Systems of Care

Description of the Strategy

In 1986, Beth Stroul and Robert Friedman published a monograph titled A System of Care for Severely Emotionally Disturbed Children and Youth, in which they described a system of care as a comprehensive spectrum of mental health and other necessary services organized into a coordinated network to meet the multiple and changing needs of severely emotionally disturbed children and adolescents. The system of care approach is built on a set of values and principles that guide the nature and provision of services to [Page 1556]children with severe emotional disturbances and their families. The array of services within such a system is depicted in Figure 1, and the values and principles are presented in Table 1.

Figure 1 The System of Care Framework

The model should be regarded as flexible, with room for additional services and revised procedures as experience and changes in circumstances dictate. For example, recent findings indicate that the majority of children who receive mental health services receive these services through the school system. Therefore, the critical role of the school system as a component of a system of care needs to be the focus of increased attention and development.

Research Basis

Evaluation of the effectiveness of the system of care model has focused on two broad outcome levels: [Page 1557]system and client. Systems-level outcomes include indicators such as the amount of services received, costs, and the degree of multiple agency involvement in service delivery. Examples of client outcomes include evidence of a reduction in symptoms of emotional disturbance, improved social functioning, and improved academic functioning.

The literature base resulting from more than 20 studies of systems of care indicates a fairly consistent pattern of system outcomes supporting the system of care model. Using pre-post designs, researchers found that systems of care in a community are associated with increased access to services, greater interagency collaboration, increased satisfaction by families with the services their children receive, and reductions in out-of-home placements and in admissions to restrictive psychiatric hospitals. Costs and cost avoidance in other service systems were reduced. An example of cost avoidance is the reduced need for foster care placements as a result of more effective mental health service. The benefit would be realized in the child welfare agency. In terms of client outcomes, this same group of studies has indicated improvement in clinical measures of emotional disturbance for children who are served in community-based systems of care and a decrease in impairment for these children in areas such as home, school, and community functioning.

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