Trying to remodel the children and youth service system: Observations about barriers and opportunities

Abstract

From their perspective as participant observers, the authors discuss the initial phase of an attempt to remodel the chilafamily mental health service delivery system. Conceptualizing families as being at varying levels of risk for dismemberment is seen as: (a) providing a politically viable terminology, (b) permitting each agency to develop a continuum of services tailored to its mandate and clientele, and (c) facilitating legislative efforts to analyze simultaneously the budgets of all those state agencies with major responsibilities for children's services. A planning team endorsed cooperative planning between a state-level coordinating council and individual locales. Cultural communities were invited to participate in a manner paralleling the planning role of local communities. A model for a free standing case management entity is proposed. The concept of empowerment is discussed as a criterion for multi-level outcome evaluation.Fiscal structures and available dollars drive services. Those categories of services which are reimbursable are made available through public agencies and private providers. Children who require assistance are referred for the types of services that are available even if those services do not constitute a particularly effective response to the dilemma being experienced.Fiscal structures and fbnding patterns do not self-generate spontaneously. Nor do they persist in a vacuum. Rather, they function as part of a complex system in which the number of recipients-rather than estimates of treatment effectivenessis cited as evidence that a service is worthwhile. Associated with each currently available service is a constituency comprised of recipients, providers, and sponsors. These constituencies understand the universe of dilemmas requiring remediation Brian Sarata, Ph.D., is Associate Professor of ClinicaKommunity Psychology and Dave Provorse, M.A., is a doctoral student in Clinical/Community Psychology at the University of Nebraska-Lincoln, USA. This article is based upon a paper originally written in July 1988, when the authors were completing a year-long involvement with the Nebraska Intergovernmental and Community Planning Process for Families and Children. The decision to make only editorial changes and not alter the basic content of the original paper to update subsequent events in Nebraska reflects the belief that our participantobserver perspective offers a unique view of attempts to reform a mental health system and that a discussion of subsequent developments-observed from a different role perspective-would change the nature of this paper. Address reprint requests and correspondence to Professor