Community Practice in Children's Mental Health: Developing Cultural Competence and Family-Centered Services in Systems of Care Models

Community Practice in Children's Mental Health: Developing Cultural Competence and Family-Centered Services in Systems of Care Models

For more than two decades, advocates for children's mental health, supported by the federal government, have pursued significant changes in service systems and delivery in a model referred to as systems of care. These [Page 443]changes arose in response to a fragmented system in which parents were frequently blamed for their children's mental health problems, where agencies that served children seldom talked with one another, and culturally based behaviors were often judged as one more sign of pathology. Prior to the systems of care movement, there were no federal policies to positively influence practice in children's mental health. Achieving needed changes took a movement comprising service providers who recognized the system problems, grassroots parent groups willing to fight for better services, and professionals and grassroots advocates of color, working to end discriminatory practices and to gain access to services for children of color. Together, they conducted research, sponsored public meetings, and rallied for the necessary legislation to bring the systems of care model to its current level.

A system of care is defined as a comprehensive spectrum of mental health and other necessary services that are organized into a coordinated network to meet the multiple and changing needs of children and adolescents with serious emotional disturbances and their families. According to Stroul and Friedman (1996), the core values of the systems of care model state that services must be

• Child centered and individualized
• Family focused, with families as full participants in the planning and implementation of formal and informal services and supports
• Community based (services, management, decision making, interagency collaboration, integrated services)
• Culturally competent

Planning and implementation of these systems of care is an exercise in community practice. Holding these principles in place, once gained, is proving to be equally as challenging, as budget cuts and privatization threaten the system of care ideals in many locations. However, when children end up in locked facilities because there are no community-based mental health services for them and when the demographics of those children include children of color at a rate 5 to 10 times their representation in the general population, community practice professionals cannot rest (Center for Mental Health Services, 200).

This chapter examines two of the core values of the systems of care model, cultural competence and family centeredness, and discusses community practice strategies for their implementation. As illustrated in Table 24.1, these two principles share many common values and should be pursued simultaneously. Working to bring each principle to reality, however, also involves giving attention to the unique history and circumstances associated with the call for cultural competence and for family-centered systems. For this reason, the two principles are discussed in separate sections of the chapter, noting overlap where it occurs.

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