This proposal involves a priority population, adolescents with mental disorder. Their emotional and behavioral symptoms, psychiatric diagnoses, and social role functioning will be related to receipt of mental health services and treatment outcome. We will systematically diagnose psychiatric disorder and assess the social role functioning of two samples, one being treated in a community mental health center and a random sample of students in schools. The DISC-2.2 will be used to obtain psychiatric diagnoses in both settings. In addition, an adolescent self-report instrument will provide assessment in six areas of social role functioning. A newly developed health status instrument for youth (11 - 17 years), the Child Health and Illness Profile (CHIP), will provide this self-assessment of the social aspects of health as well physical and emotional symptoms. Parents will report on access to health care and behavior problems and functioning at home, teachers will rate behavior and school performance, and school records of grades and absenteeism will also be collected on all subjects. This provides a cross- situational estimate of social role of functioning and impairment. We can then see if impairment, symptoms, or diagnosis is better able to explain why some adolescents with diagnosable mental disorder obtain mental health services while others with equal access do not. Moreover, the social role impairment associated with specific disorders will help explain factors related to treatment completion and outcome among adolescents in mental health treatment. The adolescents will be recruited from a community mental health center and a middle and high school to complete the CHIP and standard mental health screening questionnaires. Clinician diagnoses and assessments will also be obtained on the treatment sample. All adolescents in the mental health sample will be interviewed using the DISC-2.2. Subjects in schools who score in the top 20% on the screening measures, indicating they have significant emotional/behavioral problems, will also receive the DISC-2.2 along with a randomly selected 20% of the school sample whose responses did not indicate mental health problems. Parents of all adolescents who receive the DISC will also receive this interview. The DISC-2.2 diagnoses will be grouped into those that are emotional disorders--generalized anxiety, depression, dysthymia--and those that are behavioral--oppositional defiant and conduct disorders. This results in five subsamples, adolescents with: 1) emotional diagnoses who are in treatment; 2) behavioral diagnoses who are in treatment; 3) emotional diagnoses not in treatment; 4) behavioral diagnoses not in treatment; and 5) undiagnosed adolescents not in treatment (healthy students). A cross-sectional design will be used to compare the mental health and school samples and a longitudinal design will be used to examine mental health treatment sample across time.
