The purpose of this study was to identify barriers to psychotropic adherence regimens in clients with Severe and Persistent Mental Illness (SPMI). Medication non-adherence perpetuates the cycle of psychotic episodes, which leads to rehospitalization, incarceration, and homelessness.

According to Part H (Public Law 101-476), governors of each state have the authority to designate a lead agency within the state to carry out this legislation. Some lead agencies may include the Department of Education, Department of Health, or Department of Economic Security. Each lead agency has the power, within Part H, to decide whether infants and toddlers who are at risk will be served under the provisions of special education to infants and toddlers. According to The National Early childhood Technical Assistance System (NEC*TAS) (1992), 22% of states include at risk in their definitions for Part H. Of those 11 states, only 6 include services for perinatally exposed infants and toddlers in their at risk definition. The National Association for Perinatal Addiction Research and Education (NAPARE), (1993) defines perinatally exposed as, "fetal exposure to inappropriate use of licit or illicit drugs." Delivery of care is not systematic between these state agencies. There is a lack of knowledge of which services, if any, each delivery system offers to perinatally exposed infants/toddlers and their families. Therefore the purpose of this study was to examine the delivery of services in the six states that serve this population under the at risk definition of Part H and compare those results to three states that do not serve perinatally exposed infants and toddlers under this legislation. Telephone interviews of 9 state Part H Coordinators were conducted to obtain information concerning various services provided to substance exposed infants/toddlers and their families. Six of those states claimed to provide services to perinatally exposed infants and toddlers under the at risk definition of Part H and three made no such claims. Data from the survey instrument were analyzed using qualitative analysis. Findings of the study revealed that only health department lead agencies provide services to perinatally exposed infants/toddlers and their families under the at risk definition of Part H of the Individuals with Disabilities Education Act. Data analysis provided information for making recommendations to governors and lobbying organizations who are concerned about providing services to perinatally exposed infants and toddlers. / Ed. D.