Leaders' Edge Advisor

Vol. 2, No. 4 - by Gary De Carolis, President

Systems of Care - Information Sheet

“There are risks and costs to a program of action. But they are far less than the long range risks and costs of comfortable inaction.”
-John F. Kennedy

HISTORY

The concept of Systems of Care began in the early 1980’s as a response to the failure of public child serving agencies to effectively address the mental health needs of children and their families. Jane Knitzer’s book, Unclaimed Children, dramatically showed how children who had mental health disorders were either being sent to out of state facilities, found themselves in the child welfare and juvenile justice systems, not served at all, or were provided services that were available versus what the child needed. Few if any youth were actually getting the services and supports that they required in order to reduce or eliminate their disorders.

The National Institute of Mental Health responded to this situation by developing a national grant program called the Child and Adolescent Service System (CASSP). This initiative gave states and territories grants to design what was called a System of Care for children and youth who had a diagnosable serious emotional disturbance. Critical to this effort was the development of a set of Principles that guided this new effort. Robert Friedman and Beth Stroul in the book, A System of Care for Children & Youth who have a Serious Emotional Disturbance, are credited with capturing these principles.

Today, states, counties, cities, territories and Native American tribes have designed and implemented Systems of Care. Large numbers of children who have mental health disorders and their families are now able to receive individualized care within the context of their home, school and community because of this effort. Although originally designed for children who had a serious emotional disturbance Systems of Care are now being developed for other populations of children and youth, including youth in the child welfare and juvenile justice systems. While System of Care principles have been applied to address the mental health needs of children and youth across agencies there is growing interest in seeing if other populations of children and youth could also benefit from the System of Care approach.

PRINCIPLES

Families as Partners:
Systems of Care require that families of children are involved in all aspects of the work. Whether designing/planning or implementing a system; evaluating or creating policy to support the system, family members need to be considered key partners with various agency professionals. The frequently used cry of family members, “Nothing about us without us,” says it all.

Interagency Collaboration:
A key paradigm shift that occurs within Systems of Care is when all state and local child serving agencies work together on behalf of the population being targeted. Interagency collaboration in the form of teams, committees, governance structures is many times referred to the Infrastructure of Systems of Care. Many of the children that interface with one agency, e.g., child welfare, education, juvenile justice, mental health, end up needing services from a number of public agencies. Interagency teams need to be put in place to insure that all plans of care are individualized and address the whole child, and further assure that all relevant agencies are bringing their resources to bear on that particular child and family. State and local interagency teams are also able to resolve issues around policy, program gaps and funding. Further, it is only with interagency efforts that system issues concerning interagency information systems, interagency training programs, blended funding strategies and unified communication plans can be dealt with effectively.

Effective interagency collaboration has communities seeing children as all their responsibility versus in the old paradigm a child would be considered a “child welfare child” or a “mental health child,” and agencies would try to push a child off to one agency or another.

Individualized Care:
At the heart of a System of Care is the notion that each child and family is unique, has strengths and that any plan of care addresses those strengths and unique qualities. The Wraparound approach and Multi-systemic therapy are two evidence-based interventions used within individualized plans of care for specific populations of youth that are at risk of involvement with the child welfare and juvenile justice system. Other intervention strategies used in child welfare include Family Group Conferencing, Family-focused Therapy, Family Preservation and Family Decision Making Practice.

Individualizing care requires involvement of the family and other natural supports. The plan of care needs to assure that all cultural considerations of the family are being addressed, that financial resources to support the plan are blended from all relevant public and private agencies and that the plan calls for support of the child within their home community.

Cultural Competence:
One of the most powerful principals that will determine the success or failure of a System of Care is cultural competence. In order to build a plan of care that will have meaning, relevance and power for a child and their family a plan must consider the cultural background of the family. For example, an Oglala Lakota Tribal member’s plan of care will need to consider the healing traditions of the tribe if the plan is to be relevant for that tribal member. The same is true for all racial, ethnic and cultural groups in this country. An agency needs to insure through policy that cultural competence training programs exist for all staff and also that the staff is culturally diverse and reflects the community that the work is being done. By involving the families in your System of Care the likelihood of it being culturally competent is much greater.

Community–based:
Children and youth thrive within the context of their home and community. The natural supports of family, friends and institutions like schools, recreation centers, and places of religious worship all come to positively impact the life of a child. By building a System of Care within communities there is greater assurance that all the benefits of community life are extended to that child and family.

When children are removed from their community to receive services a number of negative factors come into play. For example, the peer group that the youth develops away from home creates a disincentive to return home; also the youth placed out of community misses many of the age appropriate markers that define youth. Finally, moving is a large stressor and by moving a child outside their home community, cutting them off from their natural supports (family, friends and community) we could be exacerbating an already difficult situation.

Accountability:
A hallmark of organized Systems of Care is the outcome data generated at the system and individual level. Interagency management information systems need to be created that allow agencies to access data across agencies on behalf of a child being served within a System of Care. The information should track all the key demographic factors, number of children served, custody status, referral source, primary and secondary problems at intake, previous service history, family history, school performance, current living arrangements, care-giver strain, substance use history, costs, services and supports an individual receives, as well as, duration and outcomes of those services and supports. System factors such as interagency collaboration, family involvement, blending of funds, cultural competence, policy development, levels of individualized care and community-based care also need to be gathered (Annual report to Congress, Comprehensive Community Mental Health Services for Children and Their Families).

Finally, effective leadership and policy development are two critical intangibles necessary for the development and sustaining of your System of Care. Given the amount of change that will take place to create the System of Care, leaders that understand and are schooled in system change is important.

Keeping an eye on developing new policies that can support your emerging System of Care is also necessary. When one thinks of strategies to sustain the work of a System of Care it is policy development that can help ensure continued growth regardless of economic and political changes. (De Carolis, 2005)

References

Stroul, B.A., & Friedman, R.M. (1993) A system of care for children and youth with severe emotional disturbances (Revised Edition). Washington, D.C.: Georgetown University Child Development Center, National Technical Assistance Center for Children’s Mental Health.

Knitzer, J. (1982). Unclaimed children: The failure of public responsibility to children and adolescents in need of mental health services. Washington, D.C.: Children’s Defense Fund.

Center for Mental Health Services, Child Adolescent and Family Branch, Annual Report to Congress (1998). Comprehensive Community Mental Health Services for Children and their Families Program.

De Carolis, G. (2005). A View from the Balcony: Leadership Challenges in Systems of Care. (Publication Pending).

Web Resources

National Clearinghouse on Child Abuse and Neglect Information

Center for Mental Health Services

University of South Florida

Portland State University

Georgetown University

National Indian Child Welfare Association

American Indian and Alaska Native Programs, University of Colorado Health Sciences Center

Center for Community Leadership

Center for Community Leadership · P.O. Box 3069, Burlington, VT 05408-3069
ph: 802-863-9132 fax: 802-863-6586 · info@centerforcommunityleadership.com

Copyright 2005 Gary De Carolis. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author.

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