System of Care is a comprehensive network of community-based services and supports organized to meet the needs of families who are involved with multiple child service agencies, such as child welfare, mental health, schools, juvenile justice, and health care. Families and youth work in partnership with public and private organizations, ensuring supports are effective and built on the individual's strengths and needs. Creating a sustainable system of care requires reshaping and redefining the approach the system takes to working collaboratively with each other and with youth and families receiving support. System of Care is not a service or a program–it is a useful way of collaborating with youth and families to achieve the desired outcomes identified by the youth and family.
System of Care is a part of a National Initiative that was established in 1992, when Congress established the Children's Mental Health Initiative (CMHI) within the Substance Abuse Mental Health Service Administration (SAMHSA). The CMHI has invested significant resources developing System of Care and testing effectiveness. Throughout the United States, Systems of Care communities are funded through cooperative agreements with states, communities, territories, and Tribal Nations. The agreements are administered by the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration (SAMHSA) and the U.S. Department of Health and Human Services.
A local System of Care, by definition, is characterized by each local community. The group comes together to share strengths, resources and to meet the specific needs of its community.
Child and Family Teams–The Child and Family Team consists of individuals agreed on by the family and committed to informal, formal, and community supports and services.
All decisions are guided by System of Care values and principles and should reflect the following:
Collaboration–System of Care is supported by teams of individuals who come together and have a strong commitment to the community's well-being. At the systems level, the community collaborative represents the voice of the community, identifies strengths and needs for its children and families. The community collaborative sets the vision for the system of care within the community and works together to develop action plans to meet needs. On the individual level, the Child and Family Team is developed around the youth and family based on individuals who know them well. Teams work collaboratively together to develop planning based on the youth and families identified strengths and needs.
Community Based–Services and supports take place in the most inclusive, most responsive, most accessible, and least restrictive settings possible to safely promote child and family integration into the homes, school and community life.
Culturally and Linguistically Competent–All processes within a System of Care demonstrate respect for and build on the values, preferences, beliefs, culture, and identity of the community and each individual, youth, and family.
Family Driven and Youth Guided–Families and youth have a voice in local and community decisions. Planning is grounded in family and members' perspectives, and each Child and Family Team provides options and choices that reflect the family's values and preferences.
Individualized–All processes are individualized to the community or individual being supported. At the community level, plans are based on the individual strengths, assessments, resources, and culture of the community. At the individual level, each Child and Family Team develops and implements a plan based on the needs and desires of the youth and family.
Natural and Community Resources–The formal service delivery system cannot meet the needs of youth and families alone. All teams identify and encourage full participation from informal, interpersonal, and community partners and networks.
Outcome Based and Data Driven–Goals, strategies, and interventions are tied to observable progress that is important to the youth and family. Plans are monitored and revised as needed to ensure that outcomes become a focus.
Persistence–Individuals must develop a "hang in there" skill and not give up when challenges occur. On every level, teams work through difficulties discovered during planning and implementation and continue to monitor and make changes in the plan.
Strengths Based–All processes identify, build upon, and enhance the capabilities, knowledge, skills, and resources of the community, team members, and individual youth and families.
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