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

Populations Served by Graduating Sites

Table 12 summarizes the characteristics of children and families served by the graduating sites. Although variability is reported across sites for specific characteristics, the overall data from the graduating sites are relatively comparable to the national evaluation summary information presented in chapter III.

Target populations varied across the sites depending upon the geographic region covered and the definition provided by local- or State-level policy regarding serious emotional disturbance. The East Baltimore Mental Health Partnership targeted a small, inner-city catchment area with a high poverty rate and primarily African American families. In contrast, ACCESS Vermont was a statewide program that served a vast majority of families who were white and had a high poverty level. The Village Project spanned urban and rural areas with a target population that was primarily African American with high poverty rates. The Stark County Family Council and Southern Consortium targeted children with serious emotional disturbance from primarily impoverished families in Ohio. The latter program focused its efforts on rural areas, including several counties from Appalachia.

Gender, Age, and Race-Ethnicity

As Table 12 shows, each of the five sites served more males than females. The proportion of clients who were male ranged from 55 percent in Vermont to 67 percent in Baltimore. The mean ages of all children and adolescents served by the graduating sites (male and female) ranged from 10.7 years in Stark County to 12.4 years in Southern Ohio.

Two of the graduating sites—Vermont and Southern Ohio—served predominantly white children and families. In Stark County, nearly 80 percent of clients were white. East Baltimore served a primarily African American population (95 percent of clients), while approximately 70 percent of Charleston’s clients were African American. Small numbers of Native American, Asian/Pacific Islander, and Hispanic clients were also served by the graduating sites.

Family Composition

Across all five graduating sites, the largest single category of family composition was single mothers caring for children and adolescents in need of services. This home situation described nearly half the clients in each site, ranging from 47 percent of clients in Southern Ohio to 57 percent in East Baltimore. The next most common configuration was children or adolescents living with both parents, ranging from 9 percent in East Baltimore to 27 percent in Vermont. In three sites—East Baltimore, Charleston, and Southern Consortium—significant numbers of children or adolescents (between 11 and 24 percent) lived with guardians other than their parents. In Charleston, Stark County, and Vermont, similar percentages of children and adolescents were wards of the State.

Income

All five of the graduating sites served families who struggled with poverty, in addition to the burdens posed by caring for family members with serious emotional disturbance. In three of the sites (East Baltimore, Charleston, and Southern Ohio), three-fourths or more of the families served had annual incomes at or below the Federal poverty threshold. In Stark County, 62 percent of families served had annual incomes at or below the Federal poverty threshold, and a quarter of families had annual incomes above $25,000. In Vermont, half the families had annual incomes below the Federal poverty threshold, 20 percent had annual incomes between $15,000 and $25,000, and 30 percent had incomes above $25,000.

Referral Sources

Referral patterns varied for children and adolescents entering the five systems of care established by the graduating sites. In four of the five sites, the two predominant sources of referrals were either schools (ranging from 19.3 percent of referrals to 27.6 percent) or parents (ranging from 29.3 percent to 28.2 percent). In East Baltimore, schools accounted for over 30 percent of referrals, but parents only accounted for 3 percent of referrals. This was not surprising, given the project’s school-based focus.

Mental health agencies accounted for significant proportions of referrals in Stark County and Vermont (18 and 19 percent, respectively), and for smaller but still sizeable proportions of clients in the other three sites (8 percent in Southern Ohio, 9 percent in Charleston, and 13 percent in East Baltimore). Social service agencies also accounted for nearly a fifth of all referrals in East Baltimore, Charleston, and Vermont, and for nearly 10 percent of all referrals in the two Ohio systems of care.

Court-ordered referrals accounted for nearly 17 percent of referrals in Southern Ohio, but much smaller percentages elsewhere. In East Baltimore, 15 percent of referrals originated in the correctional system, but this was not a significant referral source in the other sites. In Stark County, nearly 8 percent of clients had referred themselves. (The percentage of self-referrals was below 5 percent in the other four sites.)

Primary Diagnoses

The most common primary diagnoses in all five sites were conduct-related disorders, accounting for at least 38 percent (in East Baltimore) and as many as 48 percent (in Stark County) of all primary diagnoses. All five sites also reported primary diagnoses of attention deficit hyperactivity disorder in a sizeable proportion of clients, ranging from 16 percent in Vermont to 27 percent in Southern Ohio. In East Baltimore and Charleston, depression accounted for another quarter of the diagnoses. Depression was also the primary diagnosis of nearly a fifth of the clients of the Southern Consortium site. In Stark County and Vermont, however, fewer than 10 percent of the primary diagnoses were for depression. Anxiety disorders accounted for 10 percent or fewer of the primary diagnoses across all five sites.

Child and Family Risk Factors

By definition, many of the children, adolescents, and families served by the graduating sites reached their respective systems of care only after experiencing multiple child and family risks. Child risk factors included traumatic events experienced by children and adolescents as well as aspects of a child or adolescent’s history that are indicative of heightened severity and risk. Family risk factors included events within families that impact negatively on children’s functioning.

For the children and adolescents themselves, this included alarmingly high rates of physical abuse (ranging from 16 to 43 percent of children and adolescents) and sexual abuse (reported by between 17 and 33 percent). Stark County, Ohio, which reported the highest rates of sexually abused children and adolescents (a third of their clients), also reported the highest proportion of clients who had themselves become sexually abusive (11 percent). In the other sites, this figure ranged from less than 3 percent of clients in Vermont to 7 percent in Southern Ohio.

At least 10 percent and, in one case, nearly 20 percent of children and adolescents served by these systems of care reported previous suicide attempts. In Charleston, fewer than 10 percent of clients had run away from home, but in the four other sites the proportion of runaways was at least twice that of Charleston. Drug and alcohol use were highest in the two Ohio sites, but were evident across all five sites, ranging from 7 to 19 percent.

The risk factors reported by children and adolescents served by these systems of care reflect concentric circles of similar problems faced by siblings, parents, and other family members. A history of family mental illness was reported by at least 28 percent and as many as 57 percent of families served by the graduating sites. In three sites, between 9 and 12 percent of caregivers had been hospitalized with psychiatric problems. In two sites, however, these rates were much higher, affecting 29 and 41 percent of caregivers. (These were also the two sites most frequently reporting a family history of mental illness.)

In four of the sites, between 10 and 19 percent of clients had siblings who had been institutionalized. (In the fifth site, only 5 percent of clients had siblings who had been institutionalized.) Between 13 and 22 percent of clients had siblings in foster care, again reflecting the constellation of problems faced by the families and the stress under which both parents and children had operated prior to entering the system of care. Other prevalent family risks that children were exposed to included felony convictions of caregivers (ranging from a low of 6 percent to a high of 27 percent), a history of family violence (ranging from a low of 25 percent to a high of 65 percent), and a history of substance abuse among family members (ranging from 42 percent to 72 percent of families served).

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