Expenditures and Sustainability in Systems of Care

Abstract

Established by the Center for Mental Health Services (CMHS), the Comprehensive Community Mental Health Services for Children and Their Families Program is an innovative effort to establish systems of care in communities across the country. Using data from three participating sites, we examined service use and expenditures under systems of care.We found that sites provided children with a full range of mental health services. We also found that per-child expenditures were high, but for two of the sites, those expenditures were within the range of expenditures in other innovative attempts at service delivery. In one site, expenditures were especially high. One explanation is that individuals treated there had particularly severe problems, and the data confirmed this explanation, at least to some extent. In particular, when we limited the analyses to a comparable group of children with severe emotional disturbance, expenditures at that site were comparable to those from the Fort Bragg Demonstration.We also found that the sites were successful in developing alternative sources of funding over time. By the last year of the grant, CMHS funds represented no more than one fourth of project funds. This trend reflected program requirements and suggested that the sites developed fiscal sustainability over time.