
greatest cost vary considerably among
systems of care based on data obtained from
agency management information systems. In
all communities, a relatively large proportion
of cost in is incurred by a relatively small
number of children. However, per child
decreases in use of inpatient hospitalization
yielded per child cost savings of about
$1,228 over the 24-month time period.
Substantial cost savings were also identified
from a reduction in the number of arrests
among those served in systems of care. Cost
savings were $913 per child served over the
24-month time period.
Recommendations for the
Future
The CMHI’s experience with system change
is an invaluable resource to the larger
transformation agenda in children’s mental
health. As an approach for providing home
and community-based care, the CMHI
provides a successful and effective approach
to coordinated service delivery for
children/youth with serious emotional
disturbance and their families. The
community-level system transformation
begun under Federal funding continues to
evolve in subsequent years. The
collaboration among funded and
―graduated‖ communities, the structures
established among agencies, and the
experience of individuals involved in
systems of care are opportunities for
furthering larger mental health system
reform. In collaboration with partners in
funded and graduated system of care
communities, many State governments are
using the expertise of these systems of care
to inform and facilitate the expansion of this
approach to additional areas of the State,
The Comprehensive Community Mental Health Services for Children and Their Families Program Evaluation Findings
2006–2008 Annual Report to Congress ● Page 37