Introduction
In a System Of Care (SOC) approach, leaders work across systems to improve behavioral health and related outcomes for children and their families by ensuring strategic, coordinated, effective upstream service delivery. Cross-system collaboration — developed in partnership with children, families, and communities — is essential since no single system can provide all necessary services. The SOC approach requires shared accountability for outcomes regardless of which system families enter to access services.
The SOC approach can support child welfare systems in preventing child maltreatment in their communities while meeting the needs of families that come to their attention early — and in the least restrictive setting. This coordinated approach increases child safety and familystability, thereby reducing family separations, foster care entries, placements in restrictive group and institutional settings, and unwarranted calls to child protection hotlines — all of which can be mitigated through greater emphasis on front-end services. In addition to improving safety and well-being outcomes, the SOC approach helps to lower operational costs, allowing child welfare systems to invest resources toward preventing child maltreatment rather than back-end responses after harm already has occurred.
Why Use The System Of Care Approach?
States, counties, territories, and tribes recently have increased their commitments to engage in cross-system, comprehensive solutions, especially amid rising attention to the behavioral health crisis facing children and older youth. This enhanced focus to coordinate child safety and well-being services followed the COVID-19 pandemic and tracks growing interest in prevention among response systems like child welfare and juvenile justice. It also aligns with long-standing awareness of the benefits of safely reducing entries into foster care and reducing the number of children boarding at psychiatric hospitals. SOC also is an effective approach to address Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment benefit, due to the shared focus on prevention and comprehensive services.
The SOC approach can address gaps in service delivery by prioritizing coordinated care that reduces fragmentation and duplication, and creating shared accountability for quality and oversight of programs and services. While the framework is customizable, successful implementation depends on a jurisdiction’s ability to: 1) scale home- and community-based services to meet families where they are; 2) maximize multiple funding streams effectively; and 3) have shared accountability across systems for meeting outcomes.
Partnership is central to the SOC approach. In many states, child welfare is one of several system partners at the table, along with behavioral health, Medicaid, juvenile justice, education, health systems, developmental disabilities, and other community providers and local stakeholders. Partners build relationships and identify shared values and goals to build a strategy that meets the unique needs of the children and families in their communities. In addition, it is critical for state agencies to partner with children, families, and older youth, as all bring to the table levels of expertise gained through personal experience. “System of care is not a program,” explained Millie Sweeney, director of learning and workforce development for the Family-Run Executive Director Leadership Association. “It is a way of working with youth and family. It is a partnership. It is changing the way you work.”
Benefits of the system of care for child welfare
Many families involved in child welfare are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). In 2019, more than 40% of children ages 3 to 17 enrolled in Medicaid or CHIP who were also involved with the child welfare system had a behavioral health diagnosis.4 There are also high rates of psychotropic medication use among children in the child welfare system, which requires effective coordination, monitoring, and oversight — all of which can be supported through a system of care approach.
Leveraging Medicaid to support children and their families is an important sustainability strategy, as Medicaid eligibility is independent of system involvement. Medicaid can support the delivery of covered services beyond the period of a youth or family’s engagement with the child welfare system. Working together and embedding SOC values and principles throughout policy and operations helps ensure that children and families are partners in policy, system, and program design, and decision-making.