Intensive Mental Health Program Research Articles

Service Coordination and Children’s Functioning in a School-Based Intensive Mental Health Program

Coordination of mental health services in children with serious emotional disturbance (SED) has shown a preliminary relationship to positive outcomes in children. Yet, research in this area is sparse. Therefore, the relation between service coordination activities and adaptive functioning was examined for 51 children SED who were treated in the school-based Intensive Mental Health Program for elementary school students (IMHP; average treatment length was 12 months; mean age 9.37 at intake). Systematic review of detailed case records identified 16,669 episodes of service coordination that could be coded reliably for frequency, quality, and purpose (planning, linking, monitoring) of the service coordination component. Adaptive functioning was measured by Child and Adolescent Functional Assessment Scale (CAFAS) ratings and daily points earned on the behavior management system of the IMHP at intake, 6, 12 months, and discharge. Findings indicated that the frequency, quality, and purpose of the service coordination component varied from case to case and by time in treatment. Although service coordination activities overall decreased as treatment progressed, concentrated high quality service coordination (measured by frequency, quality, and component of service coordination) consistently predicted improved functioning on both CAFAS ratings and daily points earned. Results have both practice and policy implications for training interagency teams and clinicians on when and how to optimally coordinate services.

Outcomes and Findings of Program Evaluation for the Intensive Mental Health Program

We describe changes in adaptive functioning for children enrolled in the Intensive Mental Health Program (IMHP), an innovative model for serving children with the most severe forms of SED. Most children show marked improvements in multiple indicators of role performance and symptomatology. Although a high risk, high need group, most children attended school regularly and lived with a stable caregiver at discharge.

The Intensive Mental Health Program: Development and Structure of the Model of Intervention for Children with Serious Emotional Disturbances

In order to meet the challenging needs and behaviors of children with Serious Emotional Disorders (SED), a school and community based Intensive Mental Health Program (IMHP) was developed and evaluated. We describe the conceptual framework, treatment principles, and model for service delivery for psychological and educational interventions under the umbrella of the IMHP. The program illustrates a model of comprehensive services for children with SED.

Factors Related to Outcome in a School-based Intensive Mental Health Program: An Examination of Nonresponders

We examined factors related to treatment responders (n = 35) and nonresponders (n = 16) in a group of 51 children admitted to the Intensive Mental Health Program (IMHP). Children’s response to treatment was coded based on their functioning at intake and discharge using total CAFAS scores. Demographic variables, length of treatment, number of diagnoses and medications, and history of physical/emotional abuse or neglect did not significantly distinguish between responders and nonresponders. Nonresponders were more likely to present with a history of suspected or confirmed sexual abuse, internalizing diagnoses, or comorbid internalizing and externalizing diagnoses. Although the small sample size may limit interpretations, our findings indicate treatment programs need augmentation when children with serious emotional disturbances (SED) may be at risk for not responding to interventions.

Measuring Treatment Outcome for Children with Serious Emotional Disturbances: Discriminant Validity and Clinical Significance of the Child and Adolescent Functioning Assessment Scale

We investigated the use of a popular measure, the Children and Adolescent Functional Assessment Scale (CAFAS), in treatment outcome research. The sample included 70 children who had been discharged from an elementary therapeutic classroom (Intensive Mental Health Program). Significant relationships were found between decreases in CAFAS scores and optimal educational placement, contributing to evidence of the scale’s discriminant validity. Clinically significant change in CAFAS scores was also investigated, with a 30 point change in score most accurately discriminating between placements after discharge. Further investigations of real world outcomes versus changes in score on this measure are warranted.

Caregiver Involvement in the Intensive Mental Health Program: Influence on Changes in Child Functioning

We examined behavioral markers of caregiver involvement and the ways in which family participation was related to treatment outcomes in 47 elementary school children with SED enrolled in a school-based intensive mental health program. Measures of caregiver involvement included therapeutic home visits, attendance at therapeutic meetings, completion of ratings on the daily point sheet, and extra communications with the therapeutic team on the point sheet. Greater initial impairment was associated with greater caregiver involvement. Greater caregiver involvement was linked to improvement in child thought processes, increased ability to provide emotional and social supports for the child, and greater overall child functioning at discharge. Our findings also reflected increased therapists’ attempts to provide additional in-home services in cases where caregivers demonstrated a decline in their ability to provide for their children’s physical and material needs, or in which therapists discovered that the family functioning was more impaired than what was initially assessed. We provide a case study that exemplifies many of these findings.

Description of Exemplar Cases in the Intensive Mental Health Program: Illustrations of Application of the Therapeutic Model

We describe cases from the clinical records in the Intensive Mental Health Program to illustrate the diverse presenting problems, intervention strategies, therapeutic process, and outcomes for children receiving services in this school-based, community-oriented treatment model. Cases reflect varying degrees of treatment response and potential factors that influence the fluctuating levels of emotional disturbance and impaired functioning in the home, school, and community.

Enhancing Therapeutic Gains: Examination of Fidelity to the Model for the Intensive Mental Health Program

Given that the development of treatment fidelity assessment protocol is an integral but too frequently ignored aspect of clinical trials for psychological treatments, the Intensive Mental Health Program (IMHP) sought to build fidelity activities into training, program evaluation, and clinical recordkeeping from the outset of a 3 year study period. We describe (a) operational definitions and measurement of the IMHP treatment model, (b) planned fidelity-promoting activities, (c) evaluation methods, and (d) fair to appreciable accomplishment of IMHP fidelity targets. Discussion of the circumstances and processes possibly hindering better fidelity for several IMHP treatment features accompanies presentation of fidelity data. We summarize pitfalls and compensatory strategies identified during IMHP program evaluation and offer practical suggestions to enhance accountability and evaluative activity in future clinical research.

Lessons Learned from the Intensive Mental Health Program: A School-based, Community Oriented Program for Children with Serious Emotional Disturbances

The Intensive Mental Health Program meets the needs for services in school systems for children with serious emotional disturbances and for training graduate students in clinical applications with a difficult-to-serve population. We address the range of challenges and rewards experienced in the development of the comprehensive intervention program, the continued maintenance of program elements, and the program evaluation.

Demonstrating Support for the Formative and Summative Assessment Paradigm in a School-Based Intensive Mental Health Program

We illustrate the use of formative and summative assessment in evaluating a therapeutic classroom program for children with serious emotional disturbances. Information was analyzed based on data gathered for clinical decision-making during treatment (formative assessment) and measurement of outcomes at discharge (summative assessment) from a school-based Intensive Mental Health Program. Results indicated that overall ratings of daily indicators of behavior across all environments (therapeutic classroom, neighborhood school, and home) were predictive of functioning at discharge. An ecological approach during the formative assessment period of evaluation is important as compared to only examining individual environments. Formative assessment techniques can predict scores on a summative assessment measure. Thus, we found supportive evidence for the formative and summative procedures used in the Intensive Mental Health Program for therapeutic interventions, clinical decision-making, and outcomes assessment.

Intensive Mental Health Services for Children with Serious Emotional Disturbances through a School-based, Community-oriented Program

Treating children with severe, early onset emotional and behavioral disturbances remains a daunting task for mental health and education systems. This article describes key principles, features, and outcomes for the school-based Intensive Mental Health Program (IMHP), a program designed specifically to provide comprehensive evidence-based, ecologically sensitive, and individualized services for this difficult-to-treat population. Although the IMHP is a relatively new model, preliminary studies of outcomes and treatment processes give initial evidence that most children improve notably in their role performance, behavior, and emotional adjustment over the course of treatment. With increasing demands for effective, affordable school-based mental health services, the IMHP offers a developing but promising prototype for services geared to meet the unique needs of children with complex disturbances of emotions and behavior.

Innovative Treatment for Children With Serious Emotional Disturbance: Preliminary Outcomes for a School-Based Intensive Mental Health Program

This article describes the development, implementation, and preliminary evaluation of a school-based Intensive Mental Health Program (IMHP) for 50 children (42 boys, 8 girls) with severe, early-onset, serious emotional disturbances (SED). Eighty-four percent of the children showed clinically significant improvement in overall functioning as measured by the Child and Adolescent Functional Assessment Scale (CAFAS). Child functioning at home and school, behavior toward others, regulation of moods and emotions, self-harm, and problems in thinking improved significantly. Results provide initial support for the IMHP as a promising approach to serving the needs of children with SED.

Treating children with serious emotional disturbances in schools and community: The intensive mental health program.

Children with serious emotional disturbances pose challenges to psychologists and school personnel to find optimal ways to improve functioning. An intensive mental health program (IMHP) is described for providing comprehensive psychological services in a school-based therapeutic environment. Case vignettes illustrate the type and severity of the children's problems served in the IMHP with both successful and less successful outcomes. The article describes the principles and organization of services, including individual and group psychotherapy and behavioral management systems, and service coordination with caregivers, agencies, and the children's neighborhood schools. Challenges facing psychologists working with children, such as resolving turf issues and working collaboratively with other involved providers, are also addressed.

Assertive Community Treatment for People with Severe Mental Illness

This article describes the critical ingredients of the assertive community treatment (ACT) model for people with severe mental illness and then reviews the evidence regarding its effectiveness and cost effectiveness. ACT is an intensive mental health program model in which a multidisciplinary team of professionals serves patients who do not readily use clinic-based services, but who are often at high risk for psychiatric hospitalization. Most ACT contacts occur in community settings. ACT teams have a holistic approach to services, helping with medications, housing, finances and everyday problems in living. ACT differs conceptually and empirically from traditional case management approaches.