Academic journal article Education & Treatment of Children

A Developmental Ecological Perspective in Systems of Care for Children with Emotional Disturbances and Their Families

Academic journal article Education & Treatment of Children

A Developmental Ecological Perspective in Systems of Care for Children with Emotional Disturbances and Their Families

Article excerpt

Abstract

The fragmented nature of the U.S. mental health system with its focus on tertiary care has created serious gaps in mental health service provision and consequently a large percentage of children with mental health needs receive little, if any intervention in schools or communities. For those children and their families who are receiving services, the services system historically lacked home and community treatment options and outcomes for this group have continued to be poor. Moreover, identifying children as having emotional disturbances is difficult because this is a diverse group presenting a wide variety of mental health needs and current assessment technologies in both mental health and education are limited in the information that they can provide. These issues highlight the challenges of providing effective services to children with emotional disturbances and their families and emphasize the need for a comprehensive conceptual framework to guide research, assessment, and service provision. A developmen tal ecological perspective provides a useful model for addressing the complexities of emotional disturbances. The systems of care movement in children's mental health, which is congruent with the developmental ecological perspective, also provides a mechanism for responding to the multidimensional aspects of these kinds of disabilities.

KEYWORDS: Systems of care, Emotional disturbances, Developmental ecological perspectives, Wraparound services, Assessment.

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According to the latest estimates by the Surgeon General, 11% of America's youth, ages 9-17, have a diagnosable mental or addictive disorder associates that cause significant impairment in functioning (Dwyer, 2002; USDHHS, 1999). Researchers have estimated that the prevalence of emotional and behavioral challenges among children and youth probably falls between 9% and 19% (Friedman, Kutash, & Duchnowski, 1996), and it is estimated that somewhere between 2% and 6% of this group should receive school-based services under the category of emotional disturbance (ED) (Forness & Knitzer, 1992; Illback, Nelson, & Sanders, 1998), as defined by the Individuals with Disabilities Education Act (IDEA) Amendment of 1997 (IDEA, 20 U.S.C., 1997). However, the fragmented nature of the U.S. mental health system with its historical focus on tertiary care has created serious gaps in mental health service provision and a large percentage of children with mental health needs receive little, if any, intervention in schools or commu nities (Forness & Knitzer, 1992; Walrath, Nickerson, Crowel, & Leaf, 1998). Moreover, for those children and their families who are receiving services, this has translated into a service system devoid of home and community treatment options, separated from the natural settings where problems occur. For example, often these children receive services in restrictive settings (e.g., residential placements) not because this represents the most appropriate placement, but because of a lack of available community alternatives (Duchnowski, Hall, Kutash, & Friedman, 1998; Knitzer, Steinberg, & Fleisch, 1990).

Outcomes for this population of children and youth have continued to be poor. In general, research findings demonstrate that, as a group, children with ED have the poorest long-term outcomes of any disability group (Kutash & Duchnowski, 1997; Wagner, 1995). Friedman et al. (1996) reviewed several studies on the characteristics of children with emotional and behavioral disabilities and concluded that these children have serious problems in multiple domains, including emotional and behavioral functioning, educational performance, social behavior, and overall functioning. For example, these children tend to have poorer school performance and higher rates of school dropout, unemployment, and arrests than any other disability group (U.S. Department of Education, 1998). In mathematics and reading, this group is approximately 1-1/2 year behind their peers without disabilities (Duchnowski & Kutash, 1996), with the disparity increasing over time (e. …

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