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A SMART Model of Child Mental Health

February 6, 2013
Original Author: Claudia Miller


The earlier we can address mental health problems, the better it is fiscally—and, of course, for the children and public safety as well.

Sowmya Kadandale

Research Associate

Fight Crime: Invest in Kids California

Maria worries about her son’s aggressive behavior—so does his Migrant Head Start teacher.

Miguel is disruptive at Head Start and has problems getting along with his siblings at home. He isn’t talking as good as other 4-year-olds. He has trouble sleeping and his nightmares are frequent. Maria recently left his father because of domestic violence.

In the past, it might have been up to Maria to figure out the help her child needs and how to get it. Now, through a Head Start screening, developmental and behavioral problems can be identified. It is a SMART model of child mental health care.

Usually “kids between the ages of 3 and 5 don’t qualify for services unless they have a serious problem,” says Marion Karian, executive director of Exceptional Parents Unlimited.

But, now, thanks to Fresno County’s new SMART model of care, Maria can take Miguel to a central agency for a free assessment of Miguel’s health, behavior and learning skills.

With counties deciding how to spend funds from the Mental Health Services Act, Fresno’s integrated system of care could be a model for children’s mental health services in other counties.

Identifying possible problems

The SMART (Screening, Making decisions, Assessment, Referral, Treatment) model of care helps parents and teachers get help for a child they are concerned about, including those who have severe temper tantrums, withdrawal symptoms, the inability to get along with others or difficulties talking.

A parent or teacher can ask for a free screening, which may take place in the child’s home, a child care center or a doctor’s office. If the screening picks up possible problems, the parent, teacher and health provider decide whether the child should have an assessment (an in-depth evaluation).

Helping child care teachers

As a small, but growing number of children are expelled from child care for behavior problems, the SMART model helps teachers figure out a better way to handle these issues, says Daryl Hitchcock, clinical services supervisor for the Assessment Center.

“Using the screening tools helps,” Hitchcock adds, because children get care sooner, when problems are less severe.

County public health nurses visit child care centers to provide screenings and information about SMART.

Getting a thorough evaluation

For the assessment, families visit the hub of the SMART model — the Assessment Center for Children.

The center is located at Fresno-based Exceptional Parents Unlimited, a nonprofit that serves families and children with special needs.

A bilingual children’s services coordinator calls the parent to set up an appointment, arranges transportation and child care, and stays with the family during the day-long visit, ensuring their questions are answered and translated, if necessary.

During the visit, the family meets with an assessment team, which may include a psychologist, pediatrician, and behavior and speech therapists. The team talks with the parent and child to evaluate the child’s health, behavior, learning and language skills.

The Assessment Center houses all these specialists under one roof to make it easier for families to get services. There are also school district, child abuse prevention and developmental disabilities staff on site.

Getting treatment

The family receives an “intervention plan” shortly after their visit. For example, Maria’s plan includes tips for managing Miguel’s behavior at home, tips for his teacher, and referrals to both a behavior specialist and a domestic violence support group.

The children’s services coordinator continues to check on the family’s progress and help with any problems.

Visits to specialists are free for families, as long as they are part of the intervention plan—agencies participating in SMART pick up the tab.

Funds for mental health

The Mental Health Services Act, formerly known as Prop. 63, increases funding for California’s mental health services—particularly prevention and early intervention programs—by raising taxes on incomes over $1 million.

Advocates for children want to make sure some of the funds are spent on prevention and early intervention services for children.

“The earlier we can address mental health problems, the better it is fiscally—and, of course, for the children and public safety as well,” says Sowmya Kadandale, research associate for Fight Crime: Invest in Kids California.

Setting up the SMART model: Keys to success

Build on common concerns. When planning for SMART began in 1998, there was a feeling that children were “falling through the cracks in Fresno County,” says Marion Karian, executive director of Exceptional Parents Unlimited.

Fresno County’s community health department brought together Fresno First Five, the Central Valley Regional Center, Exceptional Parents Unlimited, the school districts, the board of supervisors and several county departments to plan what became SMART.

Include decision-makers. “The planning group made sure that key decision-makers attended the first planning retreat,” says Kendra Rogers, program development director for First Five Fresno County. “When it came time to make decisions and commit resources, we had someone from the school board (and) the chair of the board of supervisors on board.”

Consult the field. “We didn’t want outsiders to come in and tell people how to do their job better,” Rogers says. Mental health care providers “were part of the process.”

Secure funding. Families do not have to pay for any SMART services—funding comes from participating agencies as well as First 5 and Medi-Cal. SMART partners plan to apply for Prop 63 funds and to eventually expand SMART to all county children under 18 (currently it serves children under age 5).

Use the same tools. Agencies are encouraged to use the same screening questionnaire, which “streamlines services for families” and saves time for health providers, Rogers says.

Originally written by Claudia Miller.