Selected Sections from:
Department of Health and Human Services
Administration for Children and Families
Administration on Children, Youth and Families
Child Abuse and Neglect Discretionary Activities
2003B.2: Improving Child Welfare Outcomes through Systems of Care
ELIGIBLE APPLICANTS: State, territory, county or city child welfare agencies and federally recognized Native American Tribes are eligible applicants. No more than one application will be funded from any one State in order to insure geographic distribution of the awards. Collaborative applications are acceptable, however applications from collaborations must identify a primary applicant responsible for administering the grant.
PURPOSE: The purpose of the awards under this priority is to assist States in addressing child welfare needs and issues raised during the Child and Family Service Reviews, in the statewide assessments, final reports, or Program Improvement Plans. These awards will be funded as cooperative agreements to build home and community based "Systems of Care" to improve outcomes for children and families at risk of child maltreatment, childr en who have been substantiated for maltreatment but have not been removed from the home, or children in state custody (foster care). A Systems of Care approach is based on the development of a strong infrastructure of interagency collaboration, individualized care practices, culturally competent services and supports, child and family involvement in all aspects of the system and measures of accountability. Systems of Care have shown promise in working with various at-risk child and family populations. Given the Children's Bureau's mission of child safety, permanency of placement, and well-being of children and families, it is incumbent that new and promising approaches to supporting children and families be tested. Systems of Care have shown promise in helping stabilize placements of children and addressing, in a positive fashion, the mental health needs of children, youth and their families. Child welfare is poised to take advantage of these lessons and implement this kind of systemic change that will fundamentally t ransform the child welfare system's polices, practices, and relationships with other child and family serving agencies.
BACKGROUND INFORMATION: The child welfare system has undergone a tremendous amount of change during the past decade. Federal law has stimulated much of this change including the Adoption and Safe Families Act of 1997, amendments to the Social Security Act, which authorized reviews of title IV-B and IV-E compliance, the Multi-Ethnic Placement Act, 1996 amendments to the Child Abuse Prevention and Treatment Act, and the Children's Health Act of 2000.
The Federal Government has recently implemented the Child and Family Service Review (CFSR) process. More than half of the States have gone through their initial review and many are in the process of preparing their Program Improvement Plans. The Child and Family Service Reviews emphasize child welfare practice principles such as family-based child welfare practice, community-based services, individualizing the case planning and service delivery system to the unique needs of children and families, and strengthening the capacity of parents to care for their children whenever possible and appropriate. In many situations, making lasting improvements that incorporate these principles requires changing the culture of child welfare agencies and the conceptual framework within which services are delivered.
States must direct their change efforts to both day-to-day practice in the field and the supportive infrastructure of the agency that affect the outcomes of services for children and families. This type of system ch ange is difficult; requiring large amounts of time, strategic thinking and resources to implement the changes effectively. With the ever-present responsibility fo r assuring the safety, permanency and well-being of children in their care it is difficult for child welfare agencies to devote the time or resources needed to step back and make the necessary system adjustments.
While many systemic changes focus on State child welfare systems, other efforts are focusing on the agencies' child serving partners in education, mental health, juvenile justice and substance abuse in order to make similar reforms. For example, during the last twenty years public departments of mental health have begun to assume more responsibility for serving children and adolescents who have serious emotional disturbances. Federal legislation and subsequent appropriations have given State, county, city, territory, and federally recognized Native American Tribes funds to build interagency Systems of Care to address the mental health needs of youth in all child serving systems. In education, amendments to the Individuals with Disabilities Education Act (IDEA) call for more collaboration with other child serving systems in dealing with the various needs of children who are eligible for special education services. The juvenile justice system has also undertaken similar reforms including requirements to assess and address the mental health needs of youth in their custody.
This need for change within the child welfare system and its partner agencies calls for a new investment of time and funds in child welfare in order to achieve, manage, and sustain lasting change. State child welfare agencies must not only define their course toward systemic change internally, but must also be able to work collaboratively with partner agencies in order to assure the safety, permanency, and well-being of children and their families effectively.
The notion of community-based, interagency Systems of Care has shown merit in effectively serving the many needs of children within the context of their home, community and school. Does it have merit in helping achieve positive outcomes for children and families involved with the child welfar e agency and its partner agencies? This grant program will try and answer that question.
Results of the Child and Family Service Reviews from the first thirty-two States indicate that a majority of those States are having difficulty achieving consistently positive outcomes in the areas of safety, permanency and wellbeing for children and families. Some of the areas cited as needing particular improvement are:
- More effective services to protect children and prevent removal from their homes (16 States)
- More comprehensive and consistent needs assessments of family members and appropriate matching of services to needs (31 States)
- More active involvement of children and parents in case planning (27 States)
- Increased attention to the educational needs of children (25 States)
- Increased attention to the physical health needs of children (20 States)
- Increased attention to the mental health needs of children and families (30 States)
Child welfare agencies are beginning to address issues that have emerged from the Child and Family Services Reviews through Program Improvement Plans, and some State agencies are using this as the opportunity to create true system change. This priority area builds on the need to pursue systemic change in child welfare in order to serve children and families more effectivel y. Questions to be answered by this effort include: Do the underlying values and principles of the Systems of Care model support needed systemic changes throughout child welfare agencies? How can a child welfare agency provide leadership in a Systems of Care approach that involves the commitment of other child serving agencies? What would a child welfare-driven Systems of Care model look like? How effective will the Systems of Care approach be on the various populations within the child welfare system? Can families be partners in a child welfare-led System of Care? How might a child welfare-led System of Care address the issue of children who might need to receive services prior to or without coming into state custody?
Systems of Care History: Since the passage of Public Law 94-142 in 1975, the Individuals with Disabilities Education Act, which insures 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 the context of their home, school, and community. It has also become clear that no one child-serving agency, because of either policy, programmatic, or financial limitations, has the ability to provide all the necessary services and supports needed by families with children who have disabilities such as mental health disorders and/or are vulnerable to abuse and neglect. During the early 1980's Local Educational Authorities (LEA) joined child welfare in supporting children with various disabilities, yet children with serious emotional disturbances remained un-served, underserved, or inappropriately served with very few children getting the mental health services they needed. In 1984, the National Institute of Mental Health, United States Department of Health and Human Services, responded to this by beginning a program called the Child and Adolescent Service System Program (CASSP), to help States design "Systems of Care" to address the mental health needs of children who were experiencing a serious emotional disturbance.
The Systems of Care principles of this program have had a profound impact on where and how services are delivered to this population of children and their families. The principles include:
- Children and their families are best served within the context of their home and community;
- The System of Care needs to be culturally competent;
- Families need to be involved in all aspects of designing, building and sustaining their System of Care;
- Each child and family is unique; therefore, services and supports need to be tailored to meet the individual needs of each child and family served;
- Plans of care need to address the strengths of children and their families;
- Interagency collaboration is critical for the success of the System of Care because the needs of children and families cut across agencies; and
- Measures of accountability need to be developed to insure that client and system-level outcomes are measured.
The Robert Wood Johnson Foundation, from 1988 to 1992, supported testing the viability of these Systems of Care strategic plans by investing funds to build the infrastructure, create, and purchase the services for children who had the most profound disabilities. The results of this effort showed that, in fact, children who had serious emotional disturbances could be served effectively within the context of their home, school, and community and that these services and supports could be provided in a cost-effective manner.
In 1993, Congress passed legislation that created the Comprehensive Community Mental Health Services for Children and Their Families Program (Public Law 102-321). Built upon the work of the previous Federal grant program of the mid-eighties and the Robert Wood Johnson Foundation effort, Federal funds were then allocated to help communities build Systems of Care. The Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services administers the program that has now served over 60 thousand children in over 80 communities. Notably, nearly 25 percent of the children served have been referred from the Child We lfare System.
The results of this program have been very promising. Children and youth enrolled in Systems of Care have shown greater placement stability than children with the same level of disability that are not enrolled; school grades have improved; enrollees have fewer contacts with the juvenile justice system; children and youth with the highest levels of pathology have shown significant gains in their mental health status; parent and youth satisfaction has been very high and costs associated with serving children who have the highest level of disability have been lowered.