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Systems Of Care

Children and Adolescents With Serious Emotional Disturbances
Why are systems of care needed?
What are systems of care?
What kinds of services are included?
What is a case manager or service coordinator?
How well do systems of care work?
Important messages about children and adolescents.

Children and Adolescents With Serious Emotional Disturbances

Today, at least one in five American children and adolescents may have a behavioral, emotional, or mental health problem. At least 1 in 10-or as many as 6 million young people-may have a serious emotional disturbance that severely disrupts his or her ability to interact effectively with family, at school, and in the community.

These children live in the cities, suburbs, and rural areas of our country. They come from wealthy, middle-class, and poor families and from every race and culture. But no matter what their backgrounds are, children with serious emotional disturbances and their families often do not receive the services and support they need to help them with their problems.

Why Are "Systems of Care" Needed?

A serious emotional disturbance touches every part of a child's life. Therefore, children and adolescents with serious emotional disturbances and their families need many kinds of services from a variety of sources, such as schools, community mental health centers, and social service organizations.

Unfortunately, many State and community organizations do not work together to coordinate the services that children with serious emotional disturbances and their families need. For example, while children might be attending special education classes at school, they may not have access to after-school or recreation programs. Families might not receive the support they need to care for their children. To get needed services, some families have to give up custody or agree to place their children in a hospital or residential treatment center.

Today, with a much better understanding of serious emotional disturbances, many mental health providers know that children and their families can receive effective, accessible treatment and support through community-based "systems of care."

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What Are Systems of Care?

A system of care is a wide range of mental health and related services and supports organized to work together to provide care. It is designed to help a child or adolescent with serious emotional disturbances, with the involvement of his or her family, get the services they need in or near their home and community.

In systems of care, local public and private organizations work in teams to plan and implement a tailored set of services for each individual child's physical, emotional, social, educational, and family needs. Teams include family advocates and may consist of representatives from mental health, health, education, child welfare, juvenile justice, vocational counseling, recreation, substance abuse, or other organizations (see following graphic on "Components of Systems of Care").

Teams find and build upon the strengths of a child and his or her family, rather than focusing solely on their problems. Teams work with individual families-including the children-and with other caregivers as partners when developing a plan for the child and when making decisions affecting his or her care.

"Cultural competence" is an important goal in systems of care. It means that each provider organization must show respect for and respond to individual differences and special needs. Services must be provided in the appropriate cultural context and without discrimination related to race, national origin, income level, religion, gender, sexual orientation, age, or physical disability, to name a few.

Culturally competent caregivers are aware of the impact of their own culture on their relationships with consumers and know about and respect cultural and ethnic differences. They adapt their skills to meet each family's values and customs.

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What Kinds of Services Are Included?

The range of services that may be included in a system of care fall into the categories shown in the above graphic. A young person with a serious emotional disturbance and his or her family may be referred for one or more of these services:

Case management (service coordination)community-based in-patient psychiatric care

  • counseling (individual, group, and youth)
  • crisis residential care
  • crisis outreach teams
  • day treatment
  • education/special education services
  • family support
  • health services
  • independent living supports
  • intensive family-based counseling (in the home)
  • legal services
  • protection and advocacy
  • psychiatric consultation
  • recreation therapy
  • residential treatment
  • respite care
  • self-help or support groups
  • small therapeutic group care
  • therapeutic foster care
  • transportation
  • tutoring
  • vocational counseling

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What is a Case Manager or Service Coordinator?

A case manager or service coordinator facilitates the individualized treatment plan that is being used to serve a child or adolescent with a serious emotional disturbance and the family. This person identifies the role that each provider fills and coordinates all services.

The goal is to make sure that the plan builds on the strengths and meets the unique needs of both child and family. As the child's needs change, his or her case manager notes these changes and adjusts the mix of services, if necessary. For example, a case manager may recommend tutoring and counseling when a child no longer requires day treatment. In working with a child who is experiencing a serious emotional disorder, a case manager's role is dynamic-that of advocate, therapist, and coordinator of a package of services.

Caseloads average between 4 and 12 youths and their families per case manager.

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How Well Do Systems of Care Work?

Studies suggest that effective systems of care:

  • reduce the number of costly hospital and out-of-home residential treatment placements
  • improve how children behave and function emotionally
  • improve school performance
  • reduce violations of the law
  • provide services to more children and families who need them.

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Important Messages About Children's and Adolescents' Mental Health

  • Every child's mental health is important.
  • Many children have mental health problems.
  • These problems are real and painful and can be severe.
  • Mental health problems can be recognized and treated.
  • Caring families and communities working together can help.

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