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

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.

New Roles for Families in Systems of Care

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

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

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

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

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

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:

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Children's Partnership

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

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

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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