Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Services Interventions
Treatment Interventions
Newer Community-Based Interventions
Since the 1980s, the field of children’s mental health has witnessed a shift
from institutional to community-based interventions. The forces behind this
transformation are presented in a subsequent section, Service Delivery. This
section attempts to answer the question of whether community-based interventions
are effective. It covers a range of comprehensive community-based interventions,
including case management, home-based services, therapeutic foster care,
therapeutic group homes, and crisis services. Although the evidence for the
benefits of some of these services is uneven at best, even uncontrolled studies
offer a starting point for studying the effectiveness and feasibility of their
implementation. Many of the evaluations to date offer a first glimpse into the
benefits of these services and the extent to which they may be valuable for
further examination. Of these inter- ventions, the most convincing evidence of
effectiveness is for home-based services and therapeutic foster care, as
discussed below.
There is a special emphasis throughout this section on “children with serious
emotional disturbances,” as many of these community-based services are targeted
to this population of the most serious severely affected children. The term
serious emotional disturbance refers to a diagnosed mental health problem that
substantially disrupts a child’s ability to function socially, academically, and
emotionally. It is not a formal DSM-IV diagnosis but rather a term that has been
used both within states and at the Federal level to identify a population of
children with significant functional impairment due to mental, emotional, and
behavioral problems who have a high need for services. The official definition
of children with serious emotional disturbance adopted by the Substance Abuse
and Mental Health Services Administration is “persons from birth up to age 18
who currently or at any time during the past year had a diagnosable mental,
behavioral, or emotional disorder of sufficient duration to meet diagnostic
criteria specified within the DSM-III-R, and that resulted in functional
impairment which substantially interferes with or limits the child’s role or
functioning in family, school, or community activities” (SAMHSA, 1993, p.
29425). The term is used in a variety of Federal statutes in reference to
children fitting that description and does not signify any particular diagnosis
per se; rather, it is a legal term that triggers a host of mandated services to
meet the needs of these children (see Service Delivery section).
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