Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Service Delivery
The focus of this section is on service systems—their origins,
nature, and financing and also their effectiveness, delivery, and
utilization—rather than on individual interventions and treatments, which were
covered in previous sections of this chapter.
About 20 years ago it became clear that children and families were failing to
receive adequate care from the public sector, whose services were fragmented,
inadequate, and overreliant on institutional care. As a result, the emphasis of
service delivery has shifted to systems of care that are designed to provide
culturally competent, coordinated services; community-based services; new
financing arrangements in the private and public sectors; family participation
in decisionmaking about care for their children; and individualized care drawing
on treatment and social supports called wraparound services, described above.
Thus, there has been progress in transforming the nature of service delivery and
its financing, but the central question of the effectiveness of systems of care
has not yet been resolved.
At the outset, it is important to note that while systems of care are designed
to provide the appropriate level of services for all children, it is children
with serious emotional disturbances, particularly children who are involved in
multiple service sectors, who are likely to benefit the most. There are
approximately 6 million to 9 million children and adolescents in the United
States with serious emotional disturbances (Friedman et al., 1996a; Lavigne et
al., 1996), accounting for 9 to 13 percent of all children (Friedman et al.,
1996a; Friedman et al., 1998).
The system for delivering mental health services to children and their families
is complex, sometimes to the point of inscrutability—a patchwork of providers,
interventions, and payers. Much of the complexity stems from the multiple
pathways into treatment and the multiple funding streams for services. However,
once care has begun, the interventions and settings themselves are generally the
same as those covered in previous sections of this chapter.
Back to the Mental Health: The Surgeon General's Report Table of Contents