document resume ed 360 791 author mcmanus, marilyn c., … · document resume ed 360 791 ec 302 363...

DOCUMENT RESUME

ED 360 791 EC 302 363

AUTHOR McManus, Marilyn C., Ed.TITLE Case Management for Families and Children.INSTITUTION Portland State Univ., Oreg. Regional Research Inst.

for Human Services.SPONS AGENCY National Inst. of Mental Health (DHHS), Rockville,

MD.; National Inst. on Disability and RehabilitationResearch (ED/OSERS), Washington, DC.

PUB DATE 93NOTE 21p.; "Focal Point" is "The Bulletin of the Research

and Training Center on Family Support and Children'sMental Health."

PUB TYPE Collected Works Serials (022)JOURNAL CIT Focal Point; v7 n1 Win-Spr 1993

EDRS PRICE 2701/PC01 Plus Postage.DESCRIPTORS *Caseworker Approach; *Emotional Disturbances; Family

Involvement; Government Role; *Mental HealthPrograms; Parent Attitudes; *Parent Participation;*Professional Education; Program Evaluation; ProgramImplementation; *Public Policy; Research Needs; StateAgencies; State Government

IDENTIFIERS *Case Management

ABSTRACTThis theme issue of "Focal Point" offers an overview

of a range of children's mental health case management issues.Articles include: "Case Management for Families and Children"(Theresa J. Early); "Expectations of Case Management for Childrenwith Emotional Problems: Parent Perspectives" (Richard Donner andothers); "Principles of Training for Child Mental Health CaseManagement" (Marie Weil and others); "Case Management Research Issuesand Directions" (Barbara J. Burns and others); and "Implementing andMonitoring Case Management: A State Agency Perspective" (Lenore B.Behar). The articles discuss functions of case management; principlesof development of case management programs; the relationship betweencase managers and families; the core areas of child mental healthcase management training, which consists of values, knowledge, andskills; and the role of the states in promulgating philosophy andattitude changes, setting program policies and standards, providingtraining, ensuring funding, and monitoring and evaluating services.The bulletin concludes with profiles of staff of the Child,Adolescent and Family Branch of the Center for Mental Health Servicesof the U.S. Substance Abuse and Mental Health ServicesAdministration, and with notes concerning research projects,programs, and conferences. (JDD)

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CASE MANAGEMENT FOR FAMILIES AND CHILDREN

Case management for children and adolescents withemotional and behavioral disorders and their fami-lies is a developing and rapidly expanding service.

Roots of children's mental health case management lie inmental health services to adults with severe and persistentmental illness, particularly the Com-munity Support Program, dating tothe late 1970s, and its emphasis oncase management. The developmentof case management for variouspopulations is driven by several com-mon concerns: a need for integratedservices to overcome the fragmen- ..tation of service delivery systemsand to ensure care for the wholeperson, a need for continuity of careas needs change, and a need for indi-vidualized treatment to meet individu-als' different constellations of need.

What is"case management"? Otherterms used to denote the "case man-agement" service or activity includeservice coordination and therapeuticcase advocacy (1). The functions of case management are:1. Assessmentthe process of determining needs or

problems;r 2. Planningthe identification of specific goals and the

selection ofactivities andservices needed to achieve them;"SIrn 3. Linkingthe referral, transfer or other connection ofN. clients to appropriate services;

1 4. Monitoringongoing assurance that services arez") being delivered and remain appropriate , and the evalu-

z't) ation of client progress; andS. Advocacyintervention on behalf of the client to.)

secure services and entitlements.

lb- -4

In a survey of parents who attended a national casemanagement conference or were state leaders of parentorganizations, participants were asked to select, from a listof seventeen, the six principles most important to themand were invited, as well, to add principles. The five

principles generated follow and areuseful in the development and evalu-ation of case management programs:

11.

1. Parents should have a majorrole in determining the extent anddegree of their participation ascase manager. Much of what a casemanager does is what parents usu-ally do for their children. A casemanagement service that operatesaccording to this principle openlyengages the parent in determiningtheir level of involvement. A pro-gram that mutually identifies whattasks are required to obtain neededresources for a child and mutuallyidentifies who has the time and en-

ergy to work on the task is one that operates according tothis ideal. In this era of wrap-around funds, this principlesuggests that those parents who desire should have the"checkbook" for the purchase of needed services. It fur-ther suggests that some parents should receive a salary forbeing the case manager for their child.

2. Case managers should have frequent contactwith child, family and other key actors. Agencies inwhich case management is office-based and the case manageris heavily scheduled present baniers to parental contact. Acase manager with a large caseload is less available to parents

(maw= CM PAGE 2)

The Bulletin of the Research and Training Centeron Family Support and Children's Mental H:th

VOLUME 7 NUMBER 1

2 atiwv ibfrULIiU

CASE MANAGEMENT FOR FAMILIFS coNT.

and children. Programsshould enable case managers tospend time with youth in the community. Case managersneed to work during hours in which both parents andchildren are available after school and work.

3. A single case manager should be responsible forhelping families gain access to needed resources. Thisprinciple addresses a structural element. One of the com-plexities of case management with families of childrenwith emotional disorders is the number of community"systems" (e.g., education, child welfare, mental health,juvenile justice) with which the child is involved. Eachsystem may provide a case manager. Moreover, one fam-ily may have several case managers from the same system.

To avoid an endless parade of case managers, the commu-nity needs to coordinate efforts and allow the family towork with a single case manager.

4. Parents and child should be involved in decision-making. Case managers who conduct assessments withrather than on parents and children are involving parentsand children. Case managers who ask caregivers whatthey need to care for the child and ask children about whatthey need to live in the community are involving familiesin planning. Case managers who identify tasks with par-ents and children and jointly determine who will beresponsible for which task are operating according to theinvolvement principle.

S. Case manager roles and functions should support

RESEARCH AND TRAINING CENTERRegional Research Institute for Human ServicesPortland State UniversityP.O. Box 751Portland, Oregon 97207-0751(503) 725-4040National Clearinghouse(800) 628-16961DD (503) 725-4165

Copyright 0 1993 by Regicnal Research Institutefor Human Services. All rights reserved.Pennission to reproduce articles may be obtainedby contacting the editor.

The Research and Training Center wasestablished in 1984 with fielding from theNaticeal Institute on Disability and Rehabilita-tion Research (NIDRR) in collaboration with theNational Institute of Mental Health (N1MH). Thecontent of this publication does nee necessarilyreflect the views or policies of the fundingagencies.

We invite our audience to submit letters andcomments.

RESEARCH AND TRAINING CENTERNancy M. Koroloff, Ph.D., Acting DirectorBarbara J. Friesen, Ph.D., Center Director

(on sabbatical)Paul E. Koren, Ph.D., Director of ResearchRichard W. Hunter, M.S.W., Director of Training

Family Caregiver SurveyThomas P. McDonald, Ph.D.,

Principal InvestigatorPaul E. Koren, Ph.D.. Co-Principal InvestigatorRichard Dormer, M.S.W.

Multicultural Initiative ProjectWilliam H. Feyerherm. Ph.D.,

Principal InvestigatorJames L Mason, B.S., Project ManagerTerry L. Cross, M.S.W.Sarah Lewis, B.S.

Supportir4 Families: A Strengths Modelloin Poenner, DS.W., Principal InvestigatorMarilyn Page, M.S.W.

Families as Allies ProjectNeal Dearillo. D.S.W., Principal InvestigatorRichard W. Hunter, M.S.W.Katie H. Schultze, B.S.Tracy Williams-Murphy, B.A.

Families in Action ProjectNancy M. Koroloff. Ph.D.. Principal InvestigatorRichard W. Hunter, M.S.W.

Empowering Families: A Policy AnalysisJohn Pannier, D.S.W.

Inter.Professional Educatios ProjectBarbara J. Friesen, PhD., Principal InvestigatorPauline Jivsnjee, FILD., Project ManagerRichard W. Hunter, M.S.W.Katie H. Schukze, B.S.

Statewide Family OrganizationDemonstration ProjectBarbara J. Friesen, Ph.D., Co-Principal InvestigatorNancy M. Kordoff, Ph.D..

Co-Principal InvestigatorHarold Briggs, Ph.D.

Case Management ProjectBarbara J. Friesen, Ph.D., Principal InvestigatorJohn Poenner, D.S.W., Co-Principal InvestigatorKatie H. Schuhze, ES.

Resource Service and National Clearinghouse onFamily Support and Children'sMental HealthMarilyn C. McManus, J.D., M.S.W., ManagerColleen Wagner, B.S., Family Resource CoordinatorDenise Schmit, Publications CoordinatorKatie H. Schultze, B.S.

Focal PointMarilyn C. McManus, J.D., M.S.W., Editor

Center AssociatesViki BiglerChm Sik-Yin, B.A.Theresa Early, MS.W.Shad lessenStephanie Limoncelli, B.A.E. Darcy Shell, BS.Meg Wilson, B.A.Hcaly Winsank, B.S.

GRADUATE SCHOOL OF SOCIAL WORKJames H. Ward. Ph.D., Dean

REGIONAL RESEARCH INSTTTUTE FORHUMAN SERVICESWilliam H. Feyerhenn, Ph.D., Directee

NATIONAL ADVISORY COMMITTEEMary Hoyt, MS.W., Chair, Special Assistant to theAdministrator, Oregon Children's Services Division

Danny Amrine, JD., Tulsa, Oklahoma

Richard Angell, M.D., Department of Psychiauy,Oregon Health Sciences University

William Anthony, Ph.D., Center for RehabilitationResearch and Training in Mental Health, BostonUniversity

William Arroyo, M.D., Assistant Director, Child/Adolescent Psychiatry, LOS Angeles CountyUSC Medical Center

Marva Benjamin, M.S.W.. CASSP TechnicalAssistance Center, Georgetown Univasity

Cleepatra Caldwell, Ph.D., African-AmericanMemral Health Research Center, University ofMichigan, Institute of Social Research

Beth Dague, M.A., Stark County Mental HealthBoard, Canton, Ohio

Cory Dunn. M.S.W., Student Support Services,Linn-Bentar Education Service District, Albany,Oregon

Glenda Fme, Parents Involved Network, MentalHealth A:sedation of Southeast Pennsylvania

Bud Fredericks, Ed.D., Teaching Research, Inc.,Western Oregon State College

Paula Goldberg, PACER Center, Inc., Mirmeapolis,MimesouNaomi Karp, M.Ed., Arlington, Virginia

Jody Lubredn, Ph.D., Mental Health ProjectManager, Idaho Department of Health snd Welfare

Brenda Lyles, Ph.D., Houston, Tau

Phyllis Magrab, Ph.D., Director, Child DevelopmentCenter, Georgetown University

Larry Platt, M.D., Office of the Regional HellishAdminianninn, U.S. Pukiic Health Services, Region EC

2 FOCAL POINT Winter/Spring 1993

and strengthea family functioning. Case managers shouldwork with caregivers to assist them to acquire what theyneed to care for their child and maintain a safe, healthyfarnily. Case managers are working with children to helpthem live successfully in a family environment and be-come functioning adult members of the community.

These principles provide an overlay for analysis of thefour identified dominant approaches to case management:

Outpatient therapy approach. Assessment in thisapproach is first driven by the need to obtain a DSM-III(R)diagnosis for both reimbursement and clinical purposes.The assessment process then blends into planning with thetherapist working with the child and various family mem-bers in a mutual process of problem definition. The historyof the family and the situation are seen as importantelements in understanding the problem. The case planfollows the format indicated by the mental health centerand its funding agencies. Linkages to other services andagencies takes place as the case manager and the child orparent see the need for additional services. Monitoringand evaluation in this approach focuses on the work doneby the child and parent between sessions.

Brokerage approach. The main responsibility of acase manager employing the brokerage approach is tomake arrangements for clients to receive services. Thosewho subscribe to this approach believe that the servicedelivery system is neither well-coordinated nor flexible.In order for children with emotional disorders to receivethe full range of services they need, someone must beavailable who knows what services there are, knows howto access them, and plays the role of broker on behalf ofclients. Assessment is based upon the child's functioning(behaviorally) in the community or current placement.Case planning consists of the case manager identifyingservices to meet the needs of the child and those of thefamily, if the family is involved. Linking, or establishingthe means by which the child or family acquires theservices, is an element of this approach that varies widelyand is influenced greatly by how the broker views theiradvocacy function. Monitoring or evaluation is the pro-cess of determining if the current mix of services ismeeting the needs defined in the case plan and if differentor additional services are required. As with linking andadvocacy, this function varies widely.

Interdisciplinary or interagency team approach.The team approach is really two similar yet distinct ap-proaches. The interdisciplinary team is often used whenthe child is seen as having multiple medical needs, such aschildren with a variety of developmental delays, medicalproblems and emotional disorders. In this case the teamconsists of a group of specialists. Often this model is used

as an early intervention service. The interagency team, onthe other hand, is designed as a coordinating mechanismused when the child is currently involved in severalservice systems such as the court, special education, childwelfare and mental health. The team is composed of agroup of service providers from different agencies. As-sessment is conducted by the various members of theteam. The plan is developed through the combination ofteam perspectives and is normally a group of specializedservices reflecting the agencies or specialties representedby the team members. Linking is performed in a variety ofways. In this approach, advocacy is often seen as lessimportant because the gatekeepers to the services arerepresented on the team, take part in the decision-making,and can assist the "client" to obtain the indicated services.Monitoring or evaluation is often seen as the responsibil-ity of the individual service providers.

Strengths approach. The strengths approach to casemanagement with children and families is more than thephilosophy of identifying child and family strengths, it isa particular way to carry out the functions of case manage-ment. Assessment in this approach involves the identifica-tion of personal abilities and family resources. Thosethings that the child or family caregiver does well arestrengths upon which case plans can be built. Thesestrengths are the foundation for the case plan. Case plan-ning in the strengths approach is child and caregiverdirected and consists not of problem-solving but of pro-spective goal-setting. Linking the child and family toresources is dictated by the mutually defined case plan.Once the steps to acquiring a resource are clear, responsi-bilities are shared with the child and family performingspecified tasks and the case manager handling other tasks.Monitoring and evaluation are ongoing processes dictatedby the case plan. Advocacy takes several forms fromassisting the child and caregiver to team the steps neces-sary for acquiring a resource, to going with the child orfamily to negotiate with a service provider, to educatingagencies, professionals, and individuals about makingreasonable accommodations for families and childrenwith emotional disorders. The focus is not upon the casemanager advocating for the youth or family caregiver butupon advocacy being integrated into the goal-setting pro-cess through mutually determining the tasks required andwho will participate in a particular task and who will takeresponsibility for taA accomplishment.

Hopes for case management are high, yet our knowl-edge is just developing. This challenges usparents,researchers, practitioners, and policy-makersto worktogether to identify the tasks, structures, and methods thatproduce desired results, including normalization of chil-

Costirwedon page,/

Winter/Spring 1993 FOCAL POINT 3

4

dren with serious emotional disorders, satisfy the normsestablished by parents, and assure the safety of bothchildren and family caregivers. From this point of view itis less important who performs car e management or whatit is called; it is more important to focus on approaches thatproduce the desired results.

REFERENCE

1. Knitzer, J. (1982). Unclaimed children. Washington,DC: Children's Defense Fund.

'Theresa .1. Early, M.S.W., and John Poertner, D.S.W.,Professor, School of Social Welfare, University of Kan-sas, Lawrence, Kansas.

EDITOR'S NonCase management services were identified early in thechildren's mental health movement as a k), component of acomprehensive system of care for children with seriousmental, emotional or behavioral disorders. In the 1986 ASystem of Care for Severely Emotionally Disturbed ChildrenandYouth, Stroul and Friedman observed that case managersare the glue who hold the system together. They noted that acase manager's functionsincluding coordinating the com-prehensive interagency assessment of the child and family'sneeds, arranging for necessary services, and developing link-ages among the various services and agenciesare the veryactivities that 'systematize' the system of care."

The critical role case management services play in theprovision of care to children with emotional, behavioral ormental disabilities and their families has been recognizedin three recent federal laws. Public Law 99-660 requiresstates to develop a mental health plan to deliver commu-nity-based services to individuals with severe mentalillnesses and further mandates the provision of case man-agement services to those indiv iduals who receive sub-stantial amounts of public funds or services.

Further, Public Law 99-457 (Part H) launched aneffort to improve services for infants and toddlers withspecial needs and their families. States choosing to partici-pate in the federal infants and toddlers program provideeach child and family with a written individualized familyservice plan (IFSP) developed by a multidisciplinary teamthat includes the child's parent or guardian. The Congres-sional Record (1986) provides that the IFSP must providethe "name of the case manager...who will be responsiblefor implementation of the plan and coordination withother agencies and persons." (p. H7895).

The new Child Mental Health Services Program, autho-rized by Public Law 102-321 and implemented by the Centerfor Mental Health Services, will provide grants to states,political subdivisions of states, and Indian tribes to provide abroad array of community-based and f,mily-focused servicesfor children with serious mental, emotional, and behavioraldisorders and to enable communities to develop coordinatedlocal systems of care that involve mental health, child welfare,

education, juvenile justice, and other appropriate agencies.Under this program, case management is identified as acritical function and is required for all youngsters offeredaccess to the system of care though the specific approach andintensity of services may vary.

In tecognition of the absence of literature on case manage-ment in children's mental health, Portland Research andTraining Center staff hosted a conference with the purpose ofassembling papers for a book on the subject. The Researchand Training Center' s conference, entitled Building onFamily Strengths: A National Conference on Case Manage-ment for Children with Emotional, Behavioral or MentalDisorders was held March 28-30, 1992 in Portland, Oregon.Approximately 350 parents and professionals from 39 differ-ent states, the District of Columbia and Guam were inattendance. The conference provided state-of-the-an infor-marion about case management for childten with emotional,behavioral and mental disorders and their families; created aforum for participants to interact and exchange informationabout a wide range of case management issues; and, further,provided an opportunity for authors to present their work andgather feedback useful in the preparation of the book.

Nearly one-third of the 350 participants were familymembers. Many family members who attended were spon-sored with Research and Training Center funds, by state orlocal parent organizations, or by state mental health agencies.The extent of cooperation and support provided for familymembers by state mental health agencies suggests that statesupport for family participation has increased substantiallyduring the last few years.

This issue ofFocal Point offers a briefoverview of a rangeof children's mental health case management issues andinthe five leading articles excerpted from the upcoming bookwith the working title Building on Family Strengths: CaseManagement for Children with Emotional, Behavioral orMental Disordersprovides a snapshot of the forthcomingbook. Publication is tantatively scheduled for Fall 1994.Ordering information may be obtained by contacting:Paul H. B rookes Publishing Company, P.O. Box 10624,Baltimore, Maryland 21285-0624; (800) 638-3775.

4 FOCAL POINT Winter/Spring 1993 5

EXPECTATIONS OF CASE MANAGEMENT FOR CHILDREN

WTHI EMOTIONAL PROBLEMS: PARENT PERSPECIIVES

six parents involved in Keys for Networking, a state-wide Kansas parent organization, met and sharedtheir expectations of case management and case

managers in five areas: ( I ) the relationship between casemanagers andfamilies; (2) case managers' attitudes andbeliefs; (3) the role of the case manager with formalservices; (4) informal resources; and (5) organizationalissues that effect the implementation of the case manage-ment service.

The Case Management RelationshipIn order to accomplish the tasks of case management,

parents believe case managers need the skills to establishpositive, ongoing, trusting relationships with parents,their children and agencies. "The ultimate success of casemanagement depends on the relationship between thecase manager and their ability to work with the parent andthe child."

Parents want case managers to ask them what theyneed and to have skills in helping locate the resources andsupports that will help parents meet those needs. Thisincludes the ability to translate family concerns intoresources and services. For example, if parents say theyneed a break from being with their child, the case managertranslates that into a service such as respite care.

Parents expect the case manager to have the compe-tence to highlight family strengths, to see the value of eachmember of the family and to build on these strengths. Casemanagers should exhibit flexibility, ease and a personaltouch. Parents want case managers to reach out to them andnot always expect famBies to contact the case manager.

In effect, parents want case ,managers to be like ex-tended family members who get paid. Case managersGhould be interested, involved, available, supportive, andknow when it is time to leave. At the same time casemanagers need to know their own limits and how to takecare of theraselves.

Case Managers' Attitudes and BeliefsIt is not enough for parents that case managers have the

skills to do the tasks of their job, they also need attitudesthat support families. They need to see families in apositive, non-blaming way and know that, no matter what,parents are invested in their children. Parents also wantcase managers to be invested and committed to them andtheir children. Most importantly parents expect case man-agers to have the attitude that children and youth should be

with families and that families are the experts on theirneeds. Parents want case managers to be able to look at theworld from the family's perspective and set prioritiesbased on what the family wants. Case managers must besensitive to cultural, environmental, racial, religious andsexual orientation differences.

Working with Formal Service SystemsThe formal service systems (e.g., education, mental

health, child welfare) available to children are often frag-mented and function with little or no interaction. Parentsexpect case managers to be in touch with all of the otherpersons involved in working with them and their child.This requires case managers to be familiar with commu-nity resources and how to access them. Parents expect casemanagers to develop relationships with other providers sothat they have the "pull" to get things done and the skill toknow whom to contact and when. Parents want the casemanager to ave the capacity and the authority to makedecisions with them regarding their child. This is espe-cially critical in a crisis when families need to haveassistance in getting emergency services.

The case manager needs to be aware of the regulationsand eligibility criteria for other formalized services. Forexample, if a child is eligible for Medicaid services, thechild's case manager should know what Medicaid willfund and should assist families in securing those services.

Working with Informal Resources and SupportsParents want their children to be involved in routine

age appropriate activities such as swimming, skating,Little League, school dances and summer camps. Accord-ingly, parents expect the case manager to be able to assistthem in accessing non-traditional supports for their child.These supports may include recruiting volunteers to workwith the child. For example, if a child is interested inscouting, the case manager might identify an individualwho could attend scouting events with the child. The casemanager should be available to the volunteer to help thatindividual understand the child so that both the child andvolunteer gain from the experience.

Case managers should serve as a bridge to link familiesexperiencing similar stress and should help create re-sources where they do not exist. For example, parentsappreciate the support provided by case managers whenthey arrange for transportation for the child or family toappointments and activities.

Winta/Spring 1993 FOCAL POINT S

Organizational ConsiderationsCase management services that are responsive to fami-

lies must be flexible in all aspects. Caseloads need to besmall enough for case managers to be involved withfamilies. The service must be focused on the family andnot just the child. The case manager's hours need to beflexible so that they can meet families at times when it isconvenient for the family. They must be allowed to conieto the family and provide transportation when needed.Case management services must be available to families atall hours. Someone needs to be available to respond to aparent's needs when a case manager is not available.

When case management is family sensitive and imple-mented in a comprehensive and integrative way it can be

the backbone of a system. of care for children with emo-tional disorders. When successful, case management canensure that children and families receive the services andsupports they need to keep their children at home.

Richard Donner, M.S.W.; Barbara Huff, Executive Ad-ministrator, Federation of Families for Children' s MentalHealth, Alexandria, Virginia; Mary Gentry; DeborahMcKinney; Jana Duncan; Sharon Thompson; and PattySilver. The six women authors are each the parent of a childwith a mental, emotional, or behavioral disability and havesubstantial experience seekng appropriate services for theirchild. With the exception of Barbara Half, all of the authorslive in the Topeka, Kansas area.

PRINCIPLES OF TRAINING

FOR CHILD MENTAL HEALTH CASE MANAGEMENT

In North Carolina a model for child mental health casemanagement training is being implemented through acontract between the State's Department of Human

Resources Division of Mental Health, DevelopmentalDisabilities, and Substance Abuse Services, and the Schoolof Social Work at the University of North Carolina atChapel Hill. The model establishes a collaborative processfor content development involving the State Division ofMental Health Children and Youth Program, three dem-onstration child mental health programs, a child mentalhealth advocacy organization, and the School of Social Work.

Case managers in child mental health have a tripartitefocus: on the child, on the family, and on the servicesystem. Eligibility is determined by the child's need forservice, but the case manager must focus equally on thepartnership with the parent or responsible adult, and onservicc coordination and collaboration among serviceproviders, as well as on the child. The interactions betweenthe case manager and each focal point affect the interac-tions among all the parts. Effective case managementrequires a specific value base, knowledge relevant to thepopulation to be served and the service system, and skillsneeded to provide the service, including relating to chil-dren in the mental health system, engaging in partnershipswith their parent or responsible adult, and facilitatinginterprofessional collaboration. These three core areasform the foundation for child mental health case manage-ment training.

VALtxsCase managers who believe that community-based

services are the most relevant and appropriate for the childand the family will provide the intense involvement neededto assure that agencies, organizations, and individualscollaborate to support and preserve families. Case manag-ers need to believe that families want what is best for theirchild. Indeed, families should be valued for knowing thechild better than anyone else, although they may not fullyunderstand the child's behavior. Case managers need tovalue family preservation to the point of leaving thefamily intact in times of crisis. When this is not possiblethe case manager will work toward family reunification.This may entail advocating,on behalf of the child and thefamily for unavailable or inaccessible services.

Case managers must value the basic integrity of chil-dren and adults and respect the cultural, racial, ethnic andsexual orientation differences among individuals. Theyalso need to appreciate families' varied coping styles,recognize that all families sometimes have difficulty cop-ing effectively under stress, and believe that familiesgenerally have the capacity for positive change.

Case managers, frequently privy to strictly confiden-tial infonnation, must be keenly sensitive to client confi-dentiality, while recognizing the tensions inherent in work-ing with multiple members of a family and with multipleagencies.

Working with families from an empowerment per-spective involves promoting their ability to utilize theirexisting strengths to meet their needs (1). Case managersworking from this perspective believe that community-based and family-centered services are the most relevantand appropriate for the child and the family.

6 FOCAL POINT Winter/Swing 1993 7

Case managers need to valueinterprofessional collaboration asa means to problem-solving. Theyshould respect the expertise broughtby professionals from various dis-ciplines within the mental healthsystem and elsewhere in the ser-vice network.

KNOWLEDGE

Case managers need to under-stand the process and functions ofcase management and their role visa vis the family and service provid-ers, as conceptualized in the par-ticular case management modelused by their agency. They needspecific infonnation about relevantlegislation and about state, local,and organizational policies affecting children and ami-nes. Case managers need infonnation about agency poli-cies relative to confidentiality to guide their actions asthey encounter the ethical dilemmas that can be expected.They need to know how to access the local network ofservices for children ages birth to 18, such as thoseprovided by a ay care and preschool settings, the schoolsystem, social service agencies, medical and health ser-vices, substance abuse programs, religious groups, andcommunity organizations.

Case managers need information about the functioningof families, including how stress can affect the familysystem and how the family system affects its members.Case managers need an understanding of the total treat-ment process from assessment to termination.

Moreover, case managers need information on assess-ment strategies; they need to know what information theyare expected to gather as part of an assessment and whenchanges in behavior or circumstances warrant reassess-ment. They need to know enough about child psychopa-thology to understand the common manifestations ofthose disorders frequently seen in children served by themental health system. The case manager needs to befamiliar enough with therapy models to help interpret thetherapy process to the family and to evaluate therapyprocess. The case manager needs to know about all levelsof service, including day treatment and hospitalization,how to detennine when a transition is appropriate, and how toaccess the new level of service. The case manager needs to befamiliar with primary medications used, frequent sideeffects, and reactions needing medical evaluation.

There will be times when keeping the family intact,even though valued, is neither safe nor wise for the child

or another family member. Thus, thecase manager needs to know how toassess the nature of a crisis and how todetermine when a person needs to bemoved to a safer place or a differentlevel of service. In addition, thisinvolves knowing when and whomto call for assistance.

SKILLSCase managers' skills must be

based on values consistent with ef-fective practice and grounded in thecase management model specifiedin their agency. The particularmodelobviously will shape training pri-orities for skill development, al-though some skills are basic to allmodels. For instance, broad skills in

communicating with others are essential.Child mental health case managers should function

from a family empowerment perspective to enable parentsto support their child's development and to representfamily interests to other service providers. Case managersneed specific skills in working with families in prepara-tion for assessment, in involving them in the development'of the treatment plan, in reframing issues, in workingthrough crises, and in helping families to maintain moti-vation at predictably difficult points in therapy. Casemanagers will also be engaged in capacity building and indecision-making with the family.

Case managers, from their vantage point as servicecoordinators, are in a unique position to identify servicegaps. In order to address these gaps, they will need skillsin advocating for particular children and families. Theywill also need skills in advocating for services, which mayinvolve facilitating advocacy groups.

Case management programs rely on different modelsfor service planning. Frequently, the case manager isresponsible for assembling relevant professionals to workwith a particular family or for collaborating with anexisting team. Where decisions are made in a groupcontext, the case manager needs specific skills in groupfacilitation (2, 3).

Regardless of case management model, all case man-agers need skills in assessment, information gathering,problem analysis, planning, negotiation, collaboration,problem-solving, decision-making, and advocacy (4). Allcase managers will need skills in documentation andrecord-keeping. All will be involved in transitions todifferent levels of service, in termination, and in evalua-tion of client outcomes, as well as the case management

D!ST Y 3Winter/Spring 1993 FOCAL POINT 7

process and the service system and need skills for thesecomplex functions.

Because of the stigma attached to mental health ser-vices, it is important that case managers be able to inter-pret those services to others. In this way, case managerscan provide an important bridge between the family andthe mental health system, and between mental health andother services within the service network.

LOOICLNG TO ME FUTURE

Training in case management in child mental healthwill need to take into account the trend in service deliverysystems toward thinking in terms of wrap-around servicesgeared to the particular needs of the child and family,rather than in terms of categorical services delineated byagency function. This increased emphasis on tailoringservices to meet the needs of the child and family willincrease the importance of case management in creating,arranging for, and coordinating services. Collaborationamong service providers is critical to the success of suchfamily-centered services. The case manager plays a keyrole in ensuring that the collaboration essential to suchservice provision takes place. Carefully designed trainingprograms can help to assure that case managers in child

mental health are prepared to assume leadership in theprovision of community-based and family-centered ser-vices that meet the needs of children and families.

REFERENCES

1. Dunst, C., Trivette, C. & Deal, A. (1988). Enabling andempowering families. Cambridge, MA: BrooklineBooks.

2. Nash, J. (1990). "Public Law 99-457: Facilitatingfamily participation on the multidisciplinary team."Journal of Early Intervention, 14(4), 318-326.

3. Nash, J., Rounds, K., Bowen, G. (1992). "Level ofparental involvement on early childhood interventionteams." Families in Society, 73(2), 93-99.

4. Zipper, I., Weil, M. & Rounds, K. (1991). Servicecoordination in early intervention: Parents and pro-fessionals. Chapel Hill, NC: Frank Porter GrahamChild Development Center.

Marie Weil, D.S.W.,ProfersorofSocialWorkIreneNathanZipper A.C.S.W.,C.C.S.W.,Clinicallnstructor; &S.RachelDedmon,Ph.D.,Associate Professor; SchoolofSocialWork,University of North Carolina, Chapel Hill, North Carolina.

PARENTS' PERSPECIIVE: WERE THERE GOOD Tms?4.17:

Three weeks to graduation day. Yes, it's hard to believe. How did we make it through K-12 consiantly at oddswith the school system? All the pain, embarrassment, guilt, and the sense of hopelessness and uselessness.

Our son is emotionally impaired along with some mild neurological problems. He is our first born and oh, we lovehim so. For thirteen years we've; struggled to seek the professional help that would make it better. We grasped at eachnew theory, new diagnosit hoping that we would be a "normal happy family" at last.

We lived through the tears when Cub Scouts failed, no one wanted him on their sports teams, and the absence ofparty invitationsthe shunning of a little boy because "he's different" or "he misbehaves." The years went by andthe anger and frustration grew. The tears still came, but only after the violent verbal abuse. Our younger son shedhis own tears because his life, too, depended on his brother's mood swings and behavior. "Why does my brother dothese awful things?"

The high school years brought all of the stages of independenceonly for us mom failure. Friends passed drivers'education and got their licenses. Our son failed the course and was made the spectacle of the class. He faced the stigmaand isolation of being "special ed." There were no after-school jobs. "Good students are so plentiful, who wants tobother with one who needs a little extra?"

We faced the milestones along with the rest. We did it alone with many a family secret kept as best we could. Theremust have been some bright spots along the way, but day to day there was always tension and many problems to face.

As we reach this graduation day of melancholy, we know it means a rocky future, which we will face alone, butwe do so with a sigh of relief. No more school staff to convinceWE KNOW OUR SON AND HE IS NOT BAD!!!

I write this to remind parents to savour the good moments. It is sad when the good moments are lost in ourmemories.

Cindy Files. Cadillac, Michigan. Ms. Fates is a mother, advocate and Community Mental Health Board member.

Editor's Note: Parents are invited to submit contributions, not to exceed 250 words, for the Parents' Perspective column.


CASE MANAGEMENT RESEARCH ISSUES AND DIRECTIONS

Trhere is a virtual absence of well-controlled studiesof case management in the children' s mental healthfield. In the absence of research on case manage-

ment for children and youth an extension of studies onadult populations may prove helpful. Such comparisonsshould be made with caution, however, as children andadolescents may differ significantly from the adult popu-lation in regard to their developmental needs, servicesrequired and legal status. The needs of the infant maydiffer from those of the troubled teenager, similarly theneeds of a young adult in transition differ from those of theadult or elderly person with chronic mental illness. Differ-ent agencies may be involved with adults and children.While adults may require multiple services from manyagencies, children are always subject to multiple agenciesand legislative mandates and have only the legal status ofa dependent. They may be wards of the court, fosterchildren, or subject to parental control. Key researchquestions include the following:

Models. Can adult models of case management be adaptedfor children and youth or are there well-delineated childmodels? How do case management models vary for diffcr-ent developmental stages or diagnoses? To what extentdoes the choice of model adopted depend on the context ofthe service system or systems in which it is embedded?

Organization and service system context. Which agencyshould be responsible for the provision of case manage-ment? What federal, state or local agencies or mandatesare involved? Does the case management function belongwithin the service organization or outside of it? If placedwithin the organization there is the risk that advocacyneeds will go unmet because of the potential of co-optingthe case manager. If placed outside the organization,advocacy and brokerage needs can more easily be met butthe lack of proximity of the case manager to the organiza-tion may weaken coordination of services. Are case man-agers salaried by the organization or are purchased ser-v ices contracted outside? Is case management moreeffective when its functions are distributed among mem-bers of a team or when functions are unified in a role playedby one individual? What is the status of the case manager andwhat authority do they have? Do they allocate funds? Maketreatment decisions? Control client placement?

Implementation practices. Is there an optimum caseload size? Does it vary according to client, provider andsystem needs? How often should clients be seen? Is therea relationship between caseload size and intensity of

contact? Is there evidence to support more effective out-comes from more frequent or extended contact? How longwill case management services be needed?

Qualifications of case managers. What level of professionaltraining is needed to be a case manager? What skills areneeded by non-professionals to perform some case manage-ment functions? Does case management for children requireany training different from that needed to treat adults?

Financing. What is the cost of treatment with and withoutcase management or with different models of case man-agement? How do costs of case management vary bydiagnosis and developmental stage? Under capitated ap-proaches to what extent can case managers assume ex-pected functions such as advocacy?

The final stage of research, assessing outcomes, inves-tigates the effectiveness of case management interven-tions at client and system levels. If one were to select thebroadest rubric, or the most encompassing concept toinvestigate, it would probably be models of case manage-ment. In the same way that psychotherapy has beenresearched, types of psychotherapy (e.g. cognitive versusinterpersonal) are identified and contrasted, while care-fully specifying the structural and process variables foreach type of psychotherapy. Although clearly more com-plex than psychotherapy research, because of the servicesystem factors (e.g., effect of availability of other mentalhealth services), the notion of models that can bemanualized is appealing.

Research on case management for children and adoles-cents and their families is timely and multifaceted. Thereare exciting opportunities for researchers who want towork with public sector agencies on issues that can influ-ence the quality of life of children and families. Researchwill be requested as accountability is demanded for thisgrowing mental health intervention and as policy-makersseek answers about reasonable and effective courses totake. Progress will be incremental initially as the basicparameters of case management within a continuum ofcare are spelled out.

Barbara J. Bums, Ph.D., Professor of Medical Psychology,Department of Psychiatry, Developmental EpidemiologyProgram, Duke University Medical Center, Durham, NorthCarolina; Elizabeth Anne Gwaltney, M.A., Research As-sistant; and G. Kay Bishop, B.A., Senior Data Technician,Department ofPsychiatry,DevelopmentalEpidemiology Pro-gram, Duke University Medical Center, Durham, NorthCarolina.


0

HAVING OUR SAYThis colwnn features responses to questions posed to readers. In this issue we feature responses from participants atthe March 1992 BuiMing on Family Strengths children' s mental health case management conference to the question:"What was the most useful information you gained from your attendance at this conference?"

Always the best part of the conference for me isinformal networking. Medicaid funding, parents' per-spectives!!!

The most interesting workshop was the Parent as CaseManager. The final panel was the most interesting ma-terialfmformation presented throughout the conference.Judge English was a dynamic speaker. Wish there werejudges like her throughout the U.S. Barbara Huff is aninspiration. More speakers with her knowledge wouldbe helpful.

Clear intemalized understanding of what good casemanagement is and who it serves! Families and childrenand not agency or public budgets.

I am beginning to feel that professionals do want towork with parents.

Enjoyed the families networking special interest meet-ing! Speaking to parents and hearing what their frustra-tions, needs, and wants are and how service providerscan better serve children and families and work withthem as a team.

Creasa Reed's list of do's and don'ts in the first panel,parents' presentation with Donner, L. Behar's delineat-ing state roles and responsibilities regarding case man-agement.

That there is a God that oversees us even when wethink there is no hope for our children, because there isa national network and a Research and Training Centerin Portland that really cares what happens to familieswho have children with serious disorders. That parentscan be empowered and recognized as viable case manag-ers. That we can hold states accountable for services toour clOd..en. I am grateful.

IMPLEMENTING AND MONTDDIUNG CASE MANAGEMENT:

A STATE AGENCY PERSPECTIVE

uring the past decade, the concept of case man-agement has been widely discussed among childmental health professionals as the glue that holds

services together for children who have serious emotionaldisorders and their families (1, 2). The Child and Adoles-cent Service System Program (CASSP) created by Con-gress in 1983 and administered by the National Institute ofMental Health (NIMH), promoted the development ofcase management services as part of the child mentalhealth service system.

Funding through CASSP has made case managementservices available in some states. The Consolidated Om-nibus Budget Reconciliation Act (COBRA) of 1985 per-mitted states to fund targeted case management as anoptional service under Medicaid. Recipients of grant fundsineight states from the Robert Wood Johnson Foundation'sMental Health Services Program for Youth initiative usedgrant funds to place significant emphasis on case manage-ment services.

As state mental health systems forged public policy

together with funding for implementation, they assumedthe responsibilities associated with the development ofnew concepts, that is, to ensure proper implementationand on-going support. The responsibilities include pro-mulgating philosophy and attitude change, setting pro-gram policies and standards, providing training, ensuringfunding, and monitoring and evaluating services.

CHANGING PHILOSOPHY AND ATTITUDES

To implement case management services, changes arerequired in: (1) attitudes about families and their role inservice planning and service use; (2) attitudes about otheragencics and their roles in providing quality, coordinatedcare and in providing entitlements; and (3) attitudes aboutone's own professional functioning and sharing the re-sponsibility for service provision with others. The leader-ship role of the state is to communicate the reasons forsuch change, the positive impact change will make and theimportance of effecting change.

As the family movement has gained strength through


1 :41

organizations such as the Alliance for the Mentally Ill andthe Federation of Families for Children's Mental Health,new attitudes toward families are emerging among profes-sionals. Professionals are revising their views of familymembers and recognizing that the parents of children whohave emotional disorders are important partners in evok-ing positive change in their children and can be strongadvocates for increased, appropriate services. Familystrengths rather than family weaknesses have become themainstay of treatment.

Moreover, in light of research and evaluation studiesthat strongly suggested that, with new treatment strate-gies, many children with serious disorders may be treatedat home, professionals are learning to provide services inthe home. The emphasis on designing services to "meetthe family on its own ground" is bringing into focus theneed for professionals to gain better understanding ofethnic and cultural beliefs, styles and practices in order torelate better and provide better treatment to familiesoutside the "culture" of the clinic.

State agencies have the responsibility of encouraginglocal agencies zo have parents participate in the serviceplanning process and the advocacy process for their ownchildren and broadening such participation for all childrenin need. Further, the state agencies have the responsibility toencourage such participation in state level activities, as well.

Children with mental health problems frequently aretied legally to multiple agencies. It makes sense that thesemultiple agencies work in concert to help these childrenand their families. Case management thus becomes acomplex responsibility. On the one hand, diverse andindependent agencies need to be coordinated; and, on theother hand, these agencies frequently are mandated toperform activities that incorporate some case manage-ment type functions. Thus there is a need to clarify who ismandated to do what and who is responsible for what.

Although much can be sorted out locally, the roles andresponsibilities of the agencies need to be formally clari-fied at the state level. Initiatives that reinforce or rewardjoint efforts across agencies can be effective in promotingcross system understanding and in enhancing cross sys-tem communication. Further, cross training or joint train-ing of the staff members of local agencies can be used toenhance the interagency working relationships.

In addition to the promotion of new attitudes, themultiple state agencies involved with children and fami-lies must model the kind of behaviors that reflect the newphilosophy. Focusing on case management, examplesshould be set through: (1) the development of state-levelinteragency councils to address cross-agency issues, suchas clarification of roles for case managers; (2) jointly

sponsored, cross-agency training events; or (3) jointlyfunded local initiatives.

DEVELOPING STATE POLICIES AND PROCEDURES

A major responsibility of the state agency is to developpolicies and procedures for implementing services thatensure the consistency of services across the state and thequality of those services. States approach this task differ-ently. Although the quality of the policies and proceduresmight well be the same regardless of the mechanisms usedto develop them (e.g., developed by state office alone,jointly developed with other professionals and agencies,test piloting, public hearing, etc.), it would seem that thelikelihood of acceptance of a new service or a new modelof service implementation would be related to the amountof ownership others assumed. As a Chinese proverb sug-gests, involving those affected by policies and proceduresin their development may prove most satisfactory: "Tellme and I'll forget; Show me and I may remember; Involveme and I'll understand."

Substantial consensus exists among states on the defi-nition of the target population of children with emotionaldisorders and upon preferred caseload size. There is lessagreement, or attention to, credentials of staff, trainingand supervision of staff. In addition to addressing thesecategories, a state's plan for case management shouldemphasize the following: (1) the need to base servicedelivery on a sound model and the description of alterna-tive models; (2) clarification of the interface of casemanagement with other services; (3) the need for a localquality assurance/quality improvement program; (4) theprogram standards and mechanisms for ongoing monitor-ing, evaluation and feedback; and (5) the plan for impact-ing on the curriculum of pre-service academic programs toincrease the production of professionals trained in the areaof case management. Obviously the field is not withoutguidance concerning what is to be done, how it is to bedone, where it is to be done and by whom it is to be done.

Thus the task of the state agency, hopefully in concertwith representatives of other state agencies, local agen-cies, other providers and parents, is to review such exist-ing information, determine its appropriateness and appli-cability, and modify such information to serve as the basisfor state policies and procedures. In this process. it isimportant to de velop policies, procedures, standards, rulesand regulations that are clearwhile at the same timemaintaining an atmosphere conducive to flexibility.

TRAINING OF STAFFState agencies have two major responsibilities in the

training arena: (1) to stimulate the relevant academic


1 0

departments to revise their curriculum to include suchtraining, both classroom-based and field-bascd; and (2) toensure that appropriate in-service training and supervi-sion are provided to professionals learning to be casemanagers on the job.

FINANCLNG CASE MANAGEMENT SERVICESIt is clearly the state's responsibility to identify fi-

nancing mechanisms for services and to monitor howlocal programs are accessing and using funds. The empha-sis on financing case management services stems from therecognition that such services seem essential to improvedoutcomes for children, especially children with complexproblems who use the public mental health systems. Stateagencies have given considerable attention to financingstrategies using Medicaid and through the requirements ofPublic Law 99-457 (early intervention services). How-ever, the responsibility remains for state mental healthagencies to identify other funds for those not eligible forMedicaid or those not under the age of six, or those notmeeting the eligibility requirements of other federal en-titlement programs. Other approaches to be exploredinclude the private insurance and managed care industriesthat are seeking to lower service costs without sacrificingquality.

PROGRAM MONITORING AND EVALUATIONState agency monitoring or oversight of local pro-

grams is best accomplished by methods that emphasize

improving functioning rather than detecting problems. Itis essential to have clearly defined criteria, agreed upon byboth parties and reviewed according to agreed upon meth-ods. The monitoring should serve to identify areas whereprograms need to improve, where they need assistance andwhere the state needs to put its efforts.

The role of the state agency in the area of evaluationmay perhaps best be carried out by encouraging indepen-dent studies by research institutes or by university-basedprofessionals. Providing access for field-based research isan important contribution; this includes helping to bridgethe communication gaps that may exist between thosefocusing on delivering services and those seeking reason-able controls in the system to carry out an evaluation.

REFERENCES1. Behar, L. (1986). A state model for child mental health

services: The North Carolina experience. Children Today,15(3), 16-21.

2. Stroul, B. & Friedman. R. (1986). A system of care forseverely emotionally disturbed childrenandyouth. Washing-ton, D.C.: CASSP Technical Assistance Center, GeorgetownUniversity Child Development Center.

Lenore B. Behar, Ph.D., Head, Child and Family Ser-vices Branch, North Carolina Division of Mental Health,Developmental Disabilities and Substance Abuse Ser-vices; Raleigh, North Carolina.

SPOTLIGHT ONTHE CENTER FOR MENTAL HEALTH SERVICES'

CHILD, ADOLESCENT AND FAMILY BRANCH

ary DeCarolis, formerly Deputy Commissioner ofthe Vermont Department of Mental Health, has beenappointed Chief of the Child. Adolescent and Family

Branch, Division of Demonstration Programs, Center forMental Health Services. Gary will have the responsibility ofplanning, directing, and evaluating efforts to stimulate andsupport demonstration programs that will contribute to theimprovement and expansion of mental health services andservice systems forchildren and adolescents with or at risk forserious emotional disorders and their families.

From 1988 until the present, Gary held the position ofdeputy commissioner, Vemiont Department o f Mental Healthand Retardation where he shared the overall managementresponsibilities of that department with the Commissioner,

and served as Director, Child, Adolescent and Family Unit,Division of Mental Health. He is very skilled in working withthe Child and Adolescent Service System Progralti (CASSP)principles of care, having served as the director of the Ver-mont CASSP system where he worked to marshall the re-sources of the state to plan for a comprehensive community-based children's mental health system. In that capacity he wasresponsible for creating an interagency approach to workingwith children with serious emotional disorders by involvingfamilies and staff from child welfare, education, corrections,health and substance abuse systems at both the state and locallevels. Gary is recognized as a national leader in developingand implementing a CASSP model of c are for children in needof mental health services. In April 1993 he received an award

12 FOCAL POINT Wimer/Spring 1993

"For Excellence in Changing PublicPolicy to Promote WrapArounD Ser-v ices" at the Second AnnualWrapArounD Family Reunion in St.Charles, Illinois.

Gary has had extensive experiencein the educational and human servicesfield having been a college instmctor,assistant director of a college admis-sions office, prison counselor, mentalhealth counselor, and a children's mental health plannerbefore he moved into his most recent management positionsin the Velmont Mental Health and Mental Retardation sys-tem. In addition, Gary served for six years as an alderman inBurlington, Vermont where he represented low and moderateincome residents. In thatelected capacity he worked to protectthe quality of life in an urban neighborhood and developedand implemented a comprehensive disability access plan forthe wards of the city.

Gary is a strong proponent of people first language andopposes the use of abbreviations:"I dislike the use of acro-nyms and abbreviations. Their use really puts families at adisadvantage. I don't use them and I encourage my staff to dothe same." He is the father of two children, one of whom hasDown Syndrome. Gary has a master's degree in education.

Judith W. Katz-Leavy serves as Chief, Services andSystem Development Program; Child, Adolescent andFamily Branch; Division of Demonstration Programs;Center for Mental Health Services, Substance Abuse and

Mental Health Services Adminis-tration. Judy is a recognized nationalleader in the development, imple-mentation and evaluation of systemsof care for children and adolescentswith emotional disorders and theirfamilies. The Services and SystemDevelopment Program is responsiblefor administering the Child and Ado-lescent Service System Program(CASSP), a landmark national ini-

tiative that created a new model for viewing the develop-ment of integrated service systems with families as equalparticipants in the process. Judy is the co-founder of theCASSP program.

In addition to administering CASSP, Judy administersthe Statewide Family Network Program, a program pro-viding funds and technical assistance to family-controlledorganizations to develop or expand a statewide network ofinformation and support services available to individualfamily mem bers and to family support groups, and theComprehensive Community Mental Health Services Pro-

Gary DeCarolis

Judith Katz-Leavy

gram for Children, anew program authorized under PublicLaw 102-321 (the ADAMHA Reorganization Act). Thisprogram is based on the concept of interagency collabora-tion and services integrationrequiring individualizedservice planning by a multi-disciplinary team includingfamily members and the child, unless clinically inappro-priate, case management to ensure implementation of theplan, and the availability of a range of community-basedmental health service options.

Judy's previous positions include serving as the evalu-ation coordinator of the National Institute of MentalHealth's Most in Need Program; chief of the YouthEducation Branch, Division of Prevention, National Insti-tute on Alcohol Abuse and Alcoholism, Alcohol, DrugAbuse, and Mental Health Administration; and as a teacherin an early childhood learning program in the BaltimoreCity Department of Education. Judy has a master's degreein education.

Diane L. Sondheimer serves as Chief, Child and Ado-lescent Studies Program; Child, Adolescent and FamilyBranch; Division of Demonstration Programs; Center forMental Health Services; SubstanceAbuse and Mental Health ServicesAdministration. The Child and Ado-lescent Studies Program operates in-dependently and incoordination withother child-serving systems, federalagencies and the private sector toensure that mental health services tochildren and adolescents and theirfamilies are empirically-based. Akey goal is to support research onthe efficacy of innovative approaches to organizing, deliv-ering and financing systems of care for children andadolescents with, or at risk of developing, serious emo-tional disorders and their families. Diane is a recognizedleader in both public and private sectors as a clinician,educator, advocate, researcher, administrator and policy-maker of programs designed to improve the lives ofchildren, adolescents and their families. She has a specialinterest in urban and multi-cultural populations.

Diane's former positions include coordinating adoles-cent HIV and AIDS research for the Pediatric, Adolescentand Maternal AIDS Branch, National Institute of ChildHealth and Human Development within the NationalInstitutes of Health (NIH); and serving on the faculty ofthe University of Maryland School of Medicine, Depart-ment of Pediatrics, Division of Adolescent Medicine forseven years. She has master's degrees in nursing andpublic health and is currently completing her doctorate inpublic policy at The American University.

Diane Sondheinser


II 4

WHY NOT?Family-centered case management for children with emotional disorders addresses the needs of the family as wellas the child. In this approach, case managers help families to identify, access, and coordinate supports and servicesthat allow children to remain in their homes and enable families to live according to their own determination. Afamily-centered case management approach recognizes family strengths and builds on them.

Following this philosophy, the New York Office of Mental Health offers an innovative program that providesfamily-centered case management services to families who have children with emotional disorders and who are atrisk of out-of-home placement. Family-Centered Intensive Case Management (FCIM) gives families the same kindsof resources and support that are provided to therapeutic foster care families so that children may remain in theirhomes. The program provides respite care, parent training and mutual self-help support groups, family and childneeds assessment, case management, advocacy, and psychiatric consultation to children and their families in threerural New York counties. Unfortunately, programs such as New York's FCIM project are not available in many partsof the country. Why not expand the use of family-centered case management so that it is accessible to all families whoneed it? S.L.

Editor's Note: Readers are invited to submit contributions, not to exceed 250 words, for the Why Not? column.

We are making progress! Note the evolution from the initial "Why Not?" column (Winter 1988 Focal Pointbelow)to the current column (above).

Therapeutic foster parents need to be paid adequately, appropriately trained, be assured of a wide range of servicesto meet the needs of their children, get support from professionals and from each other, and have access to respitecare to provide relief from the demands and needs of the children in their homes. These services are necessary in orderto recruit and keep foster parents, who often "burnout" from the demands of providing twenty-four hour care forchildren with serious emotional disorders.

Since the children's own families face the same demands and have the same needs as foster families, WHY NOTprovide the same services and support for them while the children are still at home? We might prevent the need forout-of-home placement and we certainly would provide much needed help to families. B.J.F.

NAMI CAN SUMMER CONVENTION SCHEDULED

The National Alliance for the Mentally Ill-Child and Family Network (NAMI CAN) helps families with children whohave serious brain disorders or mental illness by providing support, information, and advocacy. The purpose of theorganization is to promote improved systems of care for children and adolescents with these disorders. Theorganization's annual convention, entitled Advocacy for Change, is scheduled for July 21 and 22, 1993 at theFontainebleau Hilton in Miami Beach, Florida. A one day institute will address advocacy issues including educationrights and opportunities, early intervention and the Americans With Disabilities Act. Conference topics includeprogramming for transition services, federal advocacy issues, programs for children with neurobiological disorders andcoalition building.

NAMI CAN offers a number of resources to educate families, organizations, and the general public regarding thnature of serious brain disorders and mental illness. They provide lists of helpful publications and organizations forparents with children who have children with serious brain disorders or mental illness, a series of medical informationbrochures that include up-to-date information on a wide variety of mental illnesses and treatment modalities, andnumerous publications, videos, and othcr education tools. NAMI CAN also publishes a newsletter.

For conference registration or for further general information contact; NAMI CAN, 2101 Wilson Blvd., Suite 302,Arlington, Virginia 22201; (703) 524-7600 or (800) 950-NAMI.


_1 3

NOTES & COMMENTS

Three Federal Grant Programs Announced

The Substance Abuse and Mental Health ServicesAdministration (SAMHSA) has announced the availabil-ity of federal grant funds to support the development ofthree programs to increase the quality and availability ofservices for children and adolescents with emotional,behavioral, and mental disorders and their families.

The first program, the Comprehensive CommunityMental Health Services Program for Children withSerious Emotional Disturbances (authorized by PublicLaw 102-321), will provide grants to states and other localgovernmental entitiesincluding Indian tribesto pro-vide community-based services for children and adoles-cents with serious emotional disorders. The program willenable communities to develop local systems of careinvolving mental health, child welfare, education, juve-nile justice, and other appropriate agencies.

Approximately $4.5 million is available in fiscal year1993 to plan for and begin implementation of services thatare currently underdeveloped or nonexistent: respite care,day treatment, therapeutic foster care, intensive home-based, school or clinic-based services, emergency ser-vices, and diagnostic and evaluation services. Each childwill have an individualized service plan developed withthe participation of family and, where appropriate, thechild. The plan will designate a case manager to assist thechild and family by coordinating services among multiplesystems. The program will be administered by S AMHS A 'sCenter for Mental Health Services (CMHS). Completedgrant applications are due on or before July 16, 1993.

CMHS will also administer the Mental Health Ser-vices Demonstration Grants for Statewide Family Net-works. This grant program was initiated to provide sup-port to family-controlled organizations for the developmentand expansion of statewide networks offering support andinformatioh to children and their families. Under theprogram, family-controlled organizations will provideassistance and disseminate information to individual fam-ily members and family groups throughout the UnitedStates. Approximately $1.3 million dollars are availablein fiscal year 1993 to support 20-25 projects and theaverage award is expected to be $50,000 per year for athree year period. Awards are limited to one per state.Completed grant applications are due on or before July30, 1993.

Similarly, CMHS will administer the Child and Ado-lescent Service System Program (CASSP) Infrastruc-ture Development Demonstration Grants. This pro-

gram is an effort to assist states in moving state-levelsystem improvement activities to the local level. Thisprogram is intended to demonstrate the efficacy of variousapproaches to infrastructure organization and to lay thefoundation for comprehensive, coordinated, community-based services to children and adolescents with seriousemotional disorders. Approximately $1.9 million will beavailable in fiscal year 1993 to support ten to twelveprojects. The expected average amount of each award will beapproximately $175,000 per year fora three yearperiod. Eachstate or territory may submit one application. Completedgrant applications are due on or before July 30, 1993.

Grant application kits for each of the above programsmay be obtained from: Steve Hudak, Grants ManagementOfficer, Center for Mental Health Services, Room 7C-23,5600 Fishers Lane, Rockville, Maryland 20857; (301)443-4456.

Interprofessional Education ProjectSeeks Nominations of Interdisciplinary Programs

The Interprofessional Education Project at the Re-search and Training Center on Family Support andChildren's Mental Health is engaged in a study of educa-tion and training programs around the country that arefamily-centered and that exemplify one or more of thefollowing principles: (1) interagency collaboration; (2)interprofessional collaboration; (3) family-professionalcollaboration; (4) cultural competence; and (5) commu-nity-based services.

We are seeking nominations of programs that incorpo-rate these principles, particularly those that provide inter-disciplinary or interprofessional learrdng opportunities.We will conduct a telephone and written survey of allnominated programs to find out about course content,target population, and educational methods. Our objec-tives are to locate, develop and disseminate interdiscipli-nary training materials that promote parent-professionaland interprofessional/interagency collaboration inchildren's mental health. If you know of any program(s)that meet our criteria, please call or write a note includingthe name, address and telephone number of the program,and, if possible, the name of a contact person. Pleaseprovide nominations to: Pauline Jivanjee, Project Man-ager, Interprofessional Education Project, Research andTraining Center on Family Support and Children's MentalHealth, Portland State University, P.O. Box 751, Portland,Oregon 97207-0751; (503) 725-5197.

Winter/Spring 1993 FOCAL POINT 15p,

NOTES & COMMENTS

Portland Research and Training CenterSchedules Spring 1994

Conference and Issues Call for PapersThe Research and Training Center on Family Support and

Children's Mental Health will sponsor a national conference,Building on Family Strengths: Research, Advocacy, andPartnership in Support of Children and Their Families,April 10-12, 1994, in Portland, Oregon. This conference is aforum for the examination and dissemination of state-of-theart research findings and issues in the areas of family supportand family-centered care. The conference is divided into fourtracks: Developments in Family Research Methods; FamilyMember/Consumer Involvement; Research on Family Sup-port Services; and Recognizing Family Diversity.

The conference is intended to bring together family mem-bers, researchers policy-makers, service providers, and advo-cates interested in strengthening research and practice inresponse to the needs of children and families. The conferencewill provide an opportunity for participants to disseminatefindings and innovations in family research.

Proposals are invited in the form of paper presentations,poster sessions or symposia. Preference will be given toabstracts that report on research results. For submissionapplications, general conference registration materials, orfurther information please contact Richard Hunter at theResearch and Training Center on Family Support andChildren's Mental Health, Portland State University, P.O.Box 751, Portland, Oregon 97207-0751; (503) 725-4040.

Seventh Annual Children's Mental ResearchConference Scheduled

The Research and Training Center for Children's Men-tal Health has scheduled its seventh annual research con-ference, A System of Care for Children' s Mental H ealth:Expanding the Research Base. The conference will beheld February 28-March 2, 1994 at the Hyatt RegencyWestshore in Tampa, Florida. Proposals and abstracts forpresentations addressing longitudinal research, systems-level interventions, outcome evaluations of children withserious emotional disorders and their families, and policydevelopment/change initiatives are invited. The deadlinefor submission is October 15, 1993. To request a submis-sion form, contact Dr. Krista Kutash, Deputy D; rector,Research and Training Center for Children's Mental Health,Florida Mental Health Institute, University of South

Florida, 13301 Bruce B. Downs Blvd., Tampa, Florida33612; (813) 974-4661 or (813) 974-4657.

CASSP Training Institutes Plannedfor June 1994

An important upcoming event will provide an inten-sive training opportunity for a wide range of participants.The biannual Child and Adolescent Service System Pro-gram (CASSP) Training Institutes are scheduled forJune 19-23, 1994 and will be held in Traverse City,Michigan at the Grand Traverse Resort.

The response to the 1992 Training Institutes, held inColorado, was overwhelming and confirmed an extraordi-nary level of interest in training related to the developmentof systems of care. To meet this need, the 1994 TrainingInstitutes will focus on Developing Local Systems of Carefor Children and Adolescents with Severe Emotional Dis-turbances and will offer an opportunity to obtain in-depth,practical information on how to develop, organize andoperate comprehensive, coordinated, community-basedsystems of care for children and their families. The facultywill be comprised primarily of representatives of commu-nities that have made substantial progress toward devel-oping systems of care, and participants will be able tochoose Institutes presenting different approaches to sys-tem development.

The Institutes are designed for a variety of individualsincluding state and local administrators, planners, provid-ers, parents, and advocates. A primary target group con-sists of agency administrators, managers, providers, andparents from local areas, representing mental health andother child-serving agencies. These individuals, ideallyattending as a team, are the ones who can take the knoxy.'!edge and skills developed at the Institutes and begin toapply it in their home communities. This training can be aninvaluable experience for a community that is planning asystem improvement initiative. This early announcementis intended to allow sufficient lead time to organizedelegations and make arrangements to attend.

The Institutes are sponsored by the CASSP TechnicalAssistance Center at Georgetown University and are fundedby the Substance Abuse and Mental Health ServicesAdministration, Center for Mental Health Services. Formore information contact the CASSP Technical Assis-tance Center at 2233 Wisconsin Avenue, N.W., Washing-ton, D.C. 20007; (202) 338-1831.

16 FOCAL PUNT Winter/Spring 1993

NOTES & COMMENTS

Fourth Annual Meeting of the Federation ofFamilies for Children's Mental Health HeldApproximately 300 family members and professionals

attended New Visions-New Partners: Advocacy, Involve-ment, and Strategies, the fourth an-nual meeting of the Federation ofFamilies for Children's MentalHealth. Held in Arlington, Virginiaon November 21 and 22, 1992, theconference workshops addressed theissues of early intervention, elemen-tary education, transition from schoolto work, juvenile justice, and ars--tody relinquishment.

Over 95 percent of those whoattended the meeting were family

members, and day care was provided for 30 children whoserelatives participated in the conference. Many families wereable to attend as they meived scholarships provided by theSubstance Abuse and Mental Health Services Administrationand dispersed through the Child and Adolescent ServiceSystem Program Technical Assistance Center. People ofcolor constituted 25-30 percent of those in attendance.

One highlight of the conference was a report on theMental Health Initiative for Urban Children project by theAnnie B. Casey Foundation. Communities in Massachu-setts, Florida, Virginia, Texas, Illinois, and Colorado havebeen chosen to receive grants to develop healthier neigh-borhoods, families and children. The grant money will bcused to expand and create new services, and for training tofill in service gaps and maintain children in their neighbor-hoods. The Initiative ad-dresses issues of jobs,safety, violence preven-tion, and after-schoolprograms. Over threemillion dollars will begranted to each state.

Several honors andawards were presented.The "Claiming Chil-dren" award went toBarbara Berlin of Loui-siana, who responded, "I keep my eye on the vision. Ourvoices will be heard and our children treated properly."Naomi Karp received a speci al gift of honor for her "visionand values," which have become the foundation of the

Naomi Karp

Barbara Friesen and Barbara Berlin

Federation. Barbara Friesen received the "Professional ofthe Year" award and was honored for her"honesty, creativityand integrity."

New Publications Available Through Research andTraining Center's Resource Service

Five new publications are available through the Re-search and Training Center's Resource Service. The re-sults of a nationwide study of professional training cur-ricuia in schools of social work, psychiatric nursing,clinical psychology, special education, and child psychia-try are described in Parent-Professional CollaborationContent in Professional Education Programs: A ResearchReport. The report includes descriptions of individualprograms, specific courses, and in some cases, publishedmaterials provided by faculty in response to requests forparent-professional curriculum materials.

One hundred thirty-six entries are contained in a sec-ond new publication entitled Annotated Bibliography:Collaboration Between Professionals and Families ofChildren with Serious Emotional Disorders. The topicsaddressed include the need for family-professional col-laboration, guidelines for the establishment of collabora-tive relationships, collaboration in early intervention andeducational systems, advocacy, and empowerment.

A model of family caregiving is presented in Buildinga Conceptual Model of Family Response to a Child'sChronic Illness or Disability. With the intent of informingfamily-centered research for families and children withemotional disorders, the model synthesizes the findings ofpsychological and sociological literature to identify thecausal antecedents, mediating processes, and adaptationaloutcomes of families coping with the challenges of caringfor children with emotional disorders.

Recommendations for developing a family research anddemonstration agenda for children's mental health are re-ported in the Family Research Demonstration SymposiumReport. This report is a result of a working meeting held in1992 and sponsored by the Research and Training Center incollaboration with the Child, Adolescent and Family Branch,Center for Mental Health Services, Substance Abuse andMental Health Services Administration. The document out-lines the suggestions of work groups who discussed promi-nent issues and developments in four areas of family research:parent-professional collaboration, training, and systems


!a

NOTES & COMMENTS

change; family support and advocacy; multicultural compe-tence; and financing family support options and services.

The third edition of the National Directory of Organiza-tions Serving Parents of Children and Youth with Emotionaland Behavioral Disorders is now available. While the secondedition contained 344 organizations, the third edition contains612 entries. The directory offers information on parent orga-nizations nationwide that provide education and infolmation,parent training, advocacy, support gimps, transition services,and direct assistance to parents. A wide range of organiza-tional types are listed, including self-help organizations coor-dinated by and for parents with no professional involvement,groups started by staff members of service-providing agen-cies, and groups sponsored by other organizations such asmental health associations.

Ordering infolmation is provided on page 19.

Four New Journals on Family Research AvailableThe Journal of Child and Family Studies focuses on

identifying, treating, and rehabilitating children and adoles-cents with emotional disorders, and presents family studiesfrom a mental health petspective. This international quarterlyjournal is directed toward scholars, researchers, and practitio-ners, and covers such topics as child abuse and neglect, respitecare, foster care, financing mental health care, and familystress. The format includes articles, book and media reviews,commentaries, and professional announcements. For moreinfonnation, contact: Nirbhay N. Singy, Editor, Departmentof Psychiatry, Medical College of Virginia, P.O. Box 489,Richmond, Virginia, 23298; (804) 786-4393.

The Journal of Emotional and Behavioral Disorders(JEBD) is an intemational, multidisciplinary journal featur-ing articles on research, practice, and theory related to indi-viduals with emotional and behavioral disordets and to theprofessionals who serve them. JEBD publishes original re-search reports, reviews of research, descriptions of practicesand programs, and discussions of key issues in the field.Topics focus on: characteristics, evaluation, intervention,assessment, and legal or policy issues. For additional informa-tion contact: Michael H. Epstein & Douglas Cullinan, Editors,PRO-ED Journals, 8700 Shoal Creek, Austin, Texas, 78758-6897; (512) 451-3246.

The Journal of Emotional and Behavioral Problems is aninterdisciplinary journal directed at policy leaders and practi-tioners who work with children in conflict. With a mission torevalue children and combine research with practice, thejournal addresses such topics as gangs, education, and em-

powering children and families. Each issue contains regularfeatures spotlighting the perspectives of children, problemsand stresses placing youth at risk, innovative programs, globalchallenges for youth development, and life space interview-ing for resolving conflict For mom information, contact:Nicholas Long & Larry Brendtro, Editors, Nancy R. Shin,Director of Publications, National Education Service, 1610West 3rd Street, P.O. Box 8, Bloomington, Indiana, 47402;(812) 336-7700.

A forthcoming publication, the Journal of ConvnunityPractice: Organizing, Planning, Development and Change,will provide a much needed publication forum for articles oncommunity organizing, planning, research, development,policy and social change. The journal will emphasize empiri-cal and theoretical articles and case studies focused on pro-cesses of organizing, social planning, policy analysis, socialand economic development and social change. Additionalinformation may be obtained from the following: Marie Weil,Editor, School of Social Work, University of North Carolina,Chapel Hill, 223 E. Franklin Street, CB #3550, Chapel Hill,North Carolina 27599-3550; (919) 962-1225.

Family Research Symposium HeldThe Research and Training Center on Family Support and

Children's Mental Health held a small working meeting onNovember 22-24, 1992 entitled, Family Symposium: Devel-oping a Research and Demonstration Agendafor Services inChildren' s Mental Health. The purposes of the symposiumwere to identify the current state of knowledge regardingfamily issues in children's mental health, develop recommen-dations for areas of future investigation, and identify ways toencourage investigation in the area of family-related research.

The working sessions began with presentations about thehistorical mots, dominant constructs, and research appmachesthat have characterized family research in other fields. Meet-ing participants then used a similar format to generate infor-mation on childten's mental health and identify four areas inneed of further development: (1) professionals and systems:parent-professional collaborations and training systems; (2)family support and family advocacy; (3) multicultural com-petence; and (4) financing of family support and family-centered services. Work groups then generated recommenda-tions for building a research agenda.

The results of the meeting are now available in a newdocument, the Family Research and Demonstration Sympo-sium Report. For ordering information, see page 19.

18 FOCAL POINT Winter/Spring 1993 9

Research and Training Center Resource Materials

NEW!Annotated B ibliography.Collaboration Between P rofessionalsand Families of Children with Serious Emotional Disorders. Contains136 entries addressing family-professional collaboration, establishingcollaborative relationships, collaboration in early intervention and edu-cation, advocacy, and empowerment. $6.00.

C3 Annotated Bibliography. Parents of Emotionally Handicapped Chil-dren: Needs, Resources. and Relationships with Professionals. Coversrelationships between professionals and parents, parent self-help, sup-port groups, parent panicipation. $7.50.

AnnotatedBibliography.Youth inTransition: Resources for Program Devel-opment and Direct Service Intervention. Transition needs of adolesomts:edubational and vocational issues, programs and cuniculum. researchoverviews, interpersonal issues, skills training. $6.00.

O Brothers and Sisters of Children with Disabilities: An Annotated Bibliog-raphy. Addresses the effects of children with disabilities on their brothersand sisters, relationships between children with disabilities and theirsiblings, services and education for family members. $5.00.

NEMBuilding a Conceptual Model of Family Response to a Child'sChronic Illness or Disability. Proposes comprehensive model of familycaregi..ing based on literztvre review. Causal antecedents, mediating pro-cesses and adaptational outcomes of family coping considered. $5.50.

O Changing Roles, Changing Relationships: Parent-Professional Collabora-tion on Behalf of Children With EmotionalDisabilities. Monograph exam-ines bathers to collaboration, elements of successful collaboration, strate-gies for parents and proles sionals to promote collaborative working relation-ships, checklists for collaboration, suggested resources. $4.50.

Child Advocacy Annotated Bibliography. Includes selected articles, books,anthology entries and conference papers. $9.00.

O Choices forTreaunera: Methods,Models,and Programs of Intervention forChildren With Emotional Disabilities and Their Families. An AnnotatedBibliography. Literature on the range of therapeutic interventions used withchildren and adolescents with emotional disabilities is described. Includesinnovative strategies and programs. $6.50.

O Developing and Mainsaining Mutual Aid Groups for Parents and OtherFamily Members: An Annotated Bibliography. Topics addressed includeorganization and development of parent suppon groups and self-helporganizations, professionals' roles in self-help groups, parent empower-ment in group leadership, and gre, 2 advocacy. $7.50.

Families as Allies Conference Proceedings: Parent-Professional Collabo-ration Toward Improving Services fcr Seriously Emotionally HandicappedChildren and Their Families.April 1986. Delegates from thirteen westernstates. Includes: agenda, presentation traracriptions. recommendations,worksheets, and evaluations. $9.50.

O NEW! Family Research andDemonstration Symposium Report. Summa-rizes recommendations from 1992 meeting for developing family researchand demonstration agenda in areas of parent-professional collaboration andtraining systems, family support and advocacy, multicultural competence,and financing. $7.00.

10 Gathering and Sharing: An Exploratory Study of Service Delivery toEmotionally Handicapped Indian Children. Findings from Idaho, Oregon,and Washington, covering current services, successes, service deliverybarriers, exemplary programs and innovations. S4.50.

C3 Glossary of Acronyms, Laws. and Terms for P arents W hose Children HaveEmotional Handicaps. Glossary excerpted from Taking Charge. Approxi-mately 150 acronyms, laws, and words and phrases commonly encounteredare explained. S3.00.

InteragencyCollaboration: An Annotated Bibliography for Programs Serv-ing Children With Emotional Disabilities and Their Families. Describeslocal interagency collaborative efforts and local/state efforts. Theories ofinterorganizational relationships, evaluations of interagency programs. and

practical suggestions for individuals contemplating joint programs areincluded. $5.50.

Issues in Culturally Competent Service Delivery: An Annotated Bibliogra-phy. Perspectives on culturally-appropriate service delivery; multiculturalissues; culturally specific African-American, Asian-American/Pacific Is-lander, Hispanic-Latino American, Native American sections. 55.00 .

Making the System Work: An Advocacy Workshop for Parents. A train-ers ' guide for a one-day workshop to introduce the purpose of advocacy,identify sources of power and the chain of command in agencies andschool systems, and practice advocacy techniques. 58.50.

The Multnomah County CAPS Project: An Effort to Coordinate ServiceDelivery for Children and Youth Considered Seriously Emotionally Dis-turbed. Process evaluation of an interagency collaborative effort. Theplanning process is documented and recommendations ate offered. $7.00.

NEW! National Directory of Organizations Serving Parents of Childrenand Youth with Erosional and Behavioral Disorders, Third Edition. In-cludes 612 entries describing organizations that offer support, educatice,referral, advocacy, and other assistance to parents. $12.00.

Next Steps: A National Family Agenda for Children Who Have EmotionalDisorders Conference Proceedings. December 1988. Includes: develop-ment of parent organizations, building coalitions, family suppon services,access to educational services, custody relinquishment, case management..S6.00.

Next Steps: A National Family Agenda for Children Who Have EmotionalDisorders (booklet). Briefly summarizes Next Steps Cafference and rec-ommendations made by work groups. Designed for use in educatingadministrators, policymakers and advocates about children's mental healthissues. Single copy: $2.50. Five Copies: $7.00

O Organizations for Parenss of Children Who Have Serious EmotionalDisorders: Report ofaNational Study. Results of study of 207 organizationsfor parents of children with serious emotional disorders. Organizations'activities, program operation issues, training programs described. $4.00 .

O NEW! Parent-Professional CollaborationContent in Professional Edu-cation Programs: A Research Report. Results of nationwide survey ofprofessional programs that involve parent-professional collaboration. In-cludes descriptions of individual programs . S5.00.

O Parents' Voices: A Few Speak for Many (videotape). Parents of childrenwith emotional disabilities discuss their experiences related to seeking helpfor their children (45 minutes). A trainers' guide is available to assist inpresenting the videotape. Free brochure describes the videotape and train-ers' guide and provides purchase or rental information.

O Respite Care: A Key Ingredient of Family Support. Conference proceed-ings. October 1989. Includes speeches and panel presentations on topicssuch as starting respite programs, finanang services, building advocacy,and rural respite care. $5.50.

O Respite Care: An Annotated Bibliography. Issues discussed include: therationale for respite services, family needs, program development, respiteprovider training, funding, and program evaluation. $7.00.

O Respite Care: A Monograph. Monograph describes: types of respite careprograms, recruitment and training of providers, benefits of respite servicesto families, respite care policy and future policy directions, and a summaryof funding sourccs. $4.50.

O Statewide Parent Organization Demonstration Project Final Report. De-scribes and evaluates the development of statewide parent organizations infive states. $5.00.

O Taking Charge: A Handbook for Parents Whose Chil&en Have EmotionalHandicap:. Addresses issues such as parents' feelings about themselvesand their children, labels and diagnoses, and legal issues. Second editionincludes post-traumatic stress disorder and moo:1 disorders such as child-hood depression and bipolar disorder. $7.00 .


Therapeutic Case AdvocacyTrainers'Guide: A Format forTraining DirectService Staff and Administrators. Addresses interagency collaborationamong professionals in task groups to establish comprehensive systems ofcare for children and their families. $5.75.

Therapeutic CaseAdvocacyWorkers' Handbook. Companion to the Thera-peutic Ciue Advocacy Trainers Guide. Explains the Therapeutic CaseAdvocacy model, structure of task groups, group process issues, evalua-tions. 84.50.

Transition Policies Affecting Services to Youth With Serious EmotionalDisabilities. Examines how state level transition policies can facilitatetransitions from the child service system to the adult service system.Elements of a comprehensive transition policy are described. Transitionpolicies from seventeen states are included. 88.50.

1:3 Working Together: The ParentlProfeuional Partwship. A trainers' guidefor a one-day workshop for a combined parent/professional audience.Designed to identify perceptions parents and professionals have of eachother and obstacles to cooperation: as well as discover the match betweenparent needs and professional roles, and practice effective listening tech-niques and team decision making. $8.50.

0 Youth in Transition: A Description of Selected Programs Serving Adolu-cents WithEmotionalDisabilities. Descriptions of existing youth transitionprograms provided. Residential treatment, hoapital and school based, casemanagement, and multi-service agency transition programs am included.86.50.

List of Other Publications Available Through the Research and TrainingCenter. Free.

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