servicedelivery

                         SERVICE DELIVERY

     Children with mental disorders have been effected by their disorders in all aspects of their life. Therefore they have been in great need of a variety of services. In many cases multiple social systems are involved causing problems in service delivery. This has lead to the systems of care approach.

This approach entails:

- coordinated services
- cultural competency
- a change in the public and private finances
- community based services
- family participation
- individual treatment and social supports

     According to the Surgeon General�s Report (2001), children in need of mental health services are not receiving them. It is also reported that a high drop out rate of services is evident in culturally diverse children in need.

This in part is due to:

- cost
- cultural insensitivity of the service provider
- stigma is associated with mental health services
- treatment is believed to be too demanding
- treatment is not relevant to particular populations
- previous negative experiences with treatment

Financing

     In the public sector, services are paid for by federal state and local governments but the services may be delivered by the public or private agencies.
     Private non-profit agencies raise money privately and have contract funding from the government.
     Private-for-profit agencies rely on both public and private third party payment insurers

Individual�s with Education Disabilities Act 1997

     Mandates that school systems provide special education services to students whose disabilities interfere with their education.
     When a school can not provide sufficient Mental Health services for a child that school pays for the services for the child which are provided by specialized private day schools or long term residential schools.
     Schools can obtain funding through Medicaid if the individual receives Medicaid

     Care is provided by the organization of a variety of mental health services in the systems of care approach.

These organizations are:

- Education
- Vocational
- Counseling
- Health
- juvenile justice
- substance abuse
- recreation
- child welfare

     Representatives from these organizations form a team, which also includes family advocates. These teams with the coordination of a case manager put the following three basic elements of the system of care approach into place.

1.    The mental health service system must be driven by the needs and the preferences of the child and family

2.    The locus and management of services must be within a multi-agency collaborative environment, grounded in a strong community base

3.    The services offered, the agencies participating, and the programs generated must be responsive to children�s different cultural background

4.    In addition they focus on the family and child�s strengths and development of appropriate treatment planning.

The range of services that may be included in the system are:

- case management
- vocational counseling
- protection and advocacy
- self-help or support group
- family support
- respite care
- therapeutic foster care
- day treatment
- recreation therapy
- crisis outreach teams
- health services
- crisis residential care
- psychiatric consultation
- small therapeutic group care
- tutoring
- residential treatment
- transportation
- independent living services
- legal services
- intensive family-based counseling
- counseling (individual, group, and youth)
- education/special education services
- community-based in patient-psychiatric care

Throughout the country there have been many variations of systems of care implemented:

- Integrated services
- School-linked services
- Interagency services.

     Although, there are variations of system of care approaches there are similar successful key components within the variations.

The key components are:

Trigger mechanisms are incentives for system changes (for example, law suits, research findings, advocacy from parents, and change in department heads).

Shared vision among a group of people regarding the strengths and weaknesses, the needed change and the strategies for change.

Leadership by group or individuals is necessary for change.

Governance and structure On the state level this would include service providers, consumers and policy makers. Service providers, consumers and influential community individuals would be included in the local or community level.

Effectiveness of the systems of care approach

- cost effective
- improved children�s behavior
- improved emotional functioning
- improved school performance
- reduces violence
- services are provided to more needy children and families

106th Congress addressed issues regarding children in mental health

     Legislature reports, funding for many new child mental health programs was passed. Public Law 106-310, which is the Child Health Act encompasses these new programs:

- jail diversion
- integrated treatment for co-occurring disorders
- rules on restraint and seclusion

CONCLUSION

- Mental disorders are found in children of all different cultural
   backgrounds and social classes.
- Many children are at greater risk for developing mental disorders due to
   factors such as family history of mental illness, abuse, neglect, and
   multigenerational poverty.
- Interventions focusing on prevention have shown to reduce the impacts
   of these risk factors.
- Presently, research is being conducted in order to determine the
   effectiveness of interventions in practice settings.
- Unfortunately many children with mental disorders are not having their
   needs met.
- The Surgeon General report (2001) suggests systems of care approaches
   are the most effective way to provide care for children with mental
   illness.