The impact of legislation to improve coordination of services to children with serious emotional disturbance.
OBJECTIVE
This study evaluated the impact of state legislation in Indiana mandating establishment of local coordinating committees to prevent inappropriate placement of children and youth with serious emotional disturbance out of the home and to facilitate the development of communitybased initiatives.


METHODS
In the first stage of the study, a survey was sent to the directors of mental health, welfare, education, and probation agencies of each county to estimate the extent that the structure and processes mandated by law were in place. In the second stage, structured interviews were conducted with the directors of key agencies in seven representative counties.


RESULTS
Stage 1 produced 310 completed surveys from all 92 counties; 73 counties had functioning committees. Improved coordination among providers was the most frequently cited reason for the committee's success; half of the respondents felt that the committee resulted in better services. More than half reported that too few service options were available. Other problems cited were rigid funding opportunities that limited options and lack of staff time to attend and prepare for meetings. Interviewees in the second stage noted that the committee too often formalized already-made decisions, that consideration of individual cases came too late in the process, and that in many cases less restrictive options had already been tried unsuccessfully. They also noted that the committee process had not achieved its major objective of pooling resources to address the needs of particular children.


CONCLUSIONS
Adequate funding and a fiscal strategy to support coordination and staffing of local coordinating committees are critical to their successful implementation.
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, USA.
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Petti
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Phillips
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Williams
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Killen
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Jackson
D000342:Affective Symptoms / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D002648:Child; D002662:Child Health Services / Q000331:legislation & jurisprudence*; D003131:Combined Modality Therapy; D006288:Health Planning Organizations / Q000331:legislation & jurisprudence; D006801:Humans; D007196:Indiana; D007400:Interprofessional Relations; D008605:Mental Health Services / Q000331:legislation & jurisprudence*; D010348:Patient Care Team / Q000331:legislation & jurisprudence*; D015397:Program Evaluation; D011635:Public Health Administration / Q000331:legislation & jurisprudence*; D014481:United States