Early implementation of legislative children's mental health reform: the Minnesota/Hennepin County Experience

The objectives of this study were to identify the strengths and weaknesses of Minnesota's Comprehensive Children's Mental Health Act of 1989 and its early implementation in Hennepin County, Minn. Data were collected from official documents and key informants relative to three implementation criteria: (1) community-based and family-centered values; (2) the range, coordination, and affordability of services; and (3) process, outcome, and consumer accountability. Findings suggest that the state law is a laudable, yet seriously limited, attempt to reform the system of care for children with emotional disorders. While the law is strong in its intent regarding community-based value, range, and coordination of services as well as process accountability, implementation has been hampered by weaker intent with respect to other criteria and by a lack of a comprehensive financing plan. Despite these limitations in the state law, Hennepin County has moved to use the law as leverage to improve the local system of care. Implications for reformers in other states center on the issues of state/county relationships, scope of initial efforts, choice of organizational structure, and the interplay of financing and accountability issues.