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with statewide development of systems of care as the ultimate goal. Findings indicate that achiving cultural and linguistic competence and interagency collaboration continues to be challenging for system of care communities. In addition, in the study of evidence-based practices implementation, service providers were found to be less adaptable and less willing to try new ideas and practices than administrators. The areas in which systems of care encounter barriers to change are areas in which efforts need to continue to be developed and studied through the national evaluation. These areas include continued focus on the following: Implementing strategies to improve cultural and linguistic competence Addressing the challenges of crossagency collaboration to support an efficient multi-agency infrastructure Increasing the effectiveness of services by providing resources for adoption, training, and fidelity monitoring of evidence-informed practices, EBPs, practice-based evidence, and promising treatment practices Developing a skilled workforce through education, training, technical assistance, coaching and information dissemination A significant challenge for systems of care is their role in partnership with State agencies to leverage their work in order to support and facilitate the expansion of the system of care approach to other areas of the State. Qualitative data derived from the sustainability study and the system of care assessments have underscored the importance of system of care communities being part of a larger State strategy for sustaining systems of care and for expanding their application to other areas. Given these findings, the need for partnerships between system of care communities and State mental health and other child-serving agencies is critical. States can strategically employ funded and graduated communities to serve in many ways to develop these partnerships. The communities can serve as learning labs where approaches are tested and evaluated, demonstration sites for improving practice through the implementation of EBPs, models for addressing racial and ethnic disparities in services, sources of training and coaching for other communities, technical assistance providers for other communities, sources of data for assessing the outcomes of systems of care at the system and service delivery levels, conveners of family members and youth to develop and strengthen family and youth organizations, and developers of social marketing materials to build constituencies. In recognition of the importance of this partnership, requirements for local–State partnerships in the CMHI have been strengthened. Additional efforts are recommended to strengthen these partnerships and to assist system of care communities and State agencies to work together strategically to both sustain and expand systems of care. Establishing a longer term vision for evolving systems of care, built on the incremental change established during grant funding years, is an area in which systems of care may benefit from Federal leadership. Individuals from grant communities near the end of their funding or post-Federal funding find that 5 or 6 years is just a start and that long-range planning for 15 years or longer is needed to fully result in systems change. Alumni communities funded in 1993–1994, and increasingly those funded in 1997–2000, are a resource for understanding the evolution that occurs over the longer term. The Comprehensive Community Mental Health Services for Children and Their Families Program Evaluation Findings 2006–2008 Annual Report to Congress ● Page 38
References Achenbach, T. M. (1991). Manual for the Child Behavior Checklist and 1991 profile. Burlington, VT: University of Vermont Department of Psychiatry. Achenbach, T. M., & Edelbrock, C. (1987). Manual for the Youth Self-Report and profile. Burlington, VT: University of Vermont Department of Psychiatry. Achenbach, T. M., & Rescorla, L. A. (2000). Manual for ASEBA Preschool Forms & Profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families. Achenbach, T. M., & Rescorla, L. A. (2001). Manual for ASEBA School-Age Forms & Profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. Bird, H. R., Shaffer, D., Fisher, P., Gould, M. S., Staghezza, B., Chen, J. Y., et al. (1993). The Columbia Impairment Scale (CIS): Pilot findings on a measure of global impairment for children and adolescents. International Journal of Methods in Psychiatric Research, 3, 167– 176. Brannan, A. M., Heflinger, C. A., & Bickman, L. (1998). The Caregiver Strain Questionnaire: Measuring the impact on the family of living with a child with serious emotional disturbance. Journal of Emotional and Behavioral Disorders, 5, 212–222. Brunk, M., Koch, J. R., & McCall, B. (2000). Report on parent satisfaction with services at community services boards. Richmond, VA: Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services. Brunk, M., Santiago, R., Ewell, Kl, & Watts, A. (1997). Family satisfaction with level of cultural competence in systems of care: Development of a cultural competence sacle. In C. J. Liberton, K. Kutash, & R. Friedman (Eds.), The 10th Annual Research Conference Proceedings, A System of Care for Children’s Mental Health: Expanding the Research Base (pp. 113–118). Tampa, FL: University of South Florida, Florida Mental Health Institute, Research and Training Center for Children’s Mental Health. Center for Mental Health Services. (1997). Annual report to Congress on the evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program, 1997. Atlanta, GA: Atlanta, GA: Macro International Inc. Center for Mental Health Services. (1998). Annual report to Congress on the evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program, 1998. Atlanta, GA: Atlanta, GA: Macro International Inc. Center for Mental Health Services. (1999). Annual report to Congress on the evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program, 1999. Atlanta, GA: ORC Macro. Center for Mental Health Services. (2000). Annual report to Congress on the evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program, 2000. Atlanta, GA: ORC Macro. The Comprehensive Community Mental Health Services for Children and Their Families Program Evaluation Findings 2006–2008 Annual Report to Congress ● Page 39
Page 1 and 2: Comprehensive Community Mental Heal
Page 3 and 4: U.S. Department of Health and Human
Page 5 and 6: Program Overview The Comprehensive
Page 7 and 8: Figure 1: System of Care Theory-Bas
Page 9 and 10: Figure 2: Timeline of System of Car
Page 11 and 12: In addition, at the request of SAMH
Page 13 and 14: Table 2: Core Components of the Nat
Page 15 and 16: Table 4: Baseline Characteristics:
Page 17 and 18: Clinical Outcomes Child/Youth’s B
Page 19 and 20: Figure 4: Change in Caregiver Repor
Page 21 and 22: Figure 6: Change in Children’s or
Page 23 and 24: Caregiver Adequacy of Available Tim
Page 25 and 26: months after entering systems of ca
Page 27 and 28: Figure 11: Change in Percentage of
Page 29 and 30: Youth were least satisfied with the
Page 31 and 32: Figure 15: Average Infrastructure R
Page 33 and 34: How Well Are Communities Implementi
Page 35 and 36: Organizational characteristics, suc
Page 37 and 38: To What Extent Do Systems of Care I
Page 39 and 40: Sustainability Strategies (continue
Page 41: child’s mental health needs are m
Page 45 and 46: Reynolds, C. R., & Richmond, B. O.
Page 47 and 48: Appendices
Page 49 and 50: Practice-Based Evidence: Practice-b
Page 51 and 52: Appendix B System of Care Communiti
Page 53 and 54: Project Name Catchment Area State Y
Page 55 and 56: Project Name Catchment Area State P
Page 57 and 58: Nak-Nu-Wit Project Name Catchment A
Page 59 and 60: Funded Communities Date Number 1993
Page 61 and 62: Definition of Indicators Child and
Page 63 and 64: 2006-2008 Annual Report to Congress
Page 65 and 66: Appendix D National Evaluation Comp
Page 67 and 68: National Evaluation Study Component
Page 69 and 70: Appendix E Descriptive and Outcomes
Page 75 and 76: Demographic Characteristics, Clinic
Page 77 and 78: Table E-4: Baseline Child and Famil
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TableE-8: Baseline Characteristics:
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Table E-8: Baseline Characteristics
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Table E-8: Baseline Characteristics
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2006-08 Annual Report to Congress
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