Annual Report to Congress on the Evaluation of the Comprehensive Community Mental Health Services Program for Children and Their Families

Introduction

The estimated 4.5 to 6.3 million children in the United States who have a serious emotional disturbance (Friedman, Katz-Leavy, Manderscheid, & Sondheimer, 1996) come from all walks of life. Despite their diverse economic, educational, racial and ethnic backgrounds, these children and their families have important needs in common. They need a broad range of individualized services designed to be responsive to their unique strengths and challenges. Children with serious emotional disturbance face challenges in many aspects of their daily lives—at home, in school, in social situations, and in the community. Given this, they need coordinated services and supports from a variety of child-serving agencies and located in the child’s home community. Finally, they need a delivery system that supports the family’s efforts to help their child be successful in as normal an environment as possible.

Historically, the vast majority of children with serious emotional disturbance and their families had little chance to have these needs met. The mental health service system was fragmented, services were provided either in inappropriately restrictive settings or not at all, and families were not part of the assessment, planning, or treatment process. Intense advocacy from family, community, and professional groups resulted in national policy initiatives, commissions, and seminal reports addressing these problems. Two early milestones were the 1978 President’s Commission on Mental Health, Task Panel on Infants, Children and Adolescents and Jane Knitzer’s Unclaimed Children: The Failure of Public Responsibility to Children and Adolescents in Need of Mental Health Services, published in 1982. In response to the many calls for action, Congress appropriated funds for a new children’s mental health initiative in 1984, and the landscape of services for this population began to change.

Hallmarks of the System-of-Care Approach

Fundamental to this change, the Center for Mental Health Services (CMHS) within the Substance Abuse and Mental Health Services Administration (SAMHSA) has been actively transforming the way that children’s mental health services are delivered, using a system-of-care philosophy and approach. Beginning with a funding mechanism to support the creation of a service system infrastructure called the Child and Adolescent Service System Program (CASSP) and progressing to the funding of services, CMHS has supported the development of community-based, family-focused service delivery systems providing a comprehensive spectrum of mental health and other service supports, and enabling children with mental health needs to remain within their homes and communities. Funding for the development of systems of care is provided through the CMHS Comprehensive Community Mental Health Services for Children and Their Families Program.

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