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Updating the System of Care Concept: A Guide for the Future


Title: APA Presentation for Beth Stroul Author: Scott Bryant-Comstock Last modified by: Kevin Enright Created Date: 6/27/2005 4:59:51 PM Document presentation format – PowerPoint PPT presentation

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Title: Updating the System of Care Concept: A Guide for the Future

Updating the System of Care Concept A Guide for
the Future
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Updating the System of Care Concept A Guide for
the Future
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TA CALL WEBSITE http//gucchdtacenter.georgetow
n.edu/resources/2010calls.html DATA MATTERS
http//www.gucchdgeorgetown.net/data/ THANK YOU
Updating the System of Care Concept A Guide
for the Future Beth A. Stroul, M.Ed.September
16, 2010
Origins of SOC Concept
  • Began with federal CASSP 25 years ago
  • Participatory process with multiple stakeholders
    (policy makers, service providers, agency
    administrators, TA providers, family members,
    researchers, advocates, leaders in cultural
    competence, etc.)
  • First articulated in 1986 monograph
  • Provided a definition, framework,
    and philosophy
  • Intent to guide the field in
    reforming systems and services

Application of SOC Concept
  • Shaped the work of states, communities, tribes,
    and territories some elements in nearly all
  • Foundation of the federal CMHI in 1992 (Over 1
    billion invested in building SOCs)
  • Surgeon Generals Conference on Childrens Mental
    Health National Action Agenda in 2000
  • Basis of recommendations of childrens subgroup
    of the Presidents NFC in 2005
  • Framework for reform by other child-serving and
    adult systems

Application of SOC Concept
  • Groundwork for
  • Development of
    resources, training, TA
  • CQI processes
  • Methods/instruments for
    outcome measurement
  • Concepts of family-driven, youth-guided systems
    and family and youth movements
  • Concept of cultural and linguistic competence
  • Processes and tools for individualized,
    wraparound approach
  • Social marketing in childrens mental health

Original SOC Definition
A coordinated network of community-based services
and supports characterized by a wide array of
services, individualized care,
services provided restrictive full participation
youth, coordination
within the least environment, of families
and among
  • child-serving agencies and programs, and cultural
    and linguistic competence

System of Care Framework
Why Update?
  • Construct is dynamic
  • New insights through natural evolutionary process
    based on experience and increased knowledge
  • New issues have arisen in the field
  • 25th anniversary seen as an opportune time to
    re-examine and update

What Needs Updating?
  • Have been previous updates and clarifications,
    e.g. Primer, Issue Brief to address
  • Many issues for potential updates raised by
    authors in special journal issue devoted to
    updating the concept edited by Sharon Hodges and
    Kathleen Ferreira at USF (February 2010)
  • Considerable consensus has emerged on what
    aspects should be updated, based on latest
    thinking, experience, and data

Broaden Population
  • Originally crafted for children and youth with
    SED (serious mental health challenges)
  • Applicability to children and youth at risk and
    to other populations and other child-serving
    systems is apparent
  • Subsequent iterations should reflect broader
    application and relevance to populations besides
    children with SED, including early childhood,
    transition age, across child-serving systems

Include Core Values in Definition
  • Add three core values to the basic definition
  • Community-based
  • Family-driven and youth-guided
  • Cultural and linguistic competence
  • So intrinsic that they should be included in the
    overall definition, in addition to their
    specification as core values

Emphasize Commitment to Family-Driven,
Youth-Guided SOCs
  • Original definition used terms family centered
    and child focused
  • Growth of family and youth
    voice led to terms family
    driven, youth guided
  • Updated definition should reflect conceptual
    shift to primary decision-making roles of
    families and youth in their own care and in
    systems and policies at all levels

Strengthen Cultural and Linguistic Competence and
  • Increasing diversity of the populations served
    by SOCs makes it essential to add greater
    emphasis to the core value of cultural and
    linguistic competence
  • Specify that systems of care are responsible for
    strategies to ensure access to high-quality,
    acceptable services for culturally diverse groups
  • Incorporate elimination of disparities as part of
    the core value

Specify Desired Outcomes
  • Make explicit the ultimate outcome to
    improve the lives of children and their
  • Use language in current
    federal definition calling
    for SOCs and services to enable
    children, youth, and families to function better
    at home, in school, in the community, and
    throughout life

Add Greater Focus on Improving Practice
  • Definition and implementation have focused on
    system-level changes
  • Research and experience show importance of
    effective, evidence-informed clinical
    interventions and services to improve outcomes
  • Emphasis on effective practice
    should be incorporated

Emphasize Individualized Care
  • Add greater emphasis on individualized, flexible
    approach to services
  • Wraparound process has become one of the most
    significant practice-level approaches to planning
    and delivering services within SOCs
  • Emphasis on individualized, wraparound approach
    should be increased

Emphasize Role of Natural Supports
  • Specification that SOCs should provide a broad
    array of services and supports including both
    traditional and nontraditional services and
    supports and informal and natural supports
  • Acknowledge importance of natural supports (such
    as extended family, community and cultural
    organizations, cultural brokers, faith
    communities, peers, etc.)

Change Necessary to Needed Services and
  • Term necessary may connote medically
    necessary services, a term often used by public
    and private insurance programs to limit covered
  • Avoid this connotation in the definition

Broaden Concept to Incorporate Public Health
  • Need for a public health approach to mental
    health increasingly recognized
  • Concept should recognize potential for SOCs to
    incorporate or link with promotion, prevention,
    and early intervention, in addition to services
    and supports for high-need youth and their

Include Accountability
  • Accountability is a critical element
  • Should be a core component of concept to monitor
    and manage the ability to address the elements of
    SOCs (fidelity), quality, achievement of goals,
    and child and family outcomes
  • Measurement mechanisms and feedback to
    administrators and clinicians should be a
    routine function in SOCs

Recognize Need for Infrastructure
  • Although implementation has focused on
    system-level changes, definition doesnt specify
    the types of infrastructure needed to support
  • Incorporate wording on need for a supportive
    infrastructure of structures, processes,
    linkages, and relationships at the community
    level, including system-level management and
    integrated care management

Capture Dynamic Nature of SOCs
  • SOCs not static, change over time
  • Policies, organizational arrangements, service
    delivery approaches, and treatments change based
    on changing needs, opportunities, environmental
    circumstances, and populations
  • Even well-developed SOCs do not remain in a
    steady state, but continually strive to improve
  • This characteristic should be made explicit

Updated Definition
  • A spectrum of effective, community-based
    services and supports for children and youth with
    or at risk for mental health or other challenges
    and their families, that is organized into a
    coordinated network, builds meaningful
    partnerships with families and youth, and
    addresses their cultural and linguistic needs, in
    order to help them to function better at home, in
    school, in the community, and throughout life

Core Values Systems of Care are
  • Family driven and youth guided, with the
    strengths and needs of the child and family
    determining the types and mix of services and
    supports provided
  • Community based, with the locus of services as
    well as system management resting within a
    supportive, adaptive infrastructure of
    structures, processes, and relationships at the
    community level
  • Culturally and linguistically competent, with
    agencies, programs, and services that reflect the
    cultural, racial, ethnic, and linguistic
    differences of the populations they serve to
    facilitate access to and utilization of
    appropriate services and supports and to
    eliminate disparities in care

Guiding Principles
  • Broad, flexible array of effective,
    evidence-informed services and supports,
    including traditional and nontraditional
    services, informal and natural supports
  • Individualized services guided by a
    strengths-based, wraparound service planning
    process and an individualized service plan
  • Least restrictive, most normative environments
    that are clinically appropriate
  • Ensure that families, caregivers, and youth are
    full partners in services and policies/procedures
    at all levels
  • Service integration, linkages across
    administrative and funding boundaries and
    mechanisms for system-level management,
    coordination, and integrated care management

Guiding Principles
  • 6. Care management for coordination of services
  • 7. Services and supports needed to meet the
    social-emotional needs of young children and
    their families
  • 8. Services and supports needed to facilitate the
    transition of youth and young adults to adulthood
  • 9. Incorporate or link with mental health
    promotion, prevention, and early identification
    and intervention
  • 10. Rights protection and advocacy
  • 11. Continuous accountability mechanisms at the
    system level, practice level, and child and
    family level
  • 12. Nondiscrimination

What the SOC Concept is Not
  • Not a model to be replicated
    like a manualized treatment
  • Not a single program but a coordinated network
    of services across agencies
  • Not a treatment or clinical intervention that
    directly improves child and family outcomes
    without accompanying changes at the practice
    level to provide appropriate, effective,
    evidence-informed, individualized,
    community-based, family-driven, youth-guided,
    culturally competent services and supports

What the SOC Concept Is
  • Basis for a paradigm shift, ideal to describe
    how child-serving systems should function, vision
    for transformation
  • Organizational framework for system reform based
    on a clear value base
  • At the most basic level, a range of services and
    supports, guided by a philosophy, and supported
    by an infrastructure

System of Care Concept
How to Use the SOC Concept
  • Not a prescription, but a guide
  • Inherent flexibility to implement in a way that
    fits the particular state, community,
    tribe, or territory
  • Each community creates own process to plan,
    implement, and evaluate
  • Consider particular needs, goals, priorities,
    populations, environment
  • Adapt SOCs based on changes in political,
    administrative, fiscal, community contexts and
    data from CQI strategy

How to Use the SOC Concept
  • Updated version retains the flexibility for
    innovation, adaptability to different
    environments, responsiveness to the diverse
  • Consistent with its original intent, use as a
    framework, philosophy, and approach for system

Multiple Levels of Implementation
  • SOCs are complex, implementation is multifaceted,
    multilevel process
  • Changes at state, tribal, territorial level
    policies, financing, workforce development
  • Changes at local system level plan, implement,
    develop infrastructure, manage, evaluate
  • Changes at service delivery/practice level
    array of effective, evidence-informed treatment,
    services, and supports to improve outcomes
  • Evaluation must measure both system-level and
    practice-level outcomes

System Change Practice Change Improved
  • Cannot just implement system-level changes and
    expect improved outcomes at the child and family
  • Practice changes are needed to
    improve child and family outcomes
  • Success with system-level changes,
    less success changing practice
  • Must focus on increasing the effectiveness of
    services and supports by implementing
    evidence-based, evidence-informed, and promising

Whats Needed at the Practice Level?
  • Create and/or link with entities to train
  • Identify strategies for wide-scale implementation
    of EIPs
  • Explore approaches that
    identify critical elements
    across many EIPs and
    train providers to use
    these strategically

Whats Needed at the Practice Level?
  • Determine what EIPs are being utilized and what
    policy, system, and service delivery strategies
    can be used for wide-scale implementation and
  • Synthesize information on EIPs designed or
    adapted for culturally diverse groups
  • Develop TA resources for EIP implementation
    guides, tools, etc.

Future Directions
  • Enormous, rapid changes in US
  • Economic challenges
  • Parity law
  • Health care reform
  • Focus on prevention and public health
  • Emerging efforts to expand SOCs
  • New challenges, new opportunities

Future Areas of Improvement
  • Evidence-informed and promising
    practices to increase effectiveness
  • Expanded implementation of SOCs
  • Family-driven, youth-guided services
  • Reduced disparities and improved CLC
  • Effective financing mechanisms
  • Performance measurement and CQI
  • Public health approach
  • Skilled workforce
  • Advocacy base of support for childrens mental
    health and SOCs

Moving Forward
  • Responsibility to be clear in
    conceptualizing SOCs
  • Update way we describe SOCs in accordance with
    evolving knowledge and experience
  • Dont lose original intent of the concept and
    philosophy framework to guide systems with
    flexibility to adapt implementation to diverse
    environments and cultures
  • Vision for transforming childrens mental health
    for past 25 years and for continuing progress
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