This application is to study pathways into and through multiple systems of care, as well as short term outcomes of care, for children and adolescents with or at high risk for significant mental health problems. The proposed study is designed to assess patterns of treatment across and within multiple systems of care for children and adolescents with different diagnoses, mental health and social adjustment problems, in relation to outcomes. Particular attention is to be paid to children and adolescents with different types of maltreatment (e.g., neglect, emotional abuse, physical abuse, sexual abuse) and different exposures to violence (family, school, neighborhood, general cultural) and different patterns of cre over time by gender and race/ethnicity. In addition to carefully documenting pathways into and through multiple systems of service attention will be given to predictors and outcomes of placement at various levels of restrictiveness of care and to estimating costs of services over time in relation to outcomes. In order to accomplish these goals, a two year longitudinal study of 1850 children and adolescents (ages 2-17) is proposed. Subjects will be selected from among those listed in a one day enumeration of open cases in five child service systems (social services, mental health, SED programs in the public schools, juvenile justice and drug and alcohol) in San Diego County and who are normally resident in the City of San Diego. All children and adolescents listed in athe one day enumeration (approximately 6500) will be assigned to one of three strata: (1) ages 2-5; (2) ages 6- 17 in athe most restrictive patterns of care (e.g., hospitals, jails, residential group homes; and (3) ages 6-17 in less restrictive patterns of care. Data concerning any service involvement in the five systems over the last year will be gathered from the five MIS's. On the basis of that data a typology of patterns of system involvement (single and multiple service system care patterns) will be developed and all subjects assigned to a type. The final sample will be stratified by pattern of system involvement as well as by age/restrictiveness of care. The potential for differential patterns across four major racial ethnic groups (non-Hispanic whites, Blacks, Mexican Americans, and Asian Americans) will be explored. In addition to the interview data, a bi- annual enumeration of service system contacts and episodes will be conducted and an annual service system review will be conducted.
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