Maria worries about her son Miguel’s aggressive behavior—so does his Migrant Head Start teacher. He is disruptive at Head Start and has problems getting along with his siblings at home. He isn’t talking as well as other four-year-olds. He has trouble sleeping and frequent nightmares—and Maria recently left his father because of domestic violence. A Head Start screening (a survey that helps identify developmental and behavioral problems) turns up possible emotional issues.

In the past, it might have been up to Maria to figure out what help her child needs and how to get it. Usually “kids between the ages of three and five 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
• tips for managing his behavior at home and for passing on to his teacher
• free visits to mental health and other specialists, if needed.

With counties deciding how to spend funds from by the recently passed Mental Health Services Act (Prop. 63, see Setting up the SMART model: Keys to success), 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a child they are concerned about—for example, one who has severe temper tantrums, is not getting along with others, is withdrawn, or is not talking well. 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 Assessment Center for Children—the hub of the SMART model. 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, making sure their questions are answered and translating, 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. The center is located at Exceptional Parents Unlimited, a nonprofit that serves families and children with special needs.

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. 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 (see New Funds for Mental Health). The children’s services coordinator continues to check on the family’s progress and help with any problems.

New Funds for Mental Health

What is Proposition 63 (Mental Health Services Act)?

Proposition 63 (passed last November) 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.

How much money will be available? When?

MHSA is estimated to raise $700 million in 2006-07, with a 7 percent increase each year after that. Funds should be available between October 2005 and January 2006.

What can you do?

Counties are beginning to plan how their MHSA funds will be spent—and are required to include public input. You can find out about your county’s planning process, attend public hearings, and share your views about the importance of services for children.

For more information, contact

• Your county mental health department

• California Department of Mental Health, with information on the MHSA, including funding guidelines and timelines at www.dmh.cahwnet.gov/

• Mental Health Association in California, 916-557-1167, www.mhac.org

• From Promise to Practice: Mental Health Models that Work, a toolkit that profiles model programs that counties could fund with MHSA dollars. Fight Crime: Invest in Kids California, 510-836-2050, www.fightcrime.org/ca/toolkit/index.php

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 Karian. 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,” says Rogers. 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 (see New Funds for Mental Health) and to eventually expand SMART to all county children under 18 (currently it serves children under five).

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