Is There a National Policy for Children and Youth with Serious Emotional Disturbance?
Koyanagi, Chris, Policy Studies Journal
Of the approximately 7.5 million children who experience some type of emotional, behavioral, or mental disorder (Office of Technology Assessment, 1989), between three and five million are estimated to have serious disorders (Knitzer, 1982). These children have multiple needs (Duchnowski, 1988), and frequently require assistance from more than one human service agency. Mental health, education, and child welfare are three major systems with which significant numbers of children and adolescents who have serious emotional disturbance(1) come into contact.(2)
This article examines significant federal programs in these three systems, as well as the income support program Supplemental Security Income (SSI), which provides another important resource for such children and their families.
The Need for Services Integration
Much has been written over the past two decades regarding how poorly all systems meet the needs of these youngsters. Knitzer, in Unclaimed Children (Knitzer, 1982), and the Office of Technology Assessment (1989), in a major report, found that two-thirds of children with mental and emotional disorders were receiving either no services or services inappropriate to their needs.
As early as 1969, the Joint Commission on the Mental Health of Children recommended that an integrated network of community services be developed to meet better the needs of children and youth with serious emotional disturbance (Joint Commission on the Mental Health of Children, 1969). Several other studies since have reiterated this theme (President's Commission on Mental Health, 1978a, 1978b).
As a result, policymakers at both the national and state levels recently have focused on the need to engage in systems planning involving multiple agencies, in order to meet the needs of a growing population of young people with serious emotional disorders. The Intergovernmental Health Policy Project (Child Mental Health, 1993) has identified the following policy themes that have emerged recently in the states: (a) the identification of shared responsibilities among child-serving agencies, (b) concerns about overuse and costliness of institutional care, (c) the need for family support and family preservation to make services more family-friendly and child-focused, and (d) the recognition that case management is an essential component of the service system for children with mental and emotional disorders. But states' efforts are at a precarious stage. Although many states are moving in new directions, funds are short, the difficulties of interagency collaboration are extremely difficult to overcome, and the advocacy movement for children with emotional disorders is in its infancy. Federal leadership and support is sorely needed to assist the states in developing and sustaining these new policy themes.
Yet, despite widespread recognition of the need, federal policy in this area is still piecemeal, with no coordinated cross-agency agenda and far too few resources. In the words of Senator Edward Kennedy (D-MA), "despite 25 years of federal policy efforts, community-based treatment opportunities for the seriously mentally ill are still largely inadequate" (Kennedy, 1990).
At the national level, children with serious emotional disturbance are the responsibility of various departments and agencies. Unfortunately, the agency that has the greatest direct interest in the area, the Center for Mental Health Services (CMHS)(3), within the Substance Abuse and Mental Health Services Administration of the Department of Health and Human Services, is the one with the least resources. Dwarfing the Center's budget are the Department of Education's special education program, the child welfare programs administered by the Administration for Children and Families, and the Social Security Administration's disability programs. While interagency collaboration increasingly is seen as a fundamental part of reforms for …
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Publication information: Article title: Is There a National Policy for Children and Youth with Serious Emotional Disturbance?. Contributors: Koyanagi, Chris - Author. Journal title: Policy Studies Journal. Volume: 22. Issue: 4 Publication date: Winter 1994. Page number: 669+. © 1999 Policy Studies Organization. COPYRIGHT 1994 Gale Group.
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