Research on Child and Adolescent Mental Health

adaptations needed to make these treatments
practical and feasible for use in community
settings. Because much of the knowledge about
treatment efficacy has been developed in academic
settings, a new generation of research is needed to
address questions such as how far to adapt a
manualized therapy for use within a mental health
clinic (given that most children will attend only
four or five sessions), what kinds of outcomes to
assess when a treatment is embedded in a new
service setting, or how to engage families in
tailoring a treatment to enable it to match familial
or cultural values and experiences. It will also be
important to develop research-based triage
standards to determine when children’s mental
health needs are best managed by persons with
different levels of mental health training. In
addition, issues about whether to treat co-occurring
disorders sequentially or simultaneously will need
to be addressed for children with mental health and
substance abuse problems.
Deconstruction of Interventions to Identify Core
Potencies
Studies that deconstruct or dismantle therapies into
elements that eventuate certain outcomes and that
are practically amenable to being taught to mental
health care providers (e.g., nurse providers,
teachers, health care paraprofessionals) are sorely
needed. A related issue is identifying the dosage of
a given service that is needed to obtain a particular
outcome. In part, the issue of appropriate dosage is
being urged forward by the exigencies of health
care accountability. The notion of service dose
cannot be made meaningful until (1) the services
themselves are well-specified, (2) the active
ingredients composing the service can be specified,
and (3) appropriate statistical scaling methods of
dosage are used (Hoagwood, 2000).
Measurement Development: Functioning and
Impairment
Measurement of child mental health outcomes has
been dominated by attention to syndromes,
problem areas, and diagnoses. Yet of greater
importance to most health care administrators,
teachers, parents, and front-line clinicians is the
identification of problems related to a child’s
functioning. Unfortunately, the measures that are
currently available for assessing functional
impairments or competencies are quite limited
and reflect outdated notions of functioning. The
most widely used measures are either global, thus
inadequately reflecting cultural variations, or
confound functioning with diagnosis (Canino,
Costello, & Angold, 1999). Conceptual problems
also plague the area of measurement of
functioning. The basic concept originated from
Vineland’s notion of "social usefulness," a concept
that was pertinent to adults with mental
retardation in the 1930’s, but that is hardly
sufficient for understanding children’s mental
health needs. Further, the theoretical notions of
"functioning" are conceptualized, measured, and
used in different ways across the major service
systems in which children are seen. As used in
health settings, functioning refers to events and
consequences such as losing a limb and requiring
prosthetic devices. In education, it refers to skills
such as social or communication abilities, as well
as handwriting. In mental health settings, it may
refer to a clinician’s global rating of whether the
child completes tasks in school or at home. So
measurement approaches that will not confound
functioning with clinical syndromes, that will
reflect culturally specific attitudes (rather than
global ratings), and that can flexibly assess core
elements of functioning are needed to cross
health, education, and mental health settings.
OBSTACLES AND GAPS
These new research directions will help to connect
the research base to clinical practice. However, it
should be acknowledged that one impediment to
the efficiency and usefulness of the research base
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