Systems of Care in Child Welfare

A fully developed system of care would include all major human service systems, rather than focus on a single system. However, in building an integrated system, the needs that characterize each system and the unique mandates that affect them must be considered throughout the change process. Much of the current literature and research on systems of care reflect a focus on mental health issues. Contemporary examples of systems of care, outcomes research, and even the national network of experts and consultants are largely drawn from the mental health field. The Children's Bureau's Improving Child Welfare Outcomes Through Systems of Care demonstration initiative was designed specifically to focus on the challenges of serving children in the child welfare system while integrating with systems of care efforts in other human service agencies. This 5-year effort has enhanced understanding of how a systems of care approach can be shaped for the child welfare field.

Preliminary findings suggest that to be most effective in child welfare, especially as a framework for change, systems of care must be tailored and based on an in-depth understanding of the mandates and challenges child welfare administrations face and the diverse needs of children, youth, and families. Child welfare has a culture and history that are unique. The traditional psychosocial or ecological approach to understanding and meeting the needs of children; an emphasis on ensuring child safety, permanency, and well-being; and a history of collaborative work with other agencies are hallmarks of child welfare. However high staff turnover requires continuous orientation processes and the often adversarial relationships and power differentials between families and frontline staff make trust and strengths-based approaches difficult to implement. Responding to the unique needs of overrepresented and culturally diverse populations, and negative visibility in the wake of tragedies, also are factors in adapting the systems of care approach to child welfare.

Implementation of the Child and Family Services Reviews represents a unique opportunity for following the systems of care approach. The Child and Family Services Review process increasingly has focused not only on frontline practices but also on systemic change (Ohl, 2008). While changes in frontline practice may lead to improvements for a small, targeted group, unless those changes are adopted and supported by policies and processes throughout the organization and service array, they will remain at best pilot or demonstration projects. Conversely, policy changes without complementary change in frontline services or practices are unlikely to lead to improved safety, permanency, or well-being for children. Child and Family Services Reviews have placed increased demand on States to engage in a structural and comprehensive change process designed to address these challenges.

The core principles implemented through the Improving Child Welfare Outcomes Through Systems of Care demonstration initiative correspond closely to those underlying the Child and Family Services Reviews (Pires, 2008). Despite slight differences in terminology, the complementary principles represent a sound set of child welfare focused guidelines that can facilitate a systems of care driven change process.

Any systems change effort should promote an integrated and orderly process of change. However, like many organizations, child welfare systems can be prone to environmental stressors. Perhaps the most challenging in child welfare is the loss of a child's life while in care. The failure to protect a child is devastating, highly public, and often results in dramatic, abrupt, and often reactionary changes in the system. Line and senior staff alike often are removed from or resign their positions, policies may change, and scrutiny and oversight increase. Programs that are largely effective may be jettisoned for less effective approaches that appear to be safer. When such changes happen abruptly, they frequently are not integrated well throughout the system (Bertelli, 2004). Because the systems of care framework for change is guided by core principles that promote accountability and transparency, child welfare administrations and their partner human service agencies have greater potential to respond to crises in a purposeful and insightful manner.

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