Problems in making organizational systems work for children.

Abstract

Complex organizational systems create ethical dilemmas for professionals in providing quality clinical services to children. Some of these issues were discussed and a schematic model was presented defining parameters underlying strategies for effective action. Limitations of the model were noted and recommendations were made to initiate collective effort to develop effective approaches. A call was made for professional associations to provide greater support for clinicians facing dilemmas through workshops and conferences, and for graduate programs to implement training in systems negotiations. A challenge was issued to psychologists to share their experiences and suggestions. J. N., aged 16, was in detention after being apprehended by the police for breaking and entering. His behaviour was totally out of control with physically violent tendencies. He had along history of difficulties at home, school and within the community. Social service agencies had been involved with J. N. and his family since he was seven years old. Because of family resistance, bureaucratic red tape, inadequate program facilities, and poor service coordination, nothing was ever accomplished for J. N. and his behavioural symptoms grew more severe until he became socially dangerous. All professionals most recently involved were at a loss as to what to do for him.

Use of mental health services among severely emotionally disturbed children and adolescents in San Francisco

“…This report was followed by the National Institute of Mental Health plan for research on child and adolescent disorders (National Advisory Mental Health Council, 1991). These landmark commission findings have been supported by numerous reports by professionals in the field, which consistently address the need to increase services in the context of an integrated network of service agencies (Coren & McKale, 1985;Inouye, 1988;Julius, Lipton, Pettifor, & Smith, 1980;Knitzer, 1982;Rae-Grant, 1976). Some attempts at such integration have been attempted in North Carolina (Behar, 1984) and Ventura County, California (Feltman & Essex, 1989;Jordan & Hernandez, 1990).…”

Integrating systems of care in California for youth with severe emotional disturbance. I. A descriptive overview of the California AB377 evaluation project

“…The 1989 IOM report was followed by the National Institute of Mental Health plan for research on child and adolescent disorders (National Advisory Mental Health Council, 1991). These landmark commission findings have been supported by numerous publications which consistently address the fragmentation and underfunding of services to children suffering from severe emotional disturbance (Coren & McKale, 1985;Inouye, 1988;Julius, Lipton, Pettifor, & Smith, 1980;Knitzer, 1982;Rae-Grant, 1976).…”