SAMHSA SYSTEM OF CARE
DEFINITION, CONCEPT, CORE VALUES
A spectrum of community-based services and supports for children and youth with or at risk for mental health or other challenges and their families, that is organized into a coordinated ◊network, builds meaningful partnerships with families and youth, and addresses their cultural and linguistic needs, in order to help them function better at home, in school, in the community, and throughout life
B. Stroul, G. Blau, R. Friedman (2010) – Updating the System of Care concept and philosophy. Washington D.C.: Georgetown University Center for Child & Human Development, National Technical Assistance Center for Children’s Mental Health
The system of care model is an organizational philosophy and framework that involves collaboration across agencies, families, and youth for the purpose of improving services and access and expanding the array of coordinated community-based, culturally and linguistically competent services and supports for children and youth with a serious emotional disturbance and their families. The system of care philosophy is built upon these core values and guiding principles.
The core values of the system of care philosophy specify that systems of care are:
1. Family driven and youth guided, with the strengths and needs of the child and family determining the types and mix of services and supports provided.
2. Community based, with the locus of services as well as system management resting within a supportive, adaptive infrastructure of structures, processes, and relationships at the community level.
3. Culturally and linguistically competent, with agencies, programs, and services that reflect the cultural, racial, ethnic, and linguistic differences of the populations they serve to facilitate access to and utilization of appropriate services and supports and to eliminate disparities in care.
4. Individualized & Community Based
5. Evidence Based
SAMHSA SYSTEM OF CARE CORE VALUE DEFINITIONS
The system of care should be family driven, with the needs of the child and family dictating the types and mix of services provided. Family driven means that families have a primary decision-making role in the care of their children, as well as in the policies and procedures governing care for all children in their community, state, tribe, territory, and nation. This includes:
§ Choosing supports, services, and providers
§ Setting goals
§ Designing and implementing programs
§ Monitoring outcomes
§ Determining the effectiveness of all efforts to promote the mental health of children and youth.
The system of care should be youth guided. Youth guided means that youth are engaged as equal partners in creating systems change in policies and procedures at the individual, community, state, and national levels.
CULTURAL & LINGUISTIC COMPETENCE
The system of care should be culturally and linguistically competent, with agencies, programs, and services that are responsive to the cultural, racial, and ethnic differences of the populations it serves. Cultural competence is the integration and transformation of knowledge, behaviors, attitudes, and policies that enable policy makers, professionals, caregivers, communities, consumers, and families to work effectively in cross-cultural situations. Cultural competence is a developmental process that evolves over an extended period of time.
INDIVIDUALIZED & COMMUNITY BASED
Each child or adolescent served within a system of care should have an individualized care plan developed by the family team, with leadership from the child’s parents or legally responsible adult and the child or youth. The family team includes traditional service providers and also engages non-traditional and informal providers and supports. The individualized care plan refers to the procedures and activities that are appropriately scheduled and used to deliver services, treatments, and supports to the child and the child’s family.
Needed services and informal supports should be available within the community, and be accessible and culturally and linguistically competent. Community-based services are enhanced by building partnerships with service systems and resources in the community and ensuring that management and decision-making responsibility are from community stakeholders.
Empirically supported treatments (ESTs) and evidence-based treatments (EBTs), both frequently referred to as evidence-based practices (EBPs), are important components of a service delivery system. Additionally, there are other practices that may not be empirically based that work in culturally diverse communities that must be considered and used if appropriate. These practices may be called practice-based evidence (PBE) or community defined evidence (CDE).
SAMHSA SYSTEM OF CARE GUIDING PRINCIPLES
The following1 represent the foundational principles of the system of care philosophy, that systems of care are designed to:
1. Ensure availability and access to a broad, flexible array of effective, community-based services and supports for children and their families that address their emotional, social, educational, and physical needs, including traditional and nontraditional services as well as natural and informal supports.
2. Provide individualized services in accordance with the unique potentials and needs of each child and family, guided by a strengths-based, wraparound service planning process and an individualized service plan developed in true partnership with the child and family.
3. Ensure that services and supports include evidence-informed and promising practices, as well as interventions supported by practice-based evidence, to ensure the effectiveness of services and improve outcomes for children and their families.
4. Deliver services and supports within the least restrictive, most normative environments that are clinically appropriate.
5. Ensure that families, other caregivers, and youth are full partners in all aspects of the planning and delivery of their own services and in the policies and procedures that govern care for all children and youth in their community, state, territory, tribe, and nation.
6. Ensure that services are integrated at the system level, with linkages between child-serving agencies and programs across administrative and funding boundaries and mechanisms for system-level management, coordination, and integrated care management.
7. Provide care management or similar mechanisms at the practice level to ensure that multiple services are delivered in a coordinated and therapeutic manner and that children and their families can move through the system of services in accordance with their changing needs.
8. Provide developmentally appropriate mental health services and supports that promote optimal social-emotional outcomes for young children and their families in their homes and community settings.
9. Provide developmentally appropriate services and supports to facilitate the transition of youth to adulthood and to the adult service system as needed.
10. Incorporate or link with mental health promotion, prevention, and early identification and intervention in order to improve long-term outcomes, including mechanisms to identify problems at an earlier stage and mental health promotion and prevention activities directed at all children and adolescents.
11. Incorporate continuous accountability and quality improvement mechanisms to track, monitor, and manage the achievement of system of care goals; fidelity to the system of care philosophy; and quality, effectiveness, and outcomes at the system level, practice level, and child and family level.
12. Protect the rights of children and families and promote effective advocacy efforts.
13. Provide services and supports without regard to race, religion, national origin, gender, gender expression, sexual orientation, physical disability, socio-economic status, geography, language, immigration status, or other characteristics, and ensure that services are sensitive and responsive to these differences.
1Stroul, B., Blau, G., & Friedman, R. (2010). Updating the system of care concept and philosophy. Washington, DC: Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children’s Mental Health.