Solutions and Highlights
In order for a system to be truly coordinated, research points to several key principles for success. First, true systems coordination requires that collaborating agencies commit to a definition of mutual relationships and goals, a jointly-developed structure and shared responsibility, mutual authority and accountability for success, and sharing of resources and rewards (Harrison, n.d.). Additionally, all agencies expected to collaborate and coordinate need to identify common interests among themselves and there must be an assurance that each organization has something to gain from the process (Harrison, n.d.). There should be a shared understanding that collaborative planning takes resources and time, as the collaborating agencies have to learn about and establish trust with one another (Harrison, n.d.). Finally, there should be recognition that interagency collaboration is a means to systems coordination—where a comprehensive service array is provided and managed by multiple agencies working together instead of in isolation—but is not systems coordination in and of itself (Harrison, n.d.).
One systems reform initiative that has made a great deal of progress across the nation in the past 30 years to foster greater service coordination is what is known as systems of care. A "system of care" is an organizational philosophy and framework that involves collaboration across agencies, families, and young people for the purpose of improving access and expanding the array of coordinated, community-based, culturally and linguistically competent mental health services (Technical Assistance Partnership for Child and Family Mental Health, 2009). A systems of care approach helps break down silos by fostering collaborative relationships between all agencies and providers tasked with meeting the mental health and related needs of children, youth, and young adults. In an effective system of care community, schools, community mental health centers, psychiatric treatment programs, social service organizations, juvenile justice and child welfare programs, primary health care organizations, and other community partners coordinate services to most effectively address the needs of young people while allowing them to remain in their community (American Academy of Child and Adolescent Psychiatry, 2010).
The overarching goal of systems of care is to create and implement a single plan of care for each young person and pool a broad array of services and supports from multiple entities, making them easily accessible to youth and their families (Schaeffer, 2009). Furthermore, under systems of care, services are provided in individualized, flexible, and coordinated ways and the selection of services and supports is driven by the needs and preferences of youth and their families (Schaeffer, 2009). Providing services and supports in this way requires that each agency playing a role in the well-being of a young person works with the others to understand roles, maximize resources, and eliminate inefficiencies. A systems of care approach may also save money, as communities reduce reliance on hospitalization and utilize fewer deep-end services such as hospitalizations and incarcerations (Schaeffer, 2009). An additional benefit is that because these settings can create more risk for youth, avoiding them whenever possible can lead to more positive youth outcomes (Schaeffer, 2009).
Systems of care, even as they have evolved over the past 30 years, are not without their limitations. While research suggests some benefits of systems of care (see text box), the evidence regarding whether the actual ultimate outcomes of interest for youth (e.g., high school graduation, less drug/alcohol addiction) improve as a result of systems of care is mixed (Schaeffer, 2009). Systems of care tend to focus on youth who are already showing signs of severe mental health problems and typically have fewer collaborative efforts in place focused on youth at risk (Schaeffer, 2009). Additionally, within the systems of care framework, the methods for how agencies/partners should coordinate their efforts are not always well articulated. As such, goals are not always shared and bought into by each entity, and diffusion of responsibility can occur (Schaeffer, 2009). Particularly for youth transitioning to adulthood, systems of care sometimes fall short of providing seamless linkages to adult services, creating a stoppage or gap in service provision. Coordination between children's and adults' service providers is essential in meeting the needs of transition age youth (Schaeffer, 2009).