Defining the system of care concept and philosophy: to update or not to update?

This commentary considers the task of updating the system of care concept and philosophy within its historical context, reviewing the original intent of the definition and clarifying misconceptions about its meaning. The authors identify the aspects of the concept and philosophy that should be updated based on the latest thinking, experience, and data, such as incorporating applicability to a broader range of populations, increasing the emphasis on the core values, specifying desired outcomes, and adding accountability as a critical element. An updated definition and values and principles are proposed, and the importance of always presenting the definition along with the accompanying specification of the philosophy is emphasized in order to increase its utility in assisting the field to move from theory to practice.

The sustainability of systems of care for children's mental health: lessons learned.

The federal Comprehensive Community Mental Health Services for Children and Their Families Program was initiated in 1992 to provide grants to states, communities, territories, and Indian tribes to develop systems of care to serve children and adolescents with or at risk for emotional disorders and their families. As part of the national evaluation of this program, a study was undertaken to assess the ability of funded sites to sustain their systems of care beyond the federal grant period. The study involved a web survey and telephone interviews with local and state respondents to examine the extent to which key components of systems of care were maintained during the period in which federal funds were phasing out and during the post grant period.

Transforming mental health care for children and their families.

In April 2002, the President's New Freedom Commission on Mental Health was created by executive order to study the mental health care delivery system in our nation and to make recommendations for improvements so that individuals with serious mental disorders can live, work, learn, and fully participate in their homes and communities. In its report, "Achieving the Promise: Transforming Mental Health Care in America," the commission provided strategies to address critical infrastructure, practice, and research issues. This article focuses on the work of the commission's Subcommittee on Children and Families, describing its vision for mental health service delivery for children and providing suggestions for strengthening community-based care for youths with or at risk of behavioral health disorders.