Perhaps as a result of the federal, professional, and private influences just outlined, both the breadth and the depth of mental health services for youth and families have increased over the past several decades. Although some evidence suggests that the availability of inpatient care for youth with SED is still lacking (US PHS, 2000), the development of a range of outpatient services—including specialized and innovative programs—suggests that children and youth may now be better able to access appropriate services than ever before, but this is not a clear-cut or indisputable conclusion.
TRENDS, MODELS, AND CURRENT STATUS
As characterized by Lyman and Wilson (2001), services available to youth and families vary along a number of dimensions, including restrictiveness or disruptiveness, effectiveness (including cost-effectiveness), and child-program compatibility. From least restrictive to maximally restrictive, programs may be characterized as outpatient, day treatment (or partial hospitalization), shelter or respite care, foster care, group home, residential, inpatient hospitalization, and institutional. Variables that define this progression include the degree to which daily routines are disrupted by the intervention itself, as well as the degree to which the programs focus on reentry into the community. Certainly, one of the challenging and ultimately vital aspects of service coordination and delivery is the selection of appropriate level (or levels) of care.
Although this volume is not organized along this continuum, the services and programs presented here represent interventions from across the spectrum of mental health settings. Chapters in the first section of this handbook are specific to a particular modality of service delivery. For example, Jacobs, Randall, Vernberg, Roberts and Nyre (chapter 4) provide coverage of a specific school-based intervention for children with SED, whereas Vargas and de Dios Brambila (chapter 9) outline the services subsumed under the heading of “inpatient and residential treatments.’’
Each of the chapters in this section provides a perspective on how services are organized and delivered as well as how they are (or could be) evaluated.
Chapters in the second section outline an array of services for particular populations, and cover a range of service settings. For example, Kees and Bonner (chapter 10) focus on a range of prevention and intervention services for children who have been abused, and their families. Similarly, Murphy, Page, and Ettelson (chapter 15) address services for adolescent sex offenders, detailing the strengths of various service settings (e.g., outpatient, residential) and components of interventions. Both types of chapters demonstrate the variety and organization of various services among different populations. We anticipate that these chapters may generate creativity with regard to coordination of services within and across settings.
We devote the third section of the handbook to innovative or novel forms of service delivery. These chapters deal with specific services that are just emerging, as well as recent developments that have altered the ways in which services are delivered or evaluated. Despite concerns that current funding strategies are not encouraging of the development of novel programs for youth, the selections for this handbook suggest that a number of talented people continue to expand the range of services that are available. How widespread are these innovations? The fact that they are considered innovative—oftentimes unique—and that they stand out from the other service delivery methods suggests that there remains room for them to develop in more locales.
Consistent with the system-of-care model, the final section of this book concerns the evaluation of mental health services. After a general overview of program evaluation approaches and methods, we present two chapters on specific large-scale program evaluations that, in addition to providing valuable conclusions regarding the targets of their respective evaluations, provide a useful guide for the subsequent conduct of program evaluations. We conclude with a brief look to the future organization of mental health service delivery, and proposal for areas of research.