Systems of Care
Series: Bulletins for Professionals|
Child Welfare Information Gateway |
|Year Published: 2008|
Guiding Principles of Systems of Care
In systems of care, State, county, and local agencies partner with families and communities to address the multiple needs of children and families involved in child welfare and other service systems. At the heart of systems of care is a shared set of guiding principles that include:
- Interagency collaboration
- Individualized strengths-based care
- Cultural competence
- Family and youth involvement
- Community-based services
These principles are essential elements of any successful system of care. The implementation of these principles reflects the common goals of the agency, community, and family to ensure the safety, permanency, and well-being of children, youth, and families.
Interagency collaboration extends beyond child- and family-serving agencies to include public, private, nonprofit, community, and faith-based formal and informal service providers and supports. Examples include child welfare, juvenile justice, mental health, education, substance abuse, and health agencies and (if separate) the agency responsible for serving Native American families, as well as child advocacy and parent empowerment organizations, places of worship, local business associations, colleges and universities. In a system of care, these collaborative partners work together to address the complex needs of children and families in a spirit of community partnership. Interagency collaboration is reflected at both the governance and direct practice level.
Formal interagency governance teams can:
- Provide financial support to fill service gaps
- Develop interagency training agendas
- Develop funding strategies
- Make joint agency budget recommendations
- Create interagency management information systems
- Provide gatekeeping functions to reduce or end out-of-community placements
- Develop communication plans and program development strategies
Why is interagency collaboration important?
- Interagency collaboration creates a sense of community ownership for supporting children and families and addressing their needs and strengths.
- Children and families come to the child welfare system with multiple needs requiring the assistance of multiple agencies. Often, when multiple services are required, the effectiveness of any one service is related to the availability and effectiveness of the other services needed by the family.
- Interagency collaboration reduces duplication of services and allows for greater efficiency in the use of public resources.
- Collaboration creates a fuller understanding among community and agency partners of the policies and statutes that drive funding and practice issues, while maximizing funding and programmatic resources available to children and families.
- Interagency collaboration allows for the creation of data systems that can track children and families across agencies and provides for a unified voice to legislators on the unmet needs of children.
Questions to ask about systems of care and interagency collaboration:
- Are all child-serving agencies involved in the system of care?
- Is there broad representation of community stakeholders involved in the system of care?
- Are there interagency agreements, memoranda of understanding, or statutes that forge the interagency collaboration?
- Do families have a meaningful role in all interagency collaboration efforts?
- Are processes in place that allow for the State/county/city/tribal interagency teams to have a governance role within the system of care?
- Is each agency partner contributing funds to the system?
- Are all general fund dollars being maximized by matching them up with Federal funds where possible?
Individualized, Strengths-Based Care
Individualized, strengths-based care acknowledges each child and family's unique set of strengths and challenges. Formal and informal supports are used to create services and supports for each child and family (rather than families "fitting in" to preexisting service structures). Issues of culture, language, ethnicity, gender, age, religious background, and class are addressed in the individualized plan of care. The plan changes frequently based on ongoing individualized assessments of family strengths and needs.
Plans are created by teams comprising people who know the child and family, including neighbors; friends; family; and child welfare, mental health, education, substance abuse, and juvenile justice professionals. The team's major task is to create an individualized plan of care that is community- and strength-based, made up of formal and informal services and supports.
Why is individualized, strengths-based care important?
- Each child and family has unique attributes that must be addressed if services are going to be successful.
- Individualized care fully engages the family in designing and implementing a plan of care.
- Children and families receive services that match their unique strengths and needs.
Questions to ask about systems of care and individualized strengths-based care:
- Does the individualized care team always involve the family when designing a plan of care?
- Do plans of care take into consideration the child and family's cultural, linguistic, and religious/spiritual background?
- Do plans of care maximize all natural supports within the family and community?
- Are all funding streams being maximized within the system of care infrastructure?
- Does the system of care include a flexible fund to help create nontraditional services that are essential to the plan of care for individual children and families?
Culture and language express the world as children and families experience it. To best serve those in need of services and supports, providers must develop the capacity to understand the cultural filters that mediate the family's perspective of the agency and its plan of care. Likewise, agency professionals and service providers benefit from developing the capacity to assess the ability of individual staff and the service system overall to function effectively in multicultural communities.
Cultural competence refers to:
- A defined set of values and principles, as well as behaviors, attitudes, policies, and structures, that enable systems to work effectively cross-culturally
- The capacity to value diversity, conduct self-assessment, manage the dynamics of difference, acquire and institutionalize cultural knowledge, and adapt to diversity and the cultural contexts of the communities served
- The incorporation of the above in all policymaking, administration, practice, and service delivery, and the systematic involvement of consumers, key stakeholders, and communities
Why is cultural competence important?
- An individual's or family's culture can affect the kinds of services needed, as well as the optimal place, time, and method of delivering services and supports.
- Addressing issues of culture, race, class, and ethnic background increases the likelihood of family engagement and a positive intervention.
- By working to understand the cultural needs of the families within systems of care, service providers convey the importance of respect, dignity, nondiscrimination, and self-determination to all participants.
- The issues of child abuse and neglect are common to many cultures and communities. Being willing and able to understand the unique needs of the families seeking or needing services will improve both the families' willingness to participate and the system's capacity to provide effective services.
Questions to ask about systems of care and cultural competence:
- Is leadership committed to building cultural competence throughout the system of care?
- Are policies in place to support cultural competence throughout the system of care?
- Are the recommended services responsive to each child and family's culture?
- Is the family's cultural background taken into account in determining when, how, and where services will be offered?
- Are staff reflective of the community's racial and ethnic diversity?
- Is training regularly offered on the theory and practice of cultural competence to staff, family, and community partners?
- Are families involved in developing the system's cultural competence efforts?
- Do child welfare staff interact with children and families in culturally competent ways?
- Are staff culturally sensitive to the place and type of services made available to the child and family?
- Does the system of care reach out to the diverse racial, ethnic, and cultural groups in the community?
Family and Youth Involvement
Family and youth involvement within a system of care requires mutual respect and meaningful partnerships between families and professionals. Families and youth are involved as key stakeholders, whether they are helping tailor one child's individualized plan of care or helping design, build, or maintain the system of care. Families and youth are involved in policy development, care coordination, evaluation, strategic planning, service provision, social marketing, and individual and system advocacy. Families and youth involved in systems of care activities may include caregivers, kin, extended family members, former service recipients, and others that families identify as important.
Why is family and youth involvement important?
- The goal of permanency for children—either by reunification with their biological parents or other permanency options—is best facilitated when the family and youth are involved in planning services and participate actively in them.
- Engaging family members and youth in the planning and provision of services emphasizes a respect for their capabilities and their role as part of the solution to their problems.
- Involving families and youth helps ensure sensitivity to cultural, service, and support needs.
- Child and Family Services Reviews have found that a significantly higher percentage of children have permanency and stability in their living situations in States that rated strongly in developing case plans jointly with parents and youth.
Questions to ask about systems of care and family and youth involvement:
- Are families and youth invited to all meetings that address systems of care issues?
- Are families and youth adequately represented and meaningfully involved on all systems of care committees?
- Are training and professional development opportunities available for family and youth partners?
- Are the families and youth involved in designing and building systems of care reflective of the community's cultural and ethnic composition?
- Are staff trained in how to engage, involve, and partner with families and youth?
- Are family members and alumni youth employed in the system of care?
- Are families and youth reimbursed for time spent supporting systems of care (e.g., wages, stipends or honoraria, transportation, childcare expenses)?
A system of care builds not only on the strengths of the child and family, but also on the strengths of their community. Providing community-based services means having high quality services accessible to families in the least restrictive setting possible. A community-based system of care requires systems to see the home, school, and neighborhood of the family from an asset-based perspective, and to identify the natural supports in these familiar surroundings as part of a strengths-based approach.
Why are community-based services important?
- Keeping children in their homes, neighborhood schools, and local communities has a positive effect on child and family well-being. Moving, in many cases, generates unnecessary stress for an already traumatized child.
- By remaining in the community, the child is able to retain critical bonds with friends, family, and school personnel.
- When services are community-based, the work done with the child and family is in the context of where the child lives.
- The community (faith-based organizations, nonprofit agencies, neighbors, and other institutions) can offer additional positive, informal supports to the child and family.
Questions to ask about systems of care and community-based services:
- Is a broad array of evidence-based and promising practices, informal services, and supports available to meet the needs of children and families in the community?
- Are services available to families in their primary language and at times and locations convenient to them?
- Is in-home support offered to families?
- Are flexible funds available to meet the unique needs of each child and family?
- Are all child- and family-serving agencies and community partners invited to the table and working together on behalf of children and families?
- Are caseworkers and staff from collaborating agencies trained in maximizing informal supports for children and families?
- Do child welfare caseworkers and other staff interact with children and families in culturally competent ways?
- Are caseworkers and other staff culturally sensitive to the place and type of services made available to the child and family?
- Is the community where the family resides routinely seen as one of the child's major resources?
Accountability refers to the continual assessment of practice, organizational, and financial outcomes to determine the effectiveness of systems of care in meeting the needs of children and families. Two essential components of an effective accountability strategy in a system of care are:
- The development of an interagency management information system that tracks important indicators of service and system performance
- A strong evaluation strategy
Why is accountability important?
- By focusing on the effects and outcomes of the services provided, such as child safety while in care, communities are provided a benchmark against which they can set realistic goals and measure continuous improvement.
- To ensure continuous improvement of systems of care, it is critical to incorporate process and outcome data into ongoing decision-making at all levels.
- In times of limited resources, decision-makers are most likely to allocate resources to initiatives that demonstrate effectiveness and an efficient use of funds.
- The safety and well-being of children, youth, and families is a responsibility shared by the entire community. As such, systems of care communities join together in holding one another accountable for ensuring positive outcomes, regardless of where the child and family seek help.
Questions to ask about systems of care and accountability:
- Do caseworkers use data to monitor their progress and inform decision-making?
- Is the management information system designed to capture relevant performance information from all interagency collaboration partners?
- Have families been involved in the design and implementation of the data system?
- Does the management information system track costs, quality of services, and outcomes for children and families?
- How does the management information system line up with the federally mandated Child and Family Services Review data?
- Does the system of care have a structured process for ongoing performance improvement, including dissemination of key findings to all stakeholders, regular review of performance data, and use of outcomes data in decision-making?
- Is an ongoing interagency data improvement committee a part of the systems of care infrastructure?
- Are data from the management information system used to improve services and supports?
- Are data generated from the management information system used to inform the public, legislators, and key policy administrators about the impact of the system of care on children and families served by the agency?
- Have cultural competency principles been included in the design of the management information system?
- Is the evaluation plan culturally appropriate for the community it serves?
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