Multiple Service Sectors Research Articles

Multi-Sector Complexity of Systems of Care for Youth With Mental Health Needs

Children's mental health services have been revolutionized to reflect the realization that youth with mental health needs are served by multiple service sectors, including child welfare, juvenile justice, special education, primary health care, mental health, and alcohol and drug services. Systems of care models have attempted to improve integration of services across these multiple sectors and have been influential in driving policy and funding changes, but these models have focused primarily on cross-sectional service use. The goal of this conceptual article is to expand on these models by identifying factors that affect dynamic, longitudinal multi-sector service use. Greater understanding of these longitudinal patterns may suggest effective targets for intervention. In addition, this conceptual framework may provide a contextual template for current studies of multi-sector service need, use, and effectiveness.

Past-year use of outpatient services for psychiatric problems in the National Comorbidity Survey.

The authors present nationally representative descriptive data on 12-month use of outpatient services for psychiatric problems. They focused on the relationship between DSM-III-R disorders and service use in four broadly defined service sectors as well as the distribution of service use in multiple service sectors. Data from the National Comorbidity Survey were examined. Summary measures of the seriousness and complexity of illness were significantly related to probability of use, number of sectors used, mean number of visits, and specialty treatment. One-fourth of the people in outpatient treatment were seen in multiple service sectors, but no evidence was found of multisector offset in number of visits. Use of outpatient services for psychiatric problems appears to have increased over the decade between the early 1980s and early 1990s, especially in the self-help sector. Aggregate allocation of treatment resources was related to need, highlighting the importance of making provisions for specialty care in the triage systems currently evolving as part of managed care.