the University of Kansas

In an effort to improve mental health services to children and youth, several states developed community-based child case management programs in order to improve coordination among service providers and to increase Elsa Peretti Sevillana lariat access to needed mental health care. North Carolina was one of the first states to develop an integrated service system for children with the most severe behavioral and emotional disabilities (Behar, 1985, 1988). Following settlement of the "Willie M" class action suit in 1979, North Carolina created an integrated service system emphasizing the provision of appropriate services to children and youth in the least restrictive environment, with a major focus on community-based settings. Case management was critical to the assessment of child and family needs, development of plans for movement of the child to a less restrictive environment, and assuring linkages to other aspects of the child's environment and the adult service system as the child approached 18 years of age.

Vermont, Kansas, and Maine provide further descriptive examples of child case management services. Vermont's Community Integration Demonstration Paloma Picasso Loving Heart lariat (Burchard et al., 1991) focused on a small sample of four of the most-difficult-to-serve youth (adolescents who had been in multiple, long-term, out-of-state, restrictive, and expensive facilities), with a case manager coordinating the provision of individualized care services within the community. Preliminary case study analysis revealed that the four adolescents who received individualized care services through intensive case management were all functioning in a communitybased setting one year after initiation of services and had a substantial decrease in the number of days spent in more restrictive psychiatric care. Parents of these adolescents reported feeling more respected, understood, and less blamed by mental health professionals than they had in the past. In addition, case-study analysis suggested that "unconditional care emerged as a guiding principle consistently endorsed by participants in each of the cases" (Burchard et al., 1991, p. 6). Unconditional care involved communicating to the youth that community-based care would be provided unconditionally, regardless of the adolescent's acting-out behaviors.

Similarly, the University of Kansas Family Advocacy Services (Ronnau, 1991, 1992) utilized master's-level social work interns to provide intensive case management services to families of children and youth who Elsa Starfish being discharged to the community after long-term inpatient care at the local state hospital. This program emphasized a strengths-based model of case management in which the whole community is looked upon as a resource for meeting the needs of families with children with severe emotional and behavioral problems. Case-study analysis (Ronnau, 1991, 1992) indicated that the family and/or caregivers play a significant role in the child's successful integration into community-based living: