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SAMHSA’s Award-Winning Newsletter
July/August 2009, Volume 17, Number 4 

collage of children with families

Coordinating Care for Children with Serious Mental Health Challenges

Positive Outcomes for Families, Children, Youth

Justin* was only 4 years old, but he and his family were already in distress. He had been kicked out of several childcare centers for biting, kicking, and hitting. He had destroyed property. His temper tantrums would go on for hours.

Needing help, his mother took him to the local medical school where they came up with a diagnosis, a set of recommendations, and a treatment plan. Justin’s mother also took him to a mental health clinic where they provided a different diagnosis, recommendations, and treatment plan. Then the boy’s school came up with a third diagnosis and plan.

SAMHSA's System of Care logo

“But when the mom chose one plan and began to follow it, the other two systems labeled her as ‘resistant,’ ” recalled Rob Abrams, M.S.W., Project Director of Wraparound Oregon: Early Childhood at the Multnomah Education Service District in Portland, OR. “Nobody was getting along very well.” (Read more about the grantee program Wraparound Oregon.)

This is the type of scenario SAMHSA’s Comprehensive Community Mental Health Services Program for Children and Their Families is designed to prevent. Launched by SAMHSA’s Center for Mental Health Services (CMHS) in 1992, the program promotes a coordinated, community-based approach to care for children and adolescents with serious mental health challenges and their families.

A System of Care

There are currently 59 active grantees, including Mr. Abrams’ program. They bring together everyone involved in a child’s life to formulate a plan—a “system of care.” With the child and family at the center of the decision-making process, a workable plan is created.

“The different child-serving systems, such as child welfare, juvenile justice, and education, need to speak to each other,” emphasized Gary M. Blau, Ph.D., Chief of the Child, Adolescent, and Family Branch at CMHS. “What we’re trying to do through this program and the grants we provide is avoid fragmentation and allow the communities that receive our funding to integrate their services. Our goal is to ensure a coordinated network of care.”

As a testament to the success of this integrated approach, last spring Harvard University’s Ash Institute for Democratic Governance and Innovation named this SAMHSA program one of the top 50 innovations in government.

Meeting Children’s Needs

Of children between ages 9 and 17, 5 to 9 percent have emotional disturbances severe enough to impair their functioning, according to SAMHSA’s Children’s Mental Health Facts: Systems of Care (see Resources). Yet most of them do not get the care they need because services are either too expensive or unavailable.

“Before this program, community-based services didn’t really exist,” explained Diane L. Sondheimer, M.S.N., M.P.H., C.P.N.P., Deputy Chief of the Child, Adolescent, and Family Branch at CMHS.

Often the only choices parents had were the standard 50-minute hour with a psychologist or psychiatrist or a residential treatment program. “Still today, if parents can’t get mental health treatment for their kids, they may have to give up custody to the state. The child may be sent out of the community—or even out of state—to receive care,” she said.

The Comprehensive Community Mental Health Services Program for Children and Their Families is designed to transform the way mental health services and supports are delivered, allowing communities to provide coordinated treatment in the least restrictive way possible.

“A system of care is not a program,” Dr. Blau added. “It’s a philosophy.”

Partnership is one of the core values behind that philosophy; everyone involved in a child’s life collaborates to come up with a treatment plan for the child.

The child and family themselves are participants in that team, instead of simply being recipients of services. Because the teams are “family-driven” and “youth-guided,” said Dr. Blau, the child and family can also choose to involve grandparents, teachers, coaches, neighbors, or others who might be of assistance.

As the team crafts the treatment plan, they focus on the child’s strengths as opposed to the child’s deficits, said Ms. Sondheimer. “In contrast to the traditional medical model, which tends to be deficit-based, our philosophy is to be strengths-based.”

A system of care is not limited to traditional mental health services, Dr. Blau added. Grantees may also offer services such as respite care, tutoring, vocational counseling, legal services, peer-to-peer and family-to-family support systems, and therapeutic recreation.

The goal, said Dr. Blau, is to “wrap services around the child and family.”


  Statistics on Substance Abuse,  
  Mental Health  
State by State Estimates

State by State Estimates

Every state faces a different set of challenges with substance abuse and mental health issues, including binge drinking and depression.

Treatment Discharges: Latest Data

Treatment Discharges: Latest Data

SAMHSA's Treatment Episode Data Set (TEDS) recently updated its data on discharges from treatment facilities.

  Treatment Updates  
TIP 50: Literature Review

TIP 50: Literature Review

Part 3 of TIP 50, Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment, is available.

Alcohol Abuse Treatment: Need, Barriers

Many people who need treatment for an alcohol problem are not seeking help. Why?

National Directory Updated and Available

National Directory Updated and Available

An updated guide to finding local substance abuse treatment programs is available.

  Real Warrior Campaign  
Reaching Out Makes a Real Difference

Reaching Out Makes a Real Difference

The Real Warriors Campaign is fighting the stigma of asking for help.

  Prevention Update  
Retail Tobacco Sales to Youth

Retail Tobacco Sales to Youth

Retail sales of tobacco products to young people continue to drop.

Parent Involvement Makes a Difference

Parent Involvement Makes a Difference

Parents play an important role in preventing substance abuse.

Suicide Prevention Update

Suicide Prevention Update

New funding, Web site redesign to improve navigation, and more.

Prevention Awards

Prevention Awards

To advance community-based prevention programs, $190 million to 25 grantees.

Calculating Program Allotments

A new guide provides information on procedures to calculate allocations for some key block and formula grants.

Drug Free Communities: Continuation Awards

More than 500 community coalitions nationwide recently received Drug Free Communities (DFC) continuation awards for their programs.

  Health Reform  
Nine Core Principles

Nine Core Principles

Ensuring current reform efforts include mental health and substance abuse issues.

  Mental Health  
Forecasting the Next 5 Years

Forecasting the Next 5 Years

Changes are coming to create “whole health,” person-centered care.

  Adolescents & Young Adults  
Need Treatment? Many Say No

Need Treatment? Many Say No

Nearly 7 million Americans age 18 to 25 were classified as needing treatment in the past year.

  Recovery Month  
Celebrating 20 Years of Recovery

Celebrating 20 Years of Recovery

Get up–to–the–minute updates on September's events.

  Also in this Issue  
Under the Influence: Fathers and Alcohol Use

Under the Influence: Fathers and Alcohol Use

Does dad's drinking affect his adolescent children?

Methadone Advisory

New information on the dangers of methadone in combination with other drugs.

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