TY - JOUR
T1 - Evaluation in the community mental health centers program
T2 - A bold new reproach?
AU - Neigher, William
AU - Ciarlo, James
AU - Hoven, Christina
AU - Kirkhart, Karen
AU - Landsberg, Gerald
AU - Light, Enid
AU - Newman, Fred
AU - Struening, Elmer L.
AU - Williams, Lindsley
AU - Windle, Charles
AU - Woy, J. Richard
N1 - Funding Information:
strategic approaches to CMHC program evaluation. For readers not familiar with the CMHC Program and its evaluation efforts, we offer a brief, historical introduction to help place the papers that follow in context. The federal CMHC Program-from its inception in 1963 (PL 88-164) to its final year of categorical funding in 1981 (PL 94-63)-was landmark legislation that helped change the country’s mental health care system. As of October, 1980, 789 centers received federal funding from the National Institute of Mental Health, and their programs covered 53% of the U.S. mental health service areas. The CMHC Program during this period was both fluid and dynamic, with federal legislation contributing by no less than 13 amendments to the initial authorizing legislation of 1963, changing the number of essential services required, specifying new target groups to be served, and suggesting linkage between the CMHC Program and other programs in health and human services. Over $2 billion in federal money was invested in the Program, matched by contributions from state and local government, and reimbursement for patient services. Was it worth it? The Centers Program has spawned an enormous quantity of data, both qualitative and quantitative. A recent bibliography on the CMHC Program in the 1970s published by NIMH (1981) lists 567 publications selected as representative of the materials published about the Program during that decade. This data base has been interpreted by both the Program’s supporters and detractors in attempts at evaluation (e.g., Chu &Trotter, 1974;P resident’s Commission on Mental Health, 1978). Evaluating the CMHC Program, however, has proven to be a challenging and formidable task (e.g., Landsberg, Neigher, Hammer, Windle, & Woy, 1979), complicated by limited evaluation resources. Commentators on the early community mental health program suggestedt hat any major effort at mental health care reform should entail a set-aside of 5 to 10% of the effort to evaluate its effectiveness. In fact, a great deal less than that was spent on evaluating the CMHC Program (Windle & Volkman, 1973). Before we examine the actual level of evaluation effort, and attempt to judge its quality, we should be clear that the term evaluation conjures visions of a semantic jungle. In one attempt at typology by Windle and Neigher (1978), four purposes for evaluation were suggested: the first, an Amelioration Model, saw evaluation as generating better information for a program’s own internal decision-makers; the second, an Accountability Model, focused on public data disclosure and citizen participation in the evaluation process; the third, an Advocacy Model described evaluation efforts designed to advance the program’s interests in the competition for resources. A fourth approach links evaluation with research, generating new knowledge about program interventions and outcomes gained from scientifically evaluating program efforts. While all four types of evaluation effort were associated with the CMHC Program, federally-funded efforts at evaluation focused mostly on evaluation for accountability and for program self-improvement. Section 513 of the Public Health Service Act authorized the Secretary of the Department of Health and Human Services to spend up to one percent of the money appropriated under the act to evaluate a wide range of programs, including the CMHC Program. The 1% evaluation effort refers specifically to Section 262 of the Community Mental Health Centers (CMHC) Act (Section 262 was added to the CMHC Act in 1968b y Section 303(a) of Public Law 90-174). A portion of the 1% evaluation monies were used centrally by NIMH to support a wide variety of studies on CMHC services, and focused on process studies from individual programs, methodology development, evaluability assessment, Biometric data collection, management information systems development, and projects intended to evaluate the CMHC Program as a whole. Feldman and Windle (1973) point out that since the CMHC Program was conceived of as a set of innovations by which to achieve ultimate goals of better mental health and less mental illness, the evaluation effort should largely focus on the extent to which these new processes were actually being carried out. (Williams & Light describe the NIMH 1% contract program in detail in Appendix A.) In part to counter opposition to the CMHC Program by the Administration, Congress passed a series of amendments to the CMHC Program in 1975. Consequently, centers were required to begin carrying out evaluations of themselves. Beginning FY 1976, each center was to comply with the following evaluation requirements:
PY - 1982
Y1 - 1982
N2 - The Federal Community Mental Health Centers Program (CMHC)-from 1963 to 1981-was heralded as a revolution in mental health care. Championed by many, and severely criticized by others, the actual impact of the program on the nation's mental health remains unclear, The authorization to evaluate the CMHC Program came originally from congressional legislation (PL 90-174), and later from the policies and regulations of NIMH under a series of Federal laws, notably PL 63-94. From 1976-1980, two dominant evaluation strategies were prevalent: funds expended by NIMH each year for studies of CMHC services or program-wide evaluations, and a much larger expenditure by CMHCs to conduct their own, independent evaluations following federal guidelines. As the Center's Program was turned over to the states in the form of block grants (PL 97-35), a group of professionals involved with setting and carrying out federal CMHC evaluation policy of both varieties met in public forum to debate the impact of these two evaluation approaches. While some participants cited gains in evaluation technology and impact upon local management of CMHCs, others found the lack of a coordinated and systematic approach to evaluating the CMHC Program to have been an opportunity missed. The impact of CMHC evaluation efforts are also discussed in terms of their major contribution to the field of evaluation research as a whole.
AB - The Federal Community Mental Health Centers Program (CMHC)-from 1963 to 1981-was heralded as a revolution in mental health care. Championed by many, and severely criticized by others, the actual impact of the program on the nation's mental health remains unclear, The authorization to evaluate the CMHC Program came originally from congressional legislation (PL 90-174), and later from the policies and regulations of NIMH under a series of Federal laws, notably PL 63-94. From 1976-1980, two dominant evaluation strategies were prevalent: funds expended by NIMH each year for studies of CMHC services or program-wide evaluations, and a much larger expenditure by CMHCs to conduct their own, independent evaluations following federal guidelines. As the Center's Program was turned over to the states in the form of block grants (PL 97-35), a group of professionals involved with setting and carrying out federal CMHC evaluation policy of both varieties met in public forum to debate the impact of these two evaluation approaches. While some participants cited gains in evaluation technology and impact upon local management of CMHCs, others found the lack of a coordinated and systematic approach to evaluating the CMHC Program to have been an opportunity missed. The impact of CMHC evaluation efforts are also discussed in terms of their major contribution to the field of evaluation research as a whole.
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U2 - 10.1016/0149-7189(82)90001-5
DO - 10.1016/0149-7189(82)90001-5
M3 - Article
C2 - 10259966
AN - SCOPUS:0020439632
SN - 0149-7189
VL - 5
SP - 283
EP - 311
JO - Evaluation and Program Planning
JF - Evaluation and Program Planning
IS - 4
ER -