Kentucky IMPACT


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In the late 1980’s, Kentucky realized that it needed to radically change how it treated children with emotional or behavior disorders. In 1990, the state identified and served about 3,000 (.51 percent) of its students for emotional or behavioral disorders. However, the Kentucky Department for Mental Health and Mental Retardation Services estimated that there were actually about 50,000 (8 percent) students with this disorder. In addition to not serving students adequately, Kentucky’s expenditures for students in residential treatment had increased from $2.8 million to $36 million in nine years. Parents pointed out that these students were often served far from home, did not improve when they returned home, and did not have access to local resources to make long-term changes. Kentucky responded to these problems with a complete restructuring of its service system, and, since then, has made concerted efforts to serve these children more effectively.

Where does this all go?

In 1990, Kentucky received a $2.4 million four-year implementation grant from the Robert Wood Johnson Foundation to implement a comprehensive, coordinated services program in central Kentucky. The state implemented the Kentucky Interagency Mobilization for Progress in Adolescent and Child Treatment (IMPACT), a system-of-care intervention program for 17 counties that works to establish a responsive, collaborative, and community-based approach to helping children with emotional or behavioral problems. The initial program, Bluegrass IMPACT, served as a model for the rest of the state. The four main goals of the program are:

Children and youth will demonstrate improvement in social competence with concomitant decreases in behavioral and emotional difficulties, in home, school, and community settings;

Families will perceive increased social and professional support in their efforts to meet the needs of these challenging children and adolescents, and will perceive this support to be timely and responsive;

Children and youth will be placed in a less restrictive treatment environment, and their placement will become more stable over time; and

Professionals, parents, and the children, themselves, will perceive that they have made meaningful gains as a consequence of their involvement in the program.

The IMPACT program has attempted to address these goals through a variety of services, including: service coordination; support services, such as hourly respite, "wraparound" aides, and "adult friend" programs; and crisis intervention.

Between 1990 and 1995, 1,971 children participated in the IMPACT program. Seventy-two percent of the participants were boys, and 61 percent were over the age of 13. Most children had been diagnosed with a behavior disorder, such as Attention Deficit Hyperactivity Disorder (22.6 percent), Oppositional Defiant Disorder (20.9 percent), or Conduct Disorder (9.2 percent). Forty-five percent of students are in regular classrooms; however, the remaining half are in some type of special education program.

Each child who participates in the IMPACT program is assigned a service coordinator or case manager, who helps the child and his or her family navigate the 65 agencies involved in the system of care. The coordinator holds meetings (Child’s Interagency Planning and Implementation Team meetings) with the representatives of agencies who work with the child, to develop a common service plan and to review and revise the plan as needed. Flexible funding also is available to provide wraparound services, crisis intervention, respite care, transportation, and special tutoring for the child and family.

Outcomes

Program evaluation data from 1995 found that the Kentucky IMPACT program has been successful in reducing behavior problems (with greater improvements in externalized behavior problems than internalized ones). Furthermore, the evaluation reported a reduction in psychiatric hospitalizations (.70 at intake to .22 in year 2) and slight increases in the use of foster care and family home living. Data also suggest that the average number of placements to which a child was assigned throughout the year decreased by 34 percent during the first year of participation in the program.

Families of children with emotional or behavioral disorders reported being generally satisfied with the social and emotional support they receive from the program. Finally, a third of the program participants complete the program successfully and return to their general education classrooms or neighborhood schools here classrooms. Evaluators suggested that this is a significant success rate, given the severity of the children’s needs. Moreover, evaluators suggest that while not all participants successfully complete the program, many make substantial gains in their behavior, social skills, and academic skills. Success rates for children under the age of 12 are higher (40 - 47 percent) than older children (32 - 38 percent). Parents (68 percent), teachers (56 percent), service coordinators (62 percent), and children (64 percent) perceived meaningful improvement in school achievement, emotional adjustment, family adjustment, relationship skills, school adjustment, and behavioral self-control after one year in the program.

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