Welcome to the 5 Things Digest from the NTTAC System of Care Transformation Team, bringing you 5 Things to know right now about adopting the System of Care (SOC) approach in your state, organization, or community.
Systems of Care (SOC) are comprehensive, coordinated networks of community-based services and supports organized to meet the challenges of children, youth, young adults, and their families. The goal is to improve service delivery and expand access to culturally and linguistically responsive mental health services for children, youth, young adults, and families1.
12017 SAMHSA CMHI Report to Congress
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#1: Addressing equity in practice and policy is paramount.
There’s a popular saying, if you build it, they will come. Unfortunately, this is not the case with many mental health organizations. Buildings do not bring people, people bring people. If our goal is equity, as providers it is our responsibility to intentionally engage with children, youth, and families in ways that acknowledge and honor who they are beyond their mental health. To foster equity in our programs, we must look at our organizations, staff, and processes through lenses that are inclusive of age (chronological and emotional), race, ethnicity, religion, culture, gender identity and expression, sexual orientation, family and community of choice, staff diversity, etc.
Not sure where to begin? Start by speaking with children, youth, and families, and including them and their voices in your organization’s decision-making processes. By integrating continuous feedback into organizational policies and practices and sharing that feedback with youth and their families, leaders demonstrate their commitment to listening to those they are serving and being transparent about how they will use that information to make organizational improvements to better address equity.
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#2: Partnering with families is critical to a successful System of Care |
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Partnering with family members of children, youth, and young adults who have mental and behavioral health needs is key to building a successful and sustainable system of care. Family partnership means viewing families as resources rather than recipients of services and as having unique expertise that is critical to building effective programs, policies, and practices.
There is measurable value added when systems partner with families - it can change, build, improve, inform, and transform the system in all areas. For example, partnering with families can help to:
- Change culture and practice;
- Build awareness, understanding, and new policies to better serve youth and their families;
- Improve organizational outcomes;
- Inform service development, research, and public policy; and
- Transform systems through quality improvement that brings about systemic and sustainable change.
Families, when informed, valued, and supported, can play numerous roles across systems of care, such as educators, parent peer support providers, evaluators, board members, social marketers, and much more. Engagement of family members in all aspects of the system of care has also been shown to positively impact success and sustainability.
Developing authentic partnerships with families is a shared responsibility and not merely the responsibility of one person or department. It requires commitment, time, energy, resources, and a willingness to overcome obstacles along the way.
There are several occasions in which specialty organizations serve as bridges and advocates for a familiy’s mental and behavioral needs. Family-run organizations are essential stakeholders within systems of care. These nonprofit organizations, founded and governed by family members of children and youth with mental and behavioral health needs, support the capacity building of family members, providers, systems, and decision-makers to create positive change on behalf of all children, youth, and families impacted by mental and behavioral health needs.
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#3: Systems of care engage young people in developing and implementing programs and policies.
The System of Care approach centers youth voice in policy development and program implementation. Identifying and developing young leaders is essential to this process; however, recruiting and retaining young adult leaders can be a struggle. The Youth Engagement Toolkit is a resource guide that outlines action steps and recruitment strategies to help you engage a wide audience of young people. The toolkit includes examples of how to engage youth in brainstorming sessions to help determine the best locations to find and recruit young adult participants in your own community. This guide also includes questions to consider to aid in group discussion, as well as follow up steps for how to maintain participants once they are engaged. These guidelines can be used to inform the recruitment plan for your program, including guiding principles, and it’s even printer-friendly!
Once youth are engaged in the work, they need to develop the leadership skills necessary for wider system level advocacy. Strategic sharing is an effective way for young adults to share their stories in a competent and meaningful way that can lead to systems change. This can be more challenging than it sounds! The Youth M.O.V.E. Strategic Sharing Workbook includes tips and tricks to ensure the personal stories of young people in your community are shared in a way that is safe and effective. The workbook also provides detailed information for how each individual’s story can create meaningful change. By working through these documents, young adults will gain the skills and knowledge not only to share their own stories, but to empower others to do the same, as well as learn talking points on what makes these stories so important to systems change.
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#4: When children and youth have access to a wide array of services and supports, their outcomes improve.
One of the guiding principles of the System of Care approach is to provide a comprehensive array of services and supports that is individualized to meet the unique needs of each child, youth, and family. Adhering to this principle ensures availability and access to a broad, flexible array of effective, community-based services and supports for young people and their families that addresses their emotional, social, educational, and physical needs, including natural and informal supports.
When children, youth, young adults, and their families have access to a wide array of services and supports, systems of care are better prepared to provide individualized treatment based on their unique needs and strengths. Components of a comprehensive service array include mobile crisis response and stabilization, intensive care coordination (such as Wraparound), intensive in-home mental health treatment services, parent and youth peer support, respite care, flex funds, trauma-informed systems and evidence-based treatments, educational supports, and other home and community-based services, such as mentoring, supported employment, and housing for young adults. Benefits of providing access to this array of services and supports has been shown to:
- Reduce costs of care
- Improve school attendance
- Increase behavioral and emotional strengths
- Improve clinical and functional outcomes
- Improve stability of living situations
- Improve attendance at work for caregivers
- Reduce suicide attempts
- Decrease contacts with law enforcement
- Increase engagement of families and youth
- Improve satisfaction with services
Now, more than ever, systems of care are necessary to ensure children, youth, and young adults with mental health needs and their families receive effective services within their communities and that providers work together to coordinate care in partnership with families in a culturally responsive manner. Especially important is addressing issues of access and equity through considerations of individual choice in treatment intervention (type, frequency), location (clinic or community-based), and delivery (telehealth or in person).
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#5: Collaboration and coordination across agencies and systems is critical to success.
Every system has its own language, norms, and values. Agencies that operate within these systems have their own cultures, expectations, and beliefs for how to work with those they serve and with each other. When these cultures or values diverge, conflict can happen and our work can become chaotic, stagnant, or increasingly difficult. When these challenges are ignored or not resolved, it can result in people not getting the care they need and high levels of staff turnover or burnout, which impacts both the agency’s mission and the bottom line.
Collaborating with cross-agency partners to develop shared language, expectations, and purpose are simple yet effective strategies to advance policy and practice goals to better serve children and families. When routinely put into practice, they can also work to prevent misunderstandings and conflict before they take root. The Structured Conversations for Building Collaboration resource below provides a quick-start guide for engaging in foundational discussions with your cross-system partners or any inter-agency or interprofessional environment. They are helpful at any stage, whether when beginning a collaborative partnership or when the work has become more challenging.
Whether you are working to engage families in services or drafting state level policy, finding the right language to influence your audience is critical. The Frameworks Institute (link below) has researched and developed a variety of evidence-based resources that can help your community, agency, or service providers find the right language to effectively engage their constituencies. Some examples include framing the foundation of community health; reframing family, school, and community engagement; and reframing developmental relationships. For a specific example of this work in action, the Impact Brief below provides an overview of how the State of Tennessee reframed the language of early childhood development to increase awareness of the long-term impact of early adversity and to secure additional funding for much needed services, supports, and training.
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Contact the National Training and Technical Assistance Center for
Child, Youth, and Family Mental Health
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Disclaimer: The views, opinions, and content expressed in this email do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), or the U.S. Department of Health and Human Services (HHS). |
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