This study evaluates an exemplary system of care designed to provide comprehensive mental health services to children and adolescents. It was believed that the system would lead to more improvement in the functioning and symptoms of clients compared to those receiving care as usual. The project employed a randomized experimental five-wave longitudinal design with 350 families. While access to care, type of care, and the amount of care were better in the system of care, there were no differences in clinical outcomes compared to care received outside the system. In addition, children who did not receive any services, regardless of experimental condition, improved at the same rate as treated children. Similar to the Fort Bragg results, the effects of systems of care are primarily limited to system-level outcomes but do not appear to affect individual outcomes such as functioning and symptomatology.

Despite the proliferation of outcomes measurement systems in managed care, there has been no systematic attempt to discover what information clinicians find useful. Five hundred thirty-nine mental health clinicians who serve adolescent clients responded to a mail survey. They rated the value of 29 categories of information describing adolescent clients. Results show how clinician background and experience influence the kind of information they prefer and how and when clinicians prefer to receive information. If outcomes measurement systems are ever to become useful tools, they must provide information that clinicians need and are willing to use. LEONARD BICKMAN received his PhD from the City University of New York. He is professor of psychology, psychiatry, and public policy at Vanderbilt University, where he directs the Center for Mental Health Policy. He is coeditor of die Applied Social Research Methods series and is the editor of a new journal, Mental Health Services Research. JULIE RosOF-WILLIAMS received her MSN in nursing from Vanderbilt University. She is a National Institute of Mental Health (NIMH) Pre-Doctorate Fellow at the Vanderbilt Institute for Public Policy Studies, Center for Mental Health Policy. She also works part time as a clinician in the Vanderbilt University School of Medicine. Her research interests focus on changing clinician behaviors and process evaluation of children's mental health services. MARK S. SALZER received his PhD in clinical psychology from the University of Illinois at Urbana-Champaign. He is a research assistant professor at the Center for Mental Health Policy and Services Research in the Department of Psychiatry at the University of Pennsylvania. His training also includes a 2-year postdoctoral fellowship in children's mental health services research at Vanderbilt University with Leonard Bickman. Dr.

Demonstrations of high-quality services have surpassed cost control as the primary task of health care. In this study we evaluated the relationship between several traditionally accepted standards of quality of children's mental health care and client mental health outcomes. Three customary performance guidelines (therapeutic relationship, satisfaction, and parent involvement) that are believed to be indicators of quality care were tested for their ability to account for improvement of mental health outcomes among adolescent clients. In addition, we examined service utilization to determine whether it represents an intermediate outcome of the treatment process.The results showed statistically significant, yet weak and inconsistent, relationships between these commonly accepted measures of quality and client outcomes among adolescents receiving outpatient treatment. We did not find service utilization to be a mediator.Limitations of the study and implications of the results are discussed.

No abstract

The effects of systems of care are primarily limited to system-level outcomes such as access to and cost of care and do not appear to affect clinical outcomes such as functioning and symptoms.