What is a System of Care?

A system of care is a comprehensive spectrum of mental health and other necessary services which are organized into a coordinated network to meet the multiple and changing needs of children and adolescents with severe emotional disturbances and their families (Stroul & Friedman, 1994). The major approach in reform of the children's mental health services system since the mid 1980s has been through the development and implementation of community-based systems of care based on a set of principles and values, and the best available research.

Since 1984, the Center has sought to describe and define key ingredients of effective systems of care. The following topics address current status of the systems of care movement, and overviews the evolution of measurement.

Values & Principles

The Center's theory suggests that a statement of values and principles is a foundation piece for effective systems of care. [see details]

Legislative Support and Policy

Use of the SOC approach is recommended in significant federal policy papers on children's mental health. [see details]

The Comprehensive Community Mental Health Services Program for Children and Their Families Program

The largest federal program to date targeting children’s mental health services. [see details]

Measures of SOC – Systems of Care Practice Review

The Center has developed strategies for evaluating systems of care, including the System of Care Practice Review (revised: SOCPR-R) [see details]

More Publications

Examining the Relationship between Family-Run Organizations and Non-Family Organization Partners in Systems of Care

This publication was produced by Study 6: Examining the Role of Family Organizations in Developing Family Voice in Systems of Care of the Research and Training Center for Children’s Mental Health. This study investigates how family voice, as represented through family-run organizations, contributes to the context of the overall mental health system, and the implementation of an effective system of care.


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Effective Financing Strategies for Systems of Care: Examples from the Field - A Resource Compendium for Developing a Comprehensive Financing Plan 

This document presents examples of effective financing strategies for seven key areas related to the development of comprehensive and strategic financing plans for systems of care. It is intended as a companion to the Self-Assessment and Planning Guide: Developing a Comprehensive Financing Plan.
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RTC Study 3 Financing Structures and Strategies to Support Effective Systems of Care: Issue Brief 2: Effective Strategies to Finance Family and Youth Partnerships

Effective Financing Strategies for Systems of Care is a Research and Training Center study that is examining financing strategies used by states, communities, and tribes to support the infrastructure, services, and support s that comprise systems of care. This issue brief presents the results of the first wave of study site visits regarding financing strategies to support family and youth partnerships.
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RTC Study 3 Financing Structures and Strategies to Support Effective Systems of Care: Issue Brief 1: Effective Strategies to Finance a Broad Array of Services and Supports

Effective Financing Strategies for Systems of Care is a Research and Training Center study that is examining financing strategies used by states, communities, and tribes to support the infrastructure, services, and support s that comprise systems of care. This issue brief presents the results of the first wave of study site visits regarding financing strategies to support a broad range of services and supports.


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Quick Guide for Self-Assessment of Family-Run Organizations in Systems of Care

The Quick Guide is for use by family-run organizations. The guide is divided into nine sections addressing important elements of family-run organization development and sustainability. Each section represents several components or characteristics of effective family-run organizations in a system of care. The guide was derived from the work of Research and Training Center investigators Kathy Lazear, René Anderson & Eloise Boterf.
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Leadership Qualities in Successful Systems of Care (System Implementation Issue Brief #3)

This issue brief presents system of care leadership as defined by stakeholders in four established systems. When asked to identify factors critical to system of care implementation, leadership was included by all systems that have participated in Case Studies of System Implementation. This overview was prepared by Research and Training Center for Children's Mental Health investigators Kathleen Ferreira, Sharon Hodges, Nathaniel Israel, & Jessica Mazza.
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Lessons from Successful Systems: Evidence-Based Practices and Systems of Care: Implementation Matters (System Implementation Issue Brief #4)

This issue brief presents key findings on the relationship between EBPs and systems of care from Case Studies of System Implementation. Strategies critical to implementing EBPs within systems of care are also presented.
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Assumptions, Indicators and Descriptors for the Family Voice Study: Assessing the Role of Family Organizations in Developing Family Voice in Systems of Care

Research suggests that systems of care with strong family voice have certain characteristics. The Family Voice Assumptions, Indicators and Descriptions (FV-AID) Chart identifies these characteristics which are listed in the first column as Assumptions. The questions to identify the importance of these characteristics, the extent or implementation and the effectiveness of these characteristics are the Indicators and are listed in the second column. And, the questions to learn how these indicators are operationalized are listed in the third column, as the Descriptors. The FV-AID Chart is also used as a framework for the development of Family Voice Study protocols and activities.
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Examining the Impact of Policy on Collaboration in Systems of Care.

We report on the methods and outcomes of a two-phase study designed to determine the relationship between the mechanisms that have been used to establish systems of care and their resulting levels of collaboration. Difference in beliefs about collaboration and collaborative behaviors were found.
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A Self-assessment and Planning Guide: Developing a Comprehensive Financing Plan (RTC Study 3): Financing structures and strategies to support effective systems of care.

Discusses critical financing structures and strategies to support systems of care for children, adolescents and their families, and examines how financing mechanisms operate separately and collectively to achieve this goal.
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The Use of Qualitative Methods in Systems of Care Research

Presents a literature review of the Annual Conference Proceedings in an attempt to uncover qualitative research published by the Proceedings. 100 Studies were identified as qualitative. Descriptions of the most used qualitative study topics are provided.
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Findings: Examining the Impact of Policy on Collaboration in Systems of Care

This article discusses how policy implementation affects collaboration at the state and community levels. Collaboration, in turn, contributes to effective systems of care.
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A Model for Implementing Effective Systems of Care

Provides a discussion of the model of implementation factors developed by the Research and Training Center for Children's Mental Health. The Center's model includes 14 implementation factors and builds upon systems of care values.
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Effective Systems of Care: A Summary of Implementation Factors

To guide its research, and to assist states and communities, the Center has developed a model of factors that it believes contribute to implementation of effective systems of care. This handout identifies and summarizes these factors.
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Evidence-Based Practices, Systems of Care, & Individualized Care

Within recent years, the focus of children's mental health policy in the United States has been improving outcomes for children with mental health challenges and their families through the use of evidence-based practices at the child and family level. This paper describes an exploratory study on the relationship between systems of care with an individualized care component, which brings family, youth (where appropriate), members of the natural support system, and members of the formal service system together to develop plans that reflect a comprehensive focus on strengths and needs of families in multiple life domains.
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A Study of Service Innovations that Enhance Systems of Care: Expanding the Array of Services using Networks of Providers in Community Based Integrated Systems of Care

This paper describes results and implications from a study designed to explore innovative service system practices in nine sites. Creative approaches to cross-agency finance, provider network development, provider selection and evaluation, and quality assurance are identified and described in order to advance the field's understanding of provider- and systems-level issues.
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Building upon Theory of Change for Systems of Care

This article describes the concept of systems of care for children with serious emotional disturbance and their families. Systems of care are presented as mutable strategies for improving organizational relationships that are best judged by outcomes focused at the organizational level. Implications for rethinking and expanding the theory of change that underlies the system of care is discussed.
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Monograph: Crafting Logic Models for Systems of Care: Ideas Into Action

This monograph is designed to provide a guide for communities engaged in developing systems of care. It provides a straightforward method that system stakeholders can use to turn their ideas into tangible action-oriented strategies for achieving their goals for system development.
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The Impact of Managed Care on Systems of Care that Serve Children with Serious Emotional Disturbances and their Families.

This article describes findings from a qualitative study evaluating the impact of managed care reforms on a select sample of systems of care funded by the Comprehensive Community Mental Health Services for Children and Their Families Program. This study’s analyses reveal conditions and factors necessary to maintain a system-of-care-philosophy and approach in a managed care environment.
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More Presentations

The System of Care Practice Review Revised (SOCPR-R): Measuring Fidelity of Service to Systems of Care Values and Principles

This presentation establishes the value of assessing service fidelity to SOC values and reviews use of the SOCPR-R method & instrument to evaluate local systems of care. The SOCPR-R method clusters SOC principles into primary domains of child-centered, family focused; community-based; culturally competent; and impact--these domains and their subdomains are examined within a system through a multiple case study method including document reviews and key informant interviews. With family case as the unit of analysis, information is synthesized to identify patterns and trends within the SOC and generate recommendations.
View Handouts [3.6mb pdf]

Child & Adolescent Mental Disorders:
Best Practices for System Improvement

This presentation handout summarizes key issues for systems improvement in Florida. Topics addressed include determining seriousness of a problem, the relationship between mental health disorders and substance abuse; comparison of current and needed actions in the system, and general and specific recommendations for actions.
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Implementing Effective Data-based and Value-based Systems of Car efor Children with Serious Mental Health Challenges and their Families

This presentation by Robert Friedman overviews key factors in implementing effective service systems that provide access to high-quality, value-based care. Use of data-driven decision making strategies for performance measurement and quality assurance are addressed within the context of the Research and Training Center's model of factors that are associated with effective system of care implementation.
View Handouts [12.1mb pdf]

Transformation: Personal, Professional,
and about Systemic

Robert Friedman addresses the APA Annual Convention about the activities of the Department of Child & Family Studies and their relationship to the national call for transformation of mental health services systems. Includes program profiles.
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Developing Data- and Value-Based Systems of Care that Incorporate Effective Practice: Expanding the Framework

This presentation at the 2004 Training Institutes in San Francisco, Robert Friedman addresses the role of theories of change and performance measurement in systems of care.
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Effectively Serving Children with Special Needs and their Families: What Does it Take?

At the Winter 2005 Systems of Care Communities Meeting in Dallas, February, 2005, Robert Friedman described a model of fourteen key factors that contribute to implementation of effectives systems of care.
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The Status of Children's Mental Health: 
A Need for Urgent Care

This presentation by Robert Friedman to the National Conference of State Legislatures in Salt Lake City, July, 2004, addressed current and future policy approaches for improving services for children with serious emotional/behavioral disorders.
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Positive Systems of Care: Effective Community Responses for Children & Families

In his October 2004 address in Waterloo, Ontario, Dr. Friedman describes the key characteristics and current status of systems of care implementation.
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Promises and Challenges of Evidence-Based Practices for Latino Youth and Families

Mario Hernandez addresses the under-representation of the Latino population in research on evidence-based practices, and identifies steps that should be taken to ensure that promising programs can be successfully adapted to systems of care with a culturally diverse population. Presented for Improving Systems of Care for Latino Youth and Families: Effective and Evidence-Based Strategies for Engagement and Treatment, July 21-23, 2004, Miami, Florida.
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View Handouts [406kb pdf]

President’s New Freedom Commission on Mental Health: A Status Report and Call to Action

In July 2002, Robert Friedman was invited to address the President’s New Freedom Commission on Mental Health regarding the status children’s mental health in the US. This presentation outlines the scope and seriousness of emotional and social problems in the nation’s children, as well as recent examples of federal recognition of the need for policy change to address children's mantal health issues. Dr. Friedman also explored the current status of the child-serving system; recommending future directions for its improvement.
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What Works Well and Why: Translating Research into Practice in Community Mental Health Services

CFS Chair Robert Friedman provided a keynote address March 14th, 2003 at the 6th Annual All-Ohio Institute on Community Psychiatry conference. The focus of this year's Institute was the implementation of evidence-based practices in community mental health services. Friedman's presentation focused on the improvement of access to care for children in need, quality and effectiveness of care, and the mental health status and well-being of all children.
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Children’s Mental Health Policy: Is it working?

This invited presentation by Dr. Robert Friedman elaborates on the current realities of the children’s mental health service system and its relationship to policy formation and implementation. This presentation specifically discusses the scope of the problem, and explores resolutions that are currently at the forefront of the field, including systems of care, evidence-based practice, and new research and evaluation paradigms.
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Child & Adolescent Mental Health: Recommendations for Improvement by State Mental Health Commissions

This presentation summarizes common themes and issues in state-level child mental health service system policy as identified by an analysis of Mental Health Commission reports for several states.
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Expanding Frame Work for Developing Operating and Sustaining Local Systems of Care

At the 2002 Training Institutes sponsored by the National Technical Assistance Center for Children’s Mental Health, Georgetown University, Dr. Friedman and colleagues Don Dixon, Steve Gilbertson, Margaret Jefferson, Bruce Kamradt, Mary Jo Meyers defined and examined the key principals and values of systems of care as they relate to real-life implementation in several sites across the nation.
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Evidence Based Practice and Systems of Care: Building on the Strengths of Each

This presentation explores two central themes: the definition and evolution of systems of care; and criteria and methods useful to support the notion of evidence based practice. Dr. Friedman also discusses the challenges of incorporating evidence-based practice within community-based system of care and effectively evaluating outcomes for the system and for children and their families.
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Systems of Care: What Makes Them Work?

In this presentation, Dr. Robert Friedman provides an in-depth look at the evolution of the system of care concept and its implementation. This presentation focuses on conditions that led to the creation and development of systems of care, and reviews key principles and values in the context of what makes a system of care successful.
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Surgeon Generals Conference on Mental
Health 1999

At the request of the Surgeon General, Dr. David Satcher over 300 mental health professionals, researchers, advocates, parents and youth gathered in Washington, D.C in September of 1999. The purpose of this gathering was to develop an action plan to improve the mental health of children in the United States. Robert Friedman, Ph.D. presented on the evolution of child mental health policy and system of care implementation in the US, its relationship to policy at all levels, and how the move toward adopting evidence based practice will interact with system efforts.
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