System of care is an organizational philosophy and framework that involves collaboration across agencies, families, and youth for the purpose of improving services for children and youth with serious mental health issues. A system of care promotes agencies and families working together to improve outcomes for the child and family. It is not a specific service; it is a different way of doing business.
System of Care Definition: A spectrum of effective, community-based services and supports for children and youth with or at risk for mental health or other challenges and their families, that is organized into a coordinated network, builds meaningful partnerships with families and youth, and addresses their cultural and linguistic needs, in order to help them to function better at home, in school, in the community, and throughout life.
In the mid-1980s, the concept of a “system of care” was introduced to address the many well-documented problems in services for children, youth, and young adults with mental health challenges and their families.1 Many children in need were not getting adequate mental health services or were served in excessively restrictive settings, and agencies rarely coordinated their services. Additionally, families were often viewed as part of the child’s problem, rather than as part of the child’s solution.
The federal Child and Adolescent Service System Program (CASSP) was initiated in 1984 to help states and communities begin to plan for and implement a child-centered, family-focused, culturally competent continuum of community-based care. That initiative provided the foundation for what became the system of care approach. A set of core values and guiding principles was established for systems of care and communities, and states across the country began to actively implement systems of care the children and families they served.
For more information on the origins of the System of Care, see “System of Care: A Framework for System Reform in Children’s Mental Health.”
Origins in Texas
In 1987, the 70th Texas Legislature passed legislation directing child-serving state agencies, with input from private sector and advocacy/consumer groups, to develop a community-based approach to coordinate service planning for children and youth who needed multi-agency services. With the passage of that legislation, Texas began statewide efforts to initiate Community Resource Coordination Groups (CRCGs) to create service plans for individual children and youth who have barriers to getting their needs met though existing resources. The first four CRCGs were launched in Henderson, Tarrant, Travis, and Val Verde counties in 1988. Approximately eight years later, local CRCGs were available to coordinate services for children, youth, and families in all 254 counties in Texas.
The next two legislative sessions continued to boast improvements in children’s mental health services, with $1.75 million designated for an interagency children’s mental health pilot programming focused on home-based services consistent with the CASSP model. Most notably, in 1991 the 72nd Legislature appropriated $22.186 million for the Texas Children’s Mental Health Plan, used to initiate locally provided CASSP-based services for children with mental health needs and their families. By the late 1990s, children’s mental health services were available for youth in every county of Texas.
In 1997, the 75th Texas Legislature directed the state’s mental health authority, Texas Department of Mental Health and Mental Retardation (TDMHMR), to conduct a pilot to study the effectiveness of intensive community-based services options for children and families in decreasing the use of and or length of stay in residential treatment. Through a grant from the Robert Wood Johnson Foundation, the Texas Health and Human Services Commission (HHSC) and TDMHMR provided seed funding to Austin/Travis County and Brownwood/Brown County, the first two sites of the Texas Integrated Funding Initiative (TIFI). In addition, other communities began receiving technical assistance and support. In the following years, TIFI expansion sites were supported by funds from each of the participating agencies. These initial TIFI sites demonstrated a system of care approach with an integrated funding base to serve children with serious emotional disturbances.
As each of these sites began to develop local expertise in serving children and adolescents with mental health needs, they became excellent candidates to successfully apply for federal SAMHSA grants to help them develop the infrastructure to provide comprehensive care to children with mental health needs. Since 2005, SAMHSA has awarded funding to several sites in Texas, including Travis County, Fort Worth, Tarrant and six surrounding counties, El Paso County, Harris County, Bexar County, the 32-county Rural Children’s Initiative in north Texas, and most recently, the Heart of Texas area in Waco.
- Stroul, B., & Friedman, R. M. (1996). The system of care concept and philosophy. In B. Stroul (Ed.), Children’s mental health: Creating systems of care in a changing society. Baltimore, MD: Paul H. Brookes Publishing Company