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Michigan
Outcome Identification Project
A. Broad issues in the target populations domain
It was found that participant responses to the question of who the children's public mental health system should serve could be divided into three broad categories or groupings. These were: 1) responses which targeted the child as a recipient of services, 2) responses which targeted the family as recipient of services, and 3) responses which targeted the community as recipient of services. The frequency with which a certain response occurred was considered in order to determine which responses showed the most strength of response. Table 6 presents a summary of these findings in the Target Population domain, and results are presented in more detail in Appendix 1. As Table 6 shows, the three priorities identified under the broad category of child as recipient of services are: 1) children in need of early intervention; 2) children in or at risk of out-of-home placement; and 3) children with serious emotional or mental illness.
Children in need of early intervention received considerable attention and concern across all stakeholder groups, with these children identified as a priority population a total of 43 times throughout all of the focus groups. This category includes children birth to 5 years, school-aged children, and anyone who needs or requests services. Of these 43 occurrences of this issue in focus group conversations, 20 came from stakeholders inside of mental health, 14 from family members, and 9 from stakeholders outside of mental health. Addressing the issue of children in need of early intervention as a priority population, a MDCH leadership participant commented, "One of the priorities, obviously, should be the younger the better. We can support the service system coordination with the schools, FIA, and the courts, giving some kind of criteria to start looking at high risk kids." A parent also commenting on early intervention said, "When a child starts deteriorating in school, somebody needs to say, Hey, that's a warning. That's a red flag that goes up. Somebody needs to say, This child is having problems." Special education administrators commented that it is important to "Shift priorities toward the front end. Prisons are costly interventions." Minority parents also spoke about the need for early intervention commenting, "The Afro-American young male [comes] into this court and they want ... to lock him up, when early prevention should have been done when these kids were in Headstart or Chapter I Programs."
Children with out-of-home placement issues were also identified as an important target audience for children's mental health with responses targeting services for children with out-of-home placement issues surfacing 31 times throughout the focus group process. This category includes children at risk of out-of-home placement, children with multi-agency involvement, children leaving out-of-home placement, and abused and neglected children. The top priority population identified by a FIA field staff focus group was "a focus on those kids at imminent risk of out-of-home placement." It is important to note that of the 31 occurrences of this issue in focus group conversations, 18 came from stakeholders outside of mental health. The FIA state staff, FIA field staff, Department of Education state staff, probate court administrators, and county commissioners each discussed children with out-of-home placement issues as a priority population for children's mental health. By comparison, 9 responses came from stakeholders within mental health and 4 from family members.
Finally, children with serious emotional disturbance were identified as an important priority population by stakeholder participants, with this response occurring 22 times across all of the stakeholder groups. This group includes children with the "most serious" disturbances, children with diagnosed mental illness, and children at risk of being unable to function at home, school, or in their community as a result of mental illness. Of the 22 occurrences of this issue in focus group sessions, 8 came from participants inside of mental health, 7 from participants outside of mental health, and 7 from family members. For example, MDCH leadership commented that, regardless of the service system of entry, a priority population for children's mental health should be, "children that have identifiable difficulty with functioning in school or home related to diagnosable mental illness . . ." Among stakeholders outside of mental health, Department of Education state staff, special education administrators, probate court administrators and county commissioners discussed the importance of children with serious emotional disturbance being a priority population for children's mental health. Among family members, adolescents, parents, and minority parents each discussed this as an important issue.
Under the category of family as recipient of services, three priority populations were also identified as important target audiences for children's public mental health services by stakeholder groups. These are: 1) families as the focus of treatment; 2) low income families; and 3) families in crisis. Families, distinguished from individual children in need, as the focus of treatment were identified as an important focus for children's mental health services 19 times during the focus group process. The top client priority expressed by FIA state staff was treating the entire family. A parent spoke of the need for families to be a priority population saying, "The family itself needs to be encapsulated in the mental health system along with the child and the community as much as possible." Of the 19 occurrences of this response, 4 came from family members, 7 from stakeholders within mental health, and 8 from stakeholders outside mental health.
Low income families as a service priority were identified 13 times during the focus group process. It is interesting that the issue of family income received considerable attention from stakeholders within mental health, with 12 of the 13 responses being generated from this stakeholder group, and only 1, probate court judges, from stakeholders outside of mental health. For example, CMH staff commented that an important priority population for children's mental health is "people on public assistance, AFDC recipients, Medicaid recipients, the working poor." These participants believed strongly that the system should be "more responsive to meet the needs of those who cannot pay." By comparison, parents did not explicitly identify low income as an issue in determining the priority population for children's mental health services. However, a closer look at the data indicates parents strongly expressed the opinion that anyone who needs or requests services should have access to services. Similarly, Prevention Coordinators said, "If we have to choose, if we have to prioritize, we need to be sure everyone has an option."
Families in crisis were identified by stakeholders as an important focus for services. Families in crisis were mentioned 11 times in the course of focus group discussions. This category includes families in crisis because of life changes or traumatic events such as divorce, suicide, or mental illness. It is important to note that the category of parents with special problems and challenges, such as children in out-of-home placement, actually had a higher frequency of mention than families in crisis. Families in crisis category was included among the top three responses within this category because it received 24 priority votes from participants who voted. By contrast parents with special problems and challenges received only 5 priority votes.
Finally, the community as the recipient of services was identified by participants as the third broad sub-category of the Priority Population domain. These responses can be summarized as prevention services for the entire community. The identification of the community as the target audience came largely from participants within mental health where it had a frequency of response of 8. Stakeholders outside of mental health identified this issue one time. Although prevention services for the entire community had a relatively low frequency count, this idea received priority votes second only to the category of children in need of early intervention services from participants who used the priority setting process. Infant mental health specialists, for example, emphasized prevention as the most important goal, commenting, "We want to be preventing not treating problems." These participants formulated a description of the most important priority population for children's mental health which strongly emphasizes prevention services for the entire community. This population was described as "pregnant women, children, parents with risk factors, caregivers who request assistance, with an emphasis on prevention as a way to promote the optimal development of the child." Prevention Coordinators also spoke of the community-wide needs of the general risk population, emphasizing that general prevention services should be available for anyone who requests services.
B. Top priorities identified for target populations domain
Using the frequency with which a certain response occurred as a determinant of priority of response, three target populations emerged as the top priorities for children's mental health. These were:
- children in need of early intervention;
- children with out-of-home placement issues;
- children with serious emotional/mental disturbance.
Each of these priorities came from the broad category of child as recipient of services. Children in need of early intervention received the highest frequency with a frequency of response of 43. Children with out-of-home placement issues emerged as second, with a frequency of response of 31. Children with serious emotional/mental disturbance was third with a frequency of 22.
Although all three of the top priorities focused on the child as the recipient of services, it is important to note that within the broad category of families as the recipient of services, families as the focus of treatment received nearly as much attention during focus group discussions, receiving a frequency count of 19.
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