Children on child protective service caseloads: prevalence and nature of serious emotional disturbance

A multivariate, criterion-referenced approach was used to assess prevalence of serious emotional disturbance among children on protective service case loads. Of 140 recipients of protective services, 72% were statistically indistinguishable from children in Washington State's most intensive mental health treatment programs. School problems, substance abuse, and antisocial behaviors were common in the sample, as were family histories of mental illness or substance abuse. Greatest service needs included family support groups, outpatient treatment, school-based treatment, and diagnostic services. These results underline the importance of structural changes to facilitate cross-system collaboration between mental health and protective services.

Service needs of severely disturbed children

BACKGROUND

As one piece of a statewide Children's Mental Health System Analysis conducted in Washington State, the specific service needs of severely emotionally disturbed children were investigated.

METHODS

The primary case-workers of 3398 children under the care of the state responded to a survey of the child's treatment history, social and clinical condition, and service needs. Service need data on the 2455 children in the sample who were classifiable as severely emotionally disturbed were examined using log linear analysis.

RESULTS

School- and home-based services were frequently reported needs of school-aged children. Adolescent children were reported to be in need of services which prepare them for adulthood. Services endorsed for female children tended to focus on assistance to family members, therapy, and protection, whereas services endorsed for male children focused on home removal, substance abuse treatment, and preparation for employment.

CONCLUSIONS

Severely emotionally disturbed children are in need of a variety of nontraditional mental health services. Significant differences in the needs of male versus female children, and of differently aged children, are present that have serious implications for service system development.

Adolescent suicide

Suicide is a major public health problem among adolescents. Although the event is rare, and rates have stabilized and even shown slight reduction in recent years, suicide has nevertheless become the second leading cause of morbidity among youths aged 15 to 24, which is otherwise a robust and relatively disease-free population. Although research on predictive factors has yielded increasingly sensitive indices of who the high-risk adolescent might be, the inherent difficulty of predicting rare events from common ones has made sensitive and specific prediction most elusive. Current neurobiologic research holds promise for the use of biologic markers in the identification of high-risk adolescents, and pharmacologic research may yield further advances in the treatment of affectively disordered youths. At this point, the most promising approaches to treating adolescent suicide appear to be (1) treatment of disorders antecedent to suicide crises, such as depression, substance abuse, family conflict, and conduct disturbance, and (2) prevention efforts targeting known high-risk groups, such as affectively disordered young men with accompanying alcohol and drug involvement and other antisocial behavior.

Children's mental health services: a parent perspective

Parents of severely emotionally and behaviorally disturbed children rarely have the opportunity to participate in the policy-making processes that affect their children's welfare. In the present study, a structured parent interview was developed as part of Washington State's Child and Adolescent Services System Program (CASSP). Thirty-five parents of disturbed children provided information about their children's problems and services histories. Respondents identified unmet needs and barriers to timely, effective intervention. The nature and quality of services received were examined in the context of CASSP service standards. The study confirmed that parents of disturbed children can provide information rich in implications for system change.