History of Systems of Care
Since the 1975 passage of the Individuals with Disabilities Education Act (Public Law 94-142), which ensures that all children with disabilities have available to them a free and appropriate education in the least restrictive environment, there has been a growing movement to deliver services to children within their homes, schools, and communities. It has also become clear that no single child-serving agency, because of policy, programmatic, or financial limitations, has the ability to provide all the services and supports needed by families with children who have disabilities and/or are vulnerable to abuse and neglect. During the early 1980s, local educational authorities joined child welfare in supporting children with various disabilities, yet children with serious emotional disturbances often remained unserved, underserved, or inappropriately served. In 1984, the National Institute of Mental Health, U.S. Department of Health and Human Services, initiated the Child and Adolescent Service System Program to help States plan for and design systems of care to address the mental health needs of children who were experiencing a serious emotional disturbance.
The systems of care approach was originally created in response to concerns that:
- Children in need of mental health treatment were not getting the services they needed
- Services were often provided in restrictive out-of-home settings
- Few community-based services were available
- Service providers did not work together
- Families were not adequately involved in their child's care
- Cultural differences were rarely taken into account (Stroul, 1996)
The systems of care approach is now being applied to other target populations who depend on public systems for services, including children, youth, and their families in the child welfare system.
Historically, systems of care have focused on improving access to and availability of services and on reducing service and funding fragmentation. In addition, systems of care have focused on improving the skills, knowledge, and attitudes of frontline service providers. Increasingly, systems of care are concerned about "treatment efficacy," ensuring effective therapeutic interactions between practitioners and children in care and their families (Pires, 2002) and system reform.
Updating the System of Care Concept and Philosophy (PDF - 925 KB)
Stroul, Blau, & Friedman (2010)
Explains the system of care concept, how it has evolved, and how it can be updated. The paper also discusses strategies for using the system of care concept and improving implementation and evaluation.
Issue Brief—Systems of Care: A Framework for System Reform in Children's Mental Health (PDF - 140 KB)
Reexamines system reform in children's mental health, clarifies the systems of care concept, and explores the continued relevance of systems of care as a framework for reform.