Improving community-based mental health care for children: a commentary.

In their article, "Improving Community-Based Mental Health Care for Children," Garland and colleagues explore and confront quality issues that are endemic to outpatient specialty mental health care for children in the United States. Their article presents evidence supporting the lack of effectiveness of usual care and draws on implementation science to explore areas for improving the quality of outpatient mental health care for young people. This commentary accepts these basic arguments and strategies, explores policy options that support the suggested reforms, and examines evidence-based programs in a broader context that draws on the systems of care approach. Specific issues addressed in this commentary include workforce capacity, policy options for improving care quality, provider incentives, systematic implementation supports, strategies to incorporate evidence-based approaches into practice, youth-guided and family-driven care, and the need to expand the definition of evidence-based practice to include the concepts of community-defined evidence and practice-based evidence.

Research on transition to adulthood: building the evidence base to inform services and supports for youth and young adults with serious mental health disorders.

Since the mid-1990s, research has established a clear picture of the poor real-life outcomes achieved by transition-age youth and young adults who have been diagnosed with a serious mental health disorder. The purpose of this article is to: (1) introduce the reader to the other eight articles in this special issue on Transition to Adulthood Research; (2) illustrate how each is contributing to the research base available to more fully understand these challenges as well as guide the creation of developmentally appropriate and effective services and supports for youth and young adults and their families; and (3) suggest future directions for continuing to advance this field of research and program implementation to improve outcomes though practice and policy improvements.

Characteristics, service experiences, and outcomes of transition-aged youth in systems of care: programmatic and policy implications.

This article examines data for 8,484 transition-aged youth (TAY) in different age groups who received services in 45 federally funded systems of care between 1997 and 2006. Data from the national evaluation of these systems of care were used to compare descriptive and clinical characteristics at intake of TAY aged 14-15, 16-17, and 18 years, and service use and outcomes of TAY aged 14-15 and 16-17 at 6 and 12 months after system of care intake. Few studies have examined outcomes of TAY. The large national evaluation database provides a unique opportunity to examine outcomes for TAY in relation to increases in age. Results revealed differences in severity and type of behavioral and emotional problems, living situations, access to Medicaid, service use, and outcomes among younger and older youth. Findings support the need to enhance access to services for older TAY and to customize services to the unique needs of each age group.

State child mental health efforts to support youth in transition to adulthood.

The ability of state child mental health (MH) systems to facilitate the transition to adulthood of adolescents in their systems was studied by interviewing members of the Children, Youth and Families Division of the National Association of State Mental Health Program Directors (NASMHPD). Results demonstrated that transition services within the state child MH systems are sparse, nationally. Continuity of services as youth age into adulthood is hampered because of generally separate child and adult MH systems, each with separate policies defining who accesses those services, lack of clarity about procedures to access adult MH services, and lack of shared client planning between adult and child MH systems. These findings suggest that adolescents in state child MH systems have difficulty accessing services that will help them with the difficult task of learning to function as an adult. Public MH systems should examine their capacity to provide transition supports and make needed improvements.