We contribute to the theoretical and research knowledge base regarding the pathways between parental social support, family well being, quality of parenting, and the development of child resilience in families with a child with serious emotional problems. Little conceptual development has been done that provides a theoretical framework for studying the relationships among these variables. We identify key findings from social support theory and research, including the impact of social support on family well being and the parents' capacity to parent, and the experience of parental social support in families with a child with a disability. We review the constructs of family well being, quality of parenting, and child resilience. Further, we explain the pathways between parental social support, family well being, quality of parenting, and child resilience in families with a child with serious emotional problems. Key variables of the model and the nature of their inter-relationships are described. Social support is constructed as a protective mechanism with main and buffering effects that can impact family well being, quality of parenting, and child resilience at a number of junctures. The conceptual model's implications for future theory development and research are discussed.KEY WORDS: social support; family well being; quality of parenting; child resilience; children with serious emotional problems.

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Commercial sexual exploitation of children has emerged as a critical issue within child welfare, but little is currently known about this population or effective treatment approaches to address their unique needs. Children in foster care and runaways are reported to be vulnerable to exploitation because they frequently have unmet needs for family relationships, and they have had inadequate supervision and histories of trauma of which traffickers take advantage. The current article presents data on the demographic characteristics, trauma history, mental and behavioral health needs, physical health needs, and strengths collected on a sample of 87 commercially sexually exploited youth. These youth were served in a specialized treatment program in Miami-Dade County, Florida, for exploited youth involved with the child welfare system. Findings revealed that the youth in this study have high rates of previous sexual abuse (86% of the youth) and other traumatic experiences prior to their exploitation. Youth also exhibited considerable mental and behavioral health needs. Given that few programs emphasize the unique needs of children who have been sexually exploited, recommendations are offered for providing a continuum of specialized housing and treatment services to meet the needs of sexually exploited youth, based on the authors' experiences working with this population.

For more than a decade, the philosophy of community-based systems of care has guided the delivery of mental health services for children and adolescents served by publicly funded agencies. This philosophy supports system attributes that include a broad array of services; interagency collaboration; treatment in the least-restrictive setting; individualized services; family involvement; and services responsive to the needs of diverse ethnic and racial populations. The notion of systems of care emerged in an era when managed health care also was gaining popularity. However, the effect of managed care on the delivery of mental health and substance-abuse services--also known as behavioral health services--has not been widely studied. Preliminary results from the nationwide Health Care Reform Tracking Project (HCRTP) inform discussions about the impact of managed behavioral health care on services for children and adolescents enrolled in state Medicaid programs. Most states have used some type of "carve-out design" to finance the delivery of behavioral health services, and there is a trend toward contracting with private-sector, for-profit companies to administer these benefits. In general, managed care has resulted in greater access to basic behavioral health and community-based services for children and adolescents, though access to inpatient hospital care has been reduced. Under managed care, it also has been more difficult for youths with serious emotional disorders, as well as the uninsured, to obtain needed services. With managed care has come a trend toward briefer, more problem-oriented treatment approaches for behavioral health disorders. A number of problems related to the implementation of managed behavioral health care for children and adolescents were illuminated by the HCRTP. First, there is concern that ongoing efforts to develop systems of care for youths with serious emotional disorders are not being linked with managed care initiatives. The lack of investment in service-capacity development, the lack of coordination with other agencies serving children with behavioral health problems, and cumbersome preauthorization requirements that may restrict access to appropriate service delivery were other concerns raised by respondents about managed care. As the adoption of managed behavioral health care arrangements for Medicaid beneficiaries expands rapidly, the HCRTP will continue to analyze how this trend has affected children and adolescents with behavioral health problems and their families.

In this article, we describe the outcomes associated with a 3-year research demonstration project. It is the second of a two-part article concerned with this research conducted in the Bronx, New York, to examine the efficacy of three models of intensive in-home services—Home-Based Crisis Intervention (HBCI), Enhanced Home-Based Crisis Intervention (HBCI+),and Crisis Case Management—as alternatives to hospitalization for children experiencing a psychiatric crisis. In Part I (Evans, Boothroyd, & Armstrong, 1997), we described the features of the three program models, the research design, data collection measures, and the presenting characteristics of the children and families. In Part 2, we describe the success of maintaining children at home (82%) and the increases in family adaptability, children's self-concept, and parental self-efficacy both at discharge and at 6 months postdischarge. Enrollees in two of the models (HBCI and HBCI+) experienced a significant increase in family cohesion,although this was not maintained at 6 months postdischarge. While enrollees in the enhanced program showed significant increase in social support at discharge, all enrollees experienced this at 6 months postdischarge.