Faculty Bibliography

This article introduces a special series on "transporting" studies of the efficacy of psychotherapy into studies of their effectiveness. Models of the relationship between efficacy and effectiveness are described. Traditional linear models of the phases of scientific expansion suggest that findings from efficacy studies can be transported into broader population samples only after a prescribed series of steps have been followed, with the ultimate goal of implementing treatments that have broad public health implications. An alternative 3-dimensional model is described. This new model posits as its organizing principle flexible movement between dimensions of efficacy and effectiveness across multiple axes.

Child and adolescent researchers must balance increasingly complex sets of ethical, legal, and scientific standards when investigating child and adolescent mental disorders. Few guidelines are available. One mechanism that provides the investigator immunity from legally compelled disclosure of research records is described. However, discretion must be exercised in its use, especially with regard to abuse reporting, voluntary disclosure of abuse, and protection of research data. Examples of discretionary issues in the use of the certificate of confidentiality are provided.

Discusses research issues related to design, methodology, and implementation of studies on service use and effectiveness of services for children and adolescents with mental disorders. An overview is provided of methodological issues common across multiple service systems (i.e., schools, primary health care settings, the juvenile justice system), as well as issues that are affected differentially by the unique service sector in which the research is embedded. The prevalence of mental disorders in children and adolescents is discussed, as well as ethical issues in child and adolescent mental health services research.

When applied to the construction of anxiety disorders, theories of poststructuralist historicism emphasize acts of interpretation that constitute and construct the disorders and problematize the processes by which meaning is constructed. An examination of the historical formulations of anxiety disorders, and in particular, agoraphobia, provides the opportunity for reanalyzing traditional approaches to the classifications of disorders. Psychological issues of paradox, attachment, and personal identity, which are crucial to current conceptualizations of agoraphobia, are acutely problematized within a poststructuralist historicist hermeneutic. A rethinking of disorder construction from within this hermeneutic suggests replacing individualistic conceptualizations of personal identity with a broader view that recognizes and celebrates multiplicity and that displays formulations of the self in a contextualized and historicized status, thus enabling a fuller engagement with the social world.

New research directions on the effectiveness of mental health services for children and adolescents offer the opportunity for school psychology to apply its knowledge base to the systemic juncture between mental health and school systems. Models of service delivery to children, adolescents, and their families that integrate school, mental health, and other service sectors are being actively studied to answer questions about the outcomes of these services for children with mental health problems. The papers in this journal were first presented at the 6th Annual Research Conference of the Florida Mental Health Institute on "A System of Care for Children's Mental Health: Expanding the Research Base." The papers describe state-of-the art studies of school-based mental health interventions for children, adolescents, and their families. In each of the papers, particular attention is paid to the salient methodological issues researchers face in conducting these studies within school settings. It is hoped that these articles will foreground the healthy and creative tensions that exist between different research paradigms and multiple service communities, especially mental health and school systems, by encouraging new research on important and as yet unanswered questions about the effectiveness of school-based service delivery to children and adolescents with mental health needs.

Research on school-based mental health systems is an important but hazardous enterprise. Current trends suggest that child mental health professionals will increasingly focus on community service systems that are family-based and school-centered. Challenges to conducting research on effectiveness of such services include underidentification of children with emotional or behavioral disorders, lack of concordance between diagnostic criteria used in school vs mental health systems, problems of comorbidity, analysis of data from multiple informants, lack of interdisciplinary or interagency collaboration, community involvement, and a variety of other factors. These issues and suggestions for addressing them are discussed.

Describes research opportunities in an emerging field for children and adolescents with mental disorders at the National Institute of Mental Health (NIMH) and the opportunities that are available for grant-funded investigations in this area. Child and Adolescent Services Research at NIMH offers many opportunities for applied research on the outcomes and effectiveness of services to children and adolescents with a variety of mental disorders, and on the organization, financing and delivery of those services. Through empirical investigations of child and adolescent mental disorders as they are manifested and treated in naturalistic settings, services research offers unique opportunities for science to return the practical advantages of its investigations to those who can benefit from them.

Examined the outcomes of 114 children and adolescents (aged 5-18 yrs) with serious emotional disturbance who had been placed in treatment facilities for educational purposes over a 3-yr period. Interviews about outcomes with special education directors, reveal that 63% of the Ss had either made no or minimal progress, had been discharged with a negative outcome, or had run away. Positive outcomes were achieved in only 25% of the cases, measured by the Ss' return to school or placement into a vocational training program. Another 11% of the Ss were making substantial progress. Positive outcomes were associated with shorter lengths of stay. Ss in the positive outcome categories had more severe functioning deficits at intake than Ss in the negative outcome categories. The availability of community-based services for the student and family was the most likely reason for positive discharge status.

Discusses the educational policy within Public Law (PL) 94-142, which dictates exclusion of socially maladjusted children from eligibility as seriously emotionally disturbed. The history of this exclusion, various state education agency attempts to serve or exclude children with behavioral problems, and major assessment issues surrounding interpretation of the exclusion are described. Substructural issues involving the conceptualization of disability and related funding exigencies are also presented. The differences between PL 94-142 and Section 504 of the Rehabilitation Act, in terms of the definition of handicap, and the implications of these differences for the exclusion are explored. Approaches to serving children in need of mental health services through multiagency collaboration are reviewed with respect to a proposal for a paradigmatic shift in redefining the role of education.