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CHILDREN'S MENTAL HEALTH BEST PRACTICES
Best practices can be defined as programs, services or processes that
research or expert opinion has shown to be effective (CAN, 2000).
Children's mental health services and supports have made impressive
advances in
researching and identifying "best practices." These advances have
provided practitioners with rigorously evaluated and scientifically
supported
guidelines and methodologies for improving cost effectiveness and
service quality. Ultimately, they have resulted in improved outcomes
for children
and their families.
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Promising Practices
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The Center for Mental Health Services (CMHS) and the Substance Abuse
and Mental Health Services Administration of the U.S. Department
of Health and Human Services have administered a number of five-year
grants
and have supported the development of a series of monographs on
the Promising Practices in Children's Mental Heath Services (Osher,
deFur,
Nava, Spencer, & Toth-Dennis, 1999). The Children's Partnership
in Austin and Travis County is one of the 45 grant sites funded
by CMHS
as a best practice and the only funded site in Texas.
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New Roles for Families in Systems
of Care
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The family movement evolved from family-run organizations that advocated
for the needs of families with children experiencing mental disorders,
emotional disorders, or behavioral problems. This evolution resulted
in the development of two roles for families in systems of care:
- Families as Service Coordinators/Case Managers: This role focuses
on a family member employed to assist other families in accessing
and participating in a specific community's system of care.
- Family as Faculty: This role has developed from family-run organizations
with the goal to provide educational and technical assistance
to families and providers.
These two roles have a goal of "full-family involvement" to influence
the positive development of better systems of care (Osher, deFur, Nava,
Spencer, & Toth-Dennis, 1999).
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Promising Practices in Family-Provider
Collaboration
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The collaboration between families and providers has been damaged
by blame and distrust. Often, providers have blamed families for
many of the problems associated with their children. Families experience
frustration and distrust of providers that have not valued their
experiences
or input. Family members, therapists, advocates, administrators,
social workers, case managers, and others involved in systems of
care focus
on the following:
- Ongoing dialogue on vision and goals;
- Attention to how power is shared;
- Attention to how responsibilities in planning and decision-making
are distributed;
- Open and honest two-way communication and sharing of information;
and
- All participants are seen as mutually respected equals.
Family-provider collaboration is a long-term commitment by family
members and providers that is "unique to each community." Each of the
individuals involved in the process of care work toward improving services
for children and their families (Simpson, Koroloff, Friesen, & Gac,
1999).
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The Role of Education in a System
of Care: Effectively
Serving Children with Emotional or Behavioral Disorders
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Collaboration among children's mental health providers and the education
system is sometimes difficult. However, collaborations can be built
and appear to be effective. CMHS funded three pilot sites in urban
areas and found six practices that are key in developing effective
systems of care (Burns & Goldman, 1999):
- The use of clinicians or other student support providers in schools
to work with students, their families, and all members of the
school community, including teachers and administrators.
- The use of school-based and school-focused wraparound services
to support learning and transition.
- The use of school-based case management. Case managers help determine
needs; they help identify goals, resources and activities;
they link children and families to other services; they monitor services
to
ensure they are delivered appropriately; and they advocate
for change when necessary.
- The provision of school wide prevention and early intervention
programs. Prevention helps students with or at risk of developing
emotional and behavioral problems. They learn the skills and
behaviors that help in following school rules and enjoying positive
academic
and social outcomes. Early intervention allows schools to provide
students with the support and training needed to be more successful
in managing behavior.
- The creation of "centers" within the school to provide support
to students with emotional and behavioral needs and their families.
Students in the centers interact with caring staff members who
can help students and their families connect with the entire system
of
care to help in meeting their needs.
- The use of family liaisons or advocates to strengthen the role
and empowerment of family members in their children's education
and care. All three sites studied have harnessed the power that involving
family members as equal partners brings to their comprehensive
programs.
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Promising Practices in Wraparound
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Wraparound is defined as a "philosophy of care" opposed to a type
of service. This definition uses a planning process that involves children
and family members in the context of services and supports provided
by a community. These services and supports are individualized to focus
on a "positive set of outcomes." There are six values associated with
this philosophy (Burns & Goldman, 1999):
- Voice and choice for the child and family;
- Compassion for the children and families;
- Integration of services and systems;
- Flexibility in approaches to working with families and in funding
and provision of services;
- Safety, success, and permanency in home, school, and community;
and
- Care that is unconditional, individualized, strengths-based, family-centered,
culturally competent, and community-based, with services close
to home and in natural settings.
In addition, there are ten elements related to the values that create
the essence of the wraparound philosophy.
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Promising Practices: Building
Collaboration in
Systems of Care
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The array of services that children and adolescents may need is coordinated
in "systems of care." Systems of care consist of families and service
providers working as partners to help children and adolescents with
mental health problems. The focus is to find and build upon strengths
instead of difficulties. The ethnic and cultural values of the people
being served are understood, respected and used in the design of
these systems. (CMHS, 1998b).
The Report To Congress on the Evaluation of the Comprehensive Community
Mental Health Services for Children and Their Families Program, 1998,
provided the following information on the effectiveness of systems
of care (bcfamily.com, 2000):
- High family satisfaction with the system-of-care approach: Seventy-five
percent of the families surveyed reported positive quality
of care;
- Family input: Seventy-five percent of families reported that their
input was sought in their child's treatment;
- Choice in services: Eighty percent of families indicated that
they were provided a choice in the range of services;
- Families as Service Coordinators/Case Managers; and
- Family as Faculty.
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Appropriate array of community-based
mental health services
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Families and communities working together with service providers is
recognized as an effective approach to helping children with mental
disorders. Children and adolescents with mental health disorders can
be identified and treated. Depending on the specific needs of families
and children, the array of services may include:
- case management (service coordination)
- community-based in-patient psychiatric care
- counseling (individual, group, and youth)
- crisis residential care
- crisis outreach teams
- day treatment
- education/special education services
- family support
- health services
- independent living supports
- intensive family-based counseling (in the home)
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- legal services
- protection and advocacy
- psychiatric consultation
- recreation therapy
- residential treatment
- respite care
- self-help or support groups
- small therapeutic group care
- therapeutic foster care
- transportation
- tutoring
- vocational counseling
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Children's Partnership
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The Children's Partnership in Travis County is affiliated with the
Texas Integrated Funding Initiative and with the Substance Abuse
and Mental Health Services Administration (SAMHSA) of the U.S. Department
of Health and Human Services. It is one of the 45 grant sites funded
around the country to implement a system of care utilizing the
philosophy
and approach identified as best practices for children with mental
health needs and their families. Locally, the Children's Partnership
Provider Network consists of 18 agencies and 43 individual providers.
The Austin Travis County Mental Health Mental Retardation Center
provides managed care services for the Children's Partnership. Local
partners
of the Children's Partnership include parents and representatives
from child-serving agencies and organizations including:
- Austin Travis County Mental Health Mental Retardation Center
- Travis County Juvenile Probation Department
- Region XIII Education Service Center
- Texas Health and Human Services Commission
- Austin Travis County Health and Human Services Department
- Region VII Department of Protective and Regulatory Service
- Federation of Families of Travis County
The Children's Partnership unites and coordinates local resources
to maintain a system of care in Travis County. The emphasis is on a
system that works hand-in-hand with families, focusing on the unique
strengths of each child and embracing the unique values and culture
of each family. The system of care allows local organizations to work
in teams with families as critical partners in order to provide a full
range of services to children and adolescents.
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Surgeon General's Recommendations
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The Surgeon General's Report on Mental Illness is an important landmark
in the study of mental health and mental illness. As part of the
assessment and planning process it is important to note the recommendations
set
forth in the Surgeon General's report and utilized in tandem with
our own planning process in Travis County. The following is a list
of the
eight recommendations that were developed in the Surgeon General's
report to assist communities in planning efforts (USDHHS, 1999).
- Continue to build a science base;
- Overcome stigma;
- Improve public awareness of effective treatment;
- Ensure the supply of mental health service providers;
- Ensure delivery of state-of-the-art treatments;
- Tailor treatment to age, gender, race, and culture;
- Facilitate entry into treatment; and
- Reduce financial barriers to treatment.
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Current Efforts
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The following table outlines some of the best practice services and
models, which are currently in place or in the planning process. These
programs represent extensive collaboration among city and county departments
as well as community-based organizations.
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Current Efforts
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Type of Best Practice
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Population Served
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Status
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| Austin Travis County MHMR Center |
Local Mental Health Authority for Travis County and
Managed Service Organization |
Youth and their families |
In Place |
| Children's Partnership |
Wraparound planning, families as partners, individualized
care, interagency collaboration |
Youth and their families |
In Place |
| Travis County Juvenile Probation Department |
Wraparound planning, families as partners, individualized
care, interagency collaboration |
Juveniles with mental health needs that meet Children's
Partnership criteria |
In Process |
| Community Resource Coordination Group |
Interagency coordination and centralized intake |
Youth and their families with multiple, complex needs |
In Place |
| Region VII Children's Protective Services |
Wraparound planning, families as partners, individualized
care, interagency collaboration |
Children involved in CPS who have mental health needs
that meet Children's Partnership criteria |
In Process |
| Children's Partnership |
Cultural Competence Assessment |
Youth and families |
In Process |
| Federation of Families |
Families as Partners |
Youth and families/ community |
In Place |
| Suicide And Violence Education Resource Service |
Families as Partners |
Community |
In Place |
| Family Preservation Program, Austin Travis County MHMR |
Individualized planning, community-based, interagency
collaboration |
Youth and families |
In Place |
| Family Preservation Program, Travis County Juvenile
Probation Department/Austin Travis County MHMR |
Individualized planning, community-based, interagency
collaboration |
Juveniles with mental health needs |
In Place |
| Youth and Family Assessment Center |
Interagency collaboration, individualized care |
Community/youth and families |
In Planning |
| Pflugerville ISD |
Wraparound planning, families as partners, individualized
care, interagency collaboration |
Youth and their families that meet Children's Partnership
criteria |
In Place |
| Manor ISD |
Wraparound planning, families as partners, individualized
care, interagency collaboration |
Youth and their families that meet Children's Partnership
criteria |
In Place |
| Austin Child Guidance Center |
Individualized care, individual, group, and family
counseling, parent classes, experiential activities |
Youth and families |
In Place |
| Child & Adolescent Psychiatric Emergency Team (CAPE
Team) |
Emergency psychiatric services for children by telephone
and face-to-face |
Youth and families |
In Place |
| Communities in Schools |
School-based intervention and prevention |
Youth and families |
In Place |
| LifeWorks |
Works with youth at high risk of pregnancy, substance
abuse, homelessness, low self-esteem & peer pressure to build resiliency |
Youth and families |
In Place |
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Children's Mental Health Home Page
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