The primary aim of the proposed research is to assess the extent to which a comprehensive system of individualized care leads to improvements in the clinical functioning of children with severe emotional disturbances. This research is distinctive in that it examines the effects of changes in a total system of care, in contrast to simply studying changes in individual components of a system (e.g., case management). The study involves a state that has developed an innovative demonstration program to provide comprehensive and managed services. The proposed project offers a rich and unique opportunity to use a randomized experimental design to study the effectiveness of a comprehensive system of managed care. A total of 360 families will be randomly assigned to either the new system or to treatment as usually received. Families will be interviewed at entry and re-interviewed 6, 12, and 24 months later using an extensive battery of instruments. This study will build upon Vanderbilt University's related efforts in its study of the implementation and outcome of the Ft. Bragg children's mental health services system demonstration funded by the Department of the Army and NIMH. This evaluation affords a field tested methodology to study service delivery and clinical outcomes that will be used in the proposed research. The proposed research focuses on five key questions: . What are the outcomes of a comprehensive system of care on the clinical functioning of children with severe emotional disturbance on the functioning of their families? . What are the child and family factors that influence the outcomes? . Are gains made through the intervention more enduring than those realized through standard care regimes? . How do the patterns of service utilization differ between the innovative program and standard care, and, . Are there patterns of service utilization that are predictive of positive, enduring changes in outcome?

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National Institute of Mental Health (NIMH)
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Vanderbilt University Medical Center
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Bickman, Leonard; Andrade, Ana Regina; Lambert, E Warren (2002) Dose response in child and adolescent mental health services. Ment Health Serv Res 4:57-70
Bickman, L; Noser, K; Summerfelt, W T (1999) Long-term effects of a system of care on children and adolescents. J Behav Health Serv Res 26:185-202
Bickman, L; Summerfelt, W T; Noser, K (1997) Comparative outcomes of emotionally disturbed children and adolescents in a system of services and usual care. Psychiatr Serv 48:1543-8