This Competitive Continuation involves a priority population--urban adolescents (11-17 years) with mental disorder who have and have not accessed the specialty mental health sector. Funds are requested for completion and extension of data analysis on two cohorts of adolescents, to: 1) develop an integrated model of need for mental health services that incorporates: symptoms, psychiatric disorder and social functioning; 2) develop a model of access that incorporates this integrated definition of need, as well as predisposing and enabling characteristics; 3) predict treatment continuation and one-year outcomes, and 4) develop a framework of adaptive functioning in adolescence. to characterize the functioning associated with the major types of psychiatric disorders: internalizing disorders (anxiety and mood disorders); externalizing disorders (Attention-Deficit, Conduct and Oppositional disorders); and combinations of both types of disorder. This work will provide a refinement of the model for need for mental health services that specifies the specific impairments associated with different disorders and different outcomes. Two samples are involved, one from schools (n=288), selected because of their high risk for psychiatric disorder and/or for their low risk, based on screening reports from youth and parents. A sample of youth entering treatment was recruited from community mental health centers in the same community (n = 119). Baseline data include DISC 2.3 psychiatric diagnoses as assessed from maternal and youth reports, social functioning, mental and physical health, family, and services access characteristics, and services use from parents and youth, and teacher reports of academic performance and services needed and used by students in middle schools. One-year follow-up data are available on mental health services use and social functioning. The findings will identify the characteristics of youth who need and who use mental health services, identify needs that are and are not met by mental health services, provide a tested model of the structure of social functioning in adolescents, suggest social functioning impairment criteria for inclusion in diagnostic algorithms, and characterize the one-year outcomes of treated and untreated youth with disorder. The results will have policy implications for the design of mental health delivery services and systems for adolescents, for psychiatric classification systems for youth, and for the development of diagnostic and functional assessments.
