Systems of Care

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 at home, at school, and in the community.¹

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. For more information on child and adolescent mental health, call 1-800-789-2647.

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 children or adolescents with serious emotional disturbances get the services they need in or near their home and community. Youth service plans are driven by their families.

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 be comprised 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 that affect the child's care.

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.

Components of Systems of Care
(see list of specific services below)

"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. For more information on cultural competence, call 1-800-789-2647.

What kinds of services are included?

The range of services that may be included in a system of care fall under the categories shown in the graphic above. A young person with a serious emotional disturbance and his or her family may be referred for one or more of these services:²

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.

What is a case manager or service coordinator?

A case manager or service coordinator facilitates delivery of the individualized treatment plan used to serve a child or adolescent with a serious emotional disturbance and his or her family. This person identifies the role of each provider and coordinates all services. The goal is to make sure the plan builds on the strengths, and meets the unique needs, of both the child and family. As the child's needs change, the case manager notes these changes and adjusts the mix of services, as necessary. For example, a case manager may recommend tutoring and counseling when a child no longer requires day treatment. When 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. A case manager has, on average, a caseload of between four and 12 youths and their families.

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; and
Provide services to more children and families who need them.

Important Messages About Child and Adolescent Mental Health:

Every child's mental health is important.
Many children have mental health problems.
These problems are real, painful, and can be severe.
Mental health problems can be recognized and treated.
Caring families and communities working together can help.
Information is available; call 1-800-789-2647.

For free information about child and adolescent mental health, including publications, references, and referrals to local and national resources and organizations, call 1-800-789-2647; (TDD) 1-866-889-2647, or go to http://mentalhealth.samhsa.gov/publications/browse.asp.

¹ Prevalence of serious emotional disturbance in children and adolescents. Mental Health, United States, 1996. Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 1996.

² This list is not meant to be complete. Individual services for children and their families implies flexibility, which creates a set of services uniquely suited for an individual child and family.

CA-0014
11/2003