Between 1985 and 1995, the Foundation funded a number of national demonstration programs that relied on communities rather than on institutions to care for people with a range of persistent health-related problems. Providing care in the community was a theme of Foundation-funded programs to serve people with chronic mental illness and with HIV or AIDS, the frail elderly, and children with chronic mental health problems.
Leonard Saxe and Theodore Cross, as faculty members at the Heller School of Brandeis University, led a team that evaluated the Mental Health Services Program for Youth, or MHSPY. They place MHSPY within the broader context of efforts to reform services for children with mental health problems and then examine what happened under the program. The chapter takes the reader through the program's attempts to address the challenges related to creating, financing and coordinating community services.
As in the case of many Foundation-supported initiatives to support innovation in service delivery, it is difficult to reach bottom-line assessments: Were the new systems of care better or worse than their predecessors? Did youth fare better under the new systems of care? For better or worse, the initiatives vary with local conditions that make scientific assessment difficult if not impossible to make. And the initiatives often do not address all of the issues needed to assess outcomes. Questions remain, but Saxe and Cross do conclude that MHSPY was able to provide services in the community and to keep children with mental health problems from being institutionalized.