The two specific aims of this project are 1) to study the implementation of a model of the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) process in Oregon and 2) to study the effectiveness of an intervention (The Family Connections Project) designed to address the major problems related to service continuance in rural areas. These problems are 1) a complex service system, 2) barriers such as lack of transportation or child care and long distances to services and 3) possible low motivation to follow through on the part of families whose children's problems are not severe or long-standing. The overall goal of the intervention is to increase the number of EPSDT-eligible children who receive mental health evaluation and treatment services once they have been identified in the EPSDT screening process as needing them. This will be accomplished through increasing the responsiveness of the system to children and families through the introduction of a Family Associate who will assist families in negotiating the service delivery system and overcome barriers to seeking and obtaining services.
The second aim of this project is to address the need for more information about how changes in the service system occur in response to the introduction of a new way of organizing and funding mental health services for low income children and families, with specific emphasis on the issues of system change in rural area. The overall goal of this portion of the proposal is to examine the implementation of the Oregon EPSDT plan for providing mental health services. The proposed research design includes elements of both quantitative and qualitative data collection procedures within a set of six counties in Oregon. The design employs a staggered implementation of the Family Connections Project to provide a series of comparisons, which, when viewed collectively provide controls for most of the major threats to internal validity. Three counties, representing a range of levels of population density, will be selected for implementation of the Family Connections Project in the first year. The remaining three counties (representing the same range of levels of population density) will implement the Family Connections Project in the second year. Qualitative study of the process whereby the EPSDT plan is implemented will continue in all six counties for the three years of the research demonstration project. By using a staggered implementation, the design also allows for the description of the process of implementing EPSDT in both """"""""late implementing"""""""" and """"""""early implementing"""""""" counties.
