Implementing System of Care services for youth with serious mental health challenges: Preliminary findings from Indiana

Background and Purpose:

The purpose of the presentation is to present preliminary findings of a new initiative to develop intensive community-based services to youth and their families. Section 6063 of the Deficit Reduction Act of 2005 authorized up to $217 million to demonstrate that youth with serious emotional disturbances and severe functional impairments can be served in a cost effective manner through home and community based services as an alternative to psychiatric residential treatment facilities.

Youth are assessed by the Child and Adolescent Needs and Strengths (CANS) tool. The CANS (Lyons, 1999) was implemented statewide in the public mental health system in 2008. The CANS considers multiple dimensions: child's strengths, functioning, behavioral health needs, risk behavior and caretaker's needs and strengths. Identified needs and strengths are used to develop individualized intervention plans; patterns of ratings form algorithms which help make decisions about the appropriate intensity of services.

The intensive community based services are based on system of care core values (Stroul & Friedman, 1994, Stephens, Holden, and Hernandez, 2004). The demonstration grant asks if targeted youth can be maintained in the community and experience stable or improved functioning.

Methodology:

CANS ratings are collected at baseline, every six months for youth receiving services and at discharge. One hundred and five youth had valid baseline and reassessment CANS data. Average length of services ranged from 2 to 7 months, averaging 180 days. The mean age of youth is 13 years. The majority of the participants are male (70%). Seventy nine percent are Caucasian and approximately 14% are African American. Most youth are non-Hispanic (95%).

Clinical outcomes for youth are defined as significant change (p<.05) in any of the CANS dimension. Improvement is computed by ‘Reliable Change Index' analysis. The difference between the baseline and reassessment dimension score is compared against the RCI value to explore outcomes.

Findings:

Outcomes are as follows, 47% of youth demonstrated significant improvement in the ‘Risk Behavior' dimension, 40 % youth improved significantly in ‘Behavior Health Needs Dimension', 39 % youth improved significantly in functioning dimension, while 34% youth demonstrated significant improvement in ‘strengths' dimension. When outcomes are combined for improvement and maintenance then we see that approximately 93% youth improved or were maintained on the ‘Behavior Health Needs' dimension. Chi-sqaure analysis of scores between baseline and reassessment scores did not vary as a function of gender, race, and ethnicity.

Overall, it was seen that 67% youth demonstrated significant improvement is at least 1 domain, 13% youth improved in all 5 domains, while 7.6 % of youth showed no change from their baseline level.

Conclusion:

The findings suggest that intensive community-based services are effective in decreasing the level of behavior needs of youth and also increasing strengths in youth. This finding suggests that strengths are related to resilience which can offer protection and buffer needs (Epstien, Dakan, Oswald, & Yoe, 2001.This demonstration intends to identify which youth benefit from intensive community based services and the role of adherence to the wraparound model in positive outcomes.