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CHILDREN'S HEALTH INITIATIVE
About the Children's Health Initiative
(mission, method, and results)
Children's Health Initiative Publications
Relevant Children's Health Initiative Resources
Figure
1- MHSPY Model Design and Infrastructure (PDF)
About the Children's Health Initiative
Mission
The Children's Health Initiative (CHI) is the research home for
a longitudinal, multi-wave study of the effectiveness of a highly
coordinated combination of mental health, pediatric and substance
abuse services in maintaining Medicaid youth with serious emotional
disturbance (SED) in their homes and communities.
The research is focused on the impact of a uniquely integrated
clinical intervention provided through the Mental Health Service
Program for Youth (MHSPY).
Methods
The Children's Health Initiative monitors and reports on four discrete
outcome domains for children with serious emotional disturbance
who are at-risk of out-of-home placement: (1) functional status,
(2) utilization, (3) cost, and (4) satisfaction. These long-term
outcomes were selected by state level advisory group of stakeholders
to measure whether a clinically intensive, family-driven system
of care, working to maximize continuity of intent across interventions
would lead to improved clinical quality and cost-effectiveness.
The study employs a longitudinal, multi-wave process using standardized
measures of clinical functioning, service utilization, cost and
satisfaction for children ages 3 through 19. Multiple standardized
measures are administered to assess the overall level of functioning
of the target population and identify the presence of change in
mental health status at intake and every six months while the participant
is enrolled in the program. These measures include the Child and
Adolescent Functional Assessment Scale (CAFAS), Child Global Assessment
Scale (CGAS), Child Patient Assessment Tool (PAT), Child Behavior
Checklist (CBCL), Youth Self Report (YSR), Teacher Report Form (TRF),
Family Centered Behavior Scale (FCBS), as well as a Family, Youth
and Agency Satisfaction Surveys. Service utilization data is also
maintained on all medical services, including mental health and
substance abuse, pharmacy, emergency room use, surgery, medication,
lab for all enrolled MHSPY youth.
Results
Analysis of MHSPY results performed by the Children's Health Initiative
Research Team, in collaboration with nationally recognized consultants,
indicates study participants experience clinically significant improvement
(>20 point drop in scores) as measured by the CAFAS. These results
are consistent with an unusual degree of engagement in mental health
services for the study population in contrast to their documented
level of participation in treatment prior to enrollment in the study.
Additionally, medical costs (including hospital, ER, etc.) are sixty-four
percent (64%) lower than those for the Medicaid standard reference
group. Ninety-eight percent (98%) of MHSPY families indicate that
their Care Manager "helps them expect good things in the future
for themselves and their children", while eighty-three percent
(83%) of parents/caregivers report being "satisfied" or
"very satisfied" with the help they received.
MHSPY Publications
Grimes, K. E. (2004). Systems of Care in North America. In Remschmidt,
Belfer & Goodyer (Eds.), Facilitating pathways: Care, treatment
and prevention in child and adolescent mental health (pp. 35-43).
Berlin: Springer.
Grimes, K. E., Kapunan, P. E., & Mullin, B. Children's Health
Services in a "System of Care": Patterns of Mental Health,
Primary and Specialty Use. Public Health Reports. 2006; 121:
311-323.
Grimes, K. E. & Mullin, B. MHSPY: A Children's Health Initiative
for Maintaining At-Risk Youth in the Community. The Journal
of Behavioral Health Services & Research. 2006; 33(2): 196-212.
Pires, S. A. & Grimes, K. E. (2006). Clinical decision making
approaches for child/adolescent behavioral health care in public
sector managed care systems. Promising approaches for behavioral
health services to children and adolescents and their families in
managed care systems, 8. Tampa, FL: Research and Training Center
for Children's Mental Health, Louis de la Parte Florida Mental Health
Institute, University of South Florida, 89-99.
Relevant MHSPY/Children's Health Initiative
Resources
www.who.int/mental_health/media
www.jhsph.edu/wchpc/publications
rtckids.fmhi.usf.edu/rtcpubs/promising_approaches
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rtckids.fmhi.usf.edu/rtcpubs/promising_approaches-2
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Contact Info:
Katherine E. Grimes, MD, MPH - Principal Investigator
Sophie Lehar, MA - Senior Research Coordinator
120 Beacon St, 4th Fl.
Somerville, MA 02143
617-503-8456 (phone)
617-503-8470 (fax)
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