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

Robert Friedman stresses that "perhaps the greatest contribution of systems of care may be the development of a set of values and principles to serve as a foundation for systems and services, with a strong emphasis on individualized and family-driven care, designed to meet the needs of children and their families rather than to meet the convenience of funders, systems, and providers, their strong focus on the need for culturally competent and family-driven systems and services, and for a balance between the focus on deficits and a focus on strengths" (Data Trends No. 137, June 2006 -pdf). He notes that this is a a dramatic shift from the status of the field in the early 1980s.

The Center's theory suggests that a statement of values and principles is a foundation component for effective systems of care. This statement is developed in a participatory manner with parents and professionals and youth working together, and with representatives from various service sectors with the target community. Such a statement of values and principles need not be identical to those presented in the original monograph in which the framework is presented for systems of care (Stroul & Friedman, 1986), but they must be consistent with those presented in the monograph. Each community may wish to define cultural competence or individualized care slightly differently, for example, but to have a system of care a community must demonstrate initially through its statement of values and principles and subsequently through its actions that it is committed to cultural competence and individualized care.

 

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Legislative Support & Policy Related to Systems of Care

The recommended use of the SOC can be found in the Surgeon General’s report on the nation’s mental health (USDHHS 1999).

Systems of care are also promoted in the report from President Bush’s New Freedom Commission on Mental Health (2003), and in the Federal Mental Health Action Agenda for the Transformation of Mental Health Care in America from SAMSHA (2005). See http://www.samhsa.gov/Federalactionagenda/NFC_execsum.aspx

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 is the Comprehensive Community Mental Health Services for Children and Their Families Program administered by SAMHSA. This federal program provides grants and cooperative agreements to States, communities, territories, Indian tribes, and tribal organizations to improve and expand their systems of care to meet the needs of an estimated 4.5–6.3 million children with serious emotional disturbances and their families. The program was first authorized in fiscal year 1992 by section 561-565 of the Public Health Service Act, as amended. The grant program has funded a total of 92 grantees across the country. There are currently 64 active system of care communities.

The current list of communities can be found at:
http://systemsofcare.samhsa.gov/ResourceDir/Comprehensivehome.aspx

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Measures of SOC – Systems of Care Practice Review

The Center has developed strategies for evaluating systems of care, and participates in the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program. The Center is pleased to be a resource for communities involved in this Federal program, and works in partnership with other centers supporting systems of care initiatives. Through this work, Center has developed the Systems of Care Practice Review, now revised (SOCPR-R). The SOCPR-R is a method and instrument for assessing whether System of Care (SOC) values and principles are operationalized at the level of practice, where children and their families have direct contact with service providers.

The SOCPR has been used extensively by both individual agencies and complex service systems to evaluate the fidelity of practice to the system of care philosophy. It has been shown to be an effective tool in interpreting the meaning of child and family experiences and assessing the degree to which SOC principles are guiding practice. Studies using the SOCPR to compare the degree to which the system of care principles guide practice in SOC service sites versus non-SOC sites (i.e., those relying on traditional service delivery approaches) provide evidence that there are significant differences. Specifically, these studies have shown that sites that adopt the SOC principles at the organizational level demonstrate greater evidence of SOC values at the practice level than non-SOC sites (Hernandez, Gomez, Lipien, Greenbaum, Armstrong, & Gonzalez, 2001; Stephens, Holden, & Hernandez, 2004). Furthermore, SOCPR scores have been linked to child outcomes. Children who received services in systems embodying high levels of SOC principles evidenced significant reductions in symptomatology and impairment one year after entry into services while children in systems embodying low levels of SOC principles did not (Stephens, et al., 2004). The SOCPR has been revised so that the format is more user-friendly. The summative
rating domains remain the same. Reliability studies of the SOCPR-R are currently
underway.

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References for Defining Systems of Care

Huang, L., Stroul, B., Friedman, R., Mrazek, R., Friesen, B., Pires, S, & Mayberg, S. (2005). Transforming mental health care for children and their families. American Psychologist, 60(6), 615-627.

Hernandez, M., Gomez, A., Lipien, L., Greenbaum, P. E., Armstrong, K. H., & Gonzalez, P. (2001). Use of the System-of-Care Practice Review in the national evaluation: Evaluating the fidelity of practice to system-of-care principles. Journal of Emotional and Behavioral Disorders, 9(1), 43-52.

Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Georgetown University Child Development Center, CASSP Technical Assistance Center.

President’s New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America, final report (Pub. No. SMA-03-3832). Rockville, MD: Department of Health and Human Services.

Stephens, Robert L., Holden, E. Wayne, and Hernandez, Mario (2004). System-of-care practice review scores as predictors of behavioral symptomatology and functional impairment. Journal of Child and Family Studies, 13(2), 179-191.

Stroul, B. A. & Friedman, R. M. (1994). A system of care for children and youth with severe emotional disturbances. (Revised edition). Washington, D.C.: Georgetown University Child Development Center, CASSP Technical Assistance Center.

Stroul, B. & Friedman, R. (1986). A system of care for children and youth with severe emotional disturbances. Washington, D.C.: Georgetown University Child Development Center, National Technical Assistance Center for Children’s Mental Health.

U. S. Department of Health and Human Services. (1999). A report of the Surgeon General. Rockville, MD: U.S. Public Health Service.