This article presents an empirical approach which views mental health service systems as interorganizational networks. Data are reported on two county-based child mental health systems in North Carolina that participated in the Robert Wood Johnson Foundation (RWJF) Mental Health Services Program for Youth. Analyses are based on a structural equivalence approach which groups organizations on the basis of similarity in their patterns of interaction. Site-specific data were collected at two time points (1991 and 1993) to measure the social network structure of these service systems including their density, fragmentation, and centralization. Findings indicate that two interesting changes occurred in these systems of care. First, each system moved in a direction consistent with the goals of the RWJF demonstration program, in that they were better organized by the end of the demonstration. Second, while the two systems started at very different levels of system development, one site made significantly larger gains, such that the systems converged over time toward moderately high levels of system organization at the end of the demonstration. Implications for further research are discussed. 01996 John Wiley & Sons, Inc.
Throughout the United States, services for children and adolescents with serious emotional disturbances (SEDs) are in scarce supply, are operated by a patchwork of public and private agencies, and are inadequately financed. These services include not only services offered by traditional mental health providers, but also by an array of support services provided by welfare and social service agencies, schools, health departments, juvenile and family courts, juvenile detention and training centers, and substance abuse agencies. Each of these programs has its special purpose, its unique sources of funding, its particular eligibility requirements, its own mode and standards of operation, and sometimes, its own geographic catchment area. Together, these features define system fragmentation, a situation in which responsibility is divided "among multiple, separate individuals and agencies, each with a categorical purpose," with "the whole lacking a coherent policy, an integrated direction, and coordinated relationships" (Roemer, Kramer, & Frink, 1975, p. 3). The results are often service systems which make inefficient use of resources and families faced with barriers, gaps, and inadequacies in caring for their children who have SEDs .
Over the past fifteen years, an advocacy movement has been mobilized to overcome these deficiencies . The guiding premise is that children and