{"id":32215,"date":"2025-04-04T15:54:13","date_gmt":"2025-04-04T15:54:13","guid":{"rendered":"https:\/\/caseyfamilyv2.wpengine.com\/soc-issue-brief\/"},"modified":"2026-07-10T22:26:02","modified_gmt":"2026-07-10T22:26:02","slug":"resumen-tematico-de-soc","status":"publish","type":"post","link":"https:\/\/www.casey.org\/es\/soc-issue-brief\/","title":{"rendered":"\u00bfC\u00f3mo puede el enfoque del sistema de atenci\u00f3n mejorar los resultados para los ni\u00f1os y las familias que est\u00e1n bajo la tutela de los servicios de protecci\u00f3n infantil?"},"content":{"rendered":"
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This issue brief was developed by the Center for Health Care Strategies<\/a>, in partnership with Casey Family Programs. It is one of a six-part series on the system of care approach that also includes a\u00a0strategy brief<\/a>\u00a0and jurisdictional profiles of\u00a0New Hampshire<\/a>,\u00a0New Jersey<\/a>,\u00a0Ohio<\/a>, and\u00a0Oklahoma<\/a>.<\/p>\n<\/div>\n \n \n \n <\/div>\n<\/div>\n\n\n

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Introduction<\/h2>\n \n \n \n

In a system of care (SOC) approach<\/a>, leaders work across systems to improve behavioral health and related outcomes for children and their families by ensuring strategic, coordinated, effective upstream service delivery. Cross-system collaboration \u2014 developed in partnership with children, families, and communities \u2014 is essential since no single system can provide all necessary services. The SOC approach requires shared accountability for outcomes regardless of which system families enter to access services.<\/p>\n

The SOC approach can support child welfare systems in preventing child maltreatment in their communities while meeting the needs of families that come to their attention early \u2014 and in the least restrictive setting. This coordinated approach increases child safety and family stability, thereby reducing family separations, foster care entries, placements in restrictive group and institutional settings, and unwarranted calls to child protection hotlines \u2014 all of which can be mitigated through greater emphasis on front-end services. In addition to improving safety and well-being outcomes, the SOC approach helps to lower operational costs, allowing child welfare systems to invest resources toward preventing child maltreatment rather than back-end responses after harm already has occurred.<\/p>\n<\/div>\n \n \n \n <\/div>\n<\/div>\n\n\n

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System of care definition<\/h3>\n

\u201cA system of care is a comprehensive spectrum of effective services and supports for children, youth, and young adults with or at risk for mental health or other challenges and their families that is organized into a coordinated network of care, builds meaningful partnerships with families and youth, and is culturally and linguistically responsive in order to help them to thrive at home, in school, in the community, and throughout life.\u201d<\/p>\n

\u2014Innovations Institute,\u00a0\u201cThe Evolution of the System of Care Approach\u201d<\/a><\/p>\n<\/div>\n \n \n \n <\/div>\n<\/div>\n\n\n

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Under an effective SOC approach, agencies and partners work together with children and families to address needs and identify appropriate services. Child-serving systems often face challenges coordinating with one other, however, and this fragmentation can exacerbate challenges for children and families seeking behavioral health services. Outcomes can be highly dependent on which agency, or door, the family enters, as each entity has different mandates, priorities, and available resources. In some cases, families are required to relinquish custody of their children to child welfare<\/a> as a means to access behavioral health services.<\/p>\n

To understand the benefits of the SOC approach for child welfare systems and strategies for effective implementation, the Center for Health Care Strategies, drawing heavily on the seminal work of Sheila Pires<\/a> and Beth Stroul<\/a>, conducted a literature review and interviews with 24 stakeholders, including national experts, state agency representatives from New Hampshire, New Jersey, Ohio, and Oklahoma, and individuals with lived experience.1<\/sup><\/a> While there are geographic, political, and other variations across the four highlighted jurisdictions, their approaches share an explicit and sustained commitment to meeting the needs of families involved with child welfare, and each includes ensuring the availability of key home- and community-based services statewide.<\/p>\n<\/div>\n \n \n \n <\/div>\n<\/div>\n\n\n

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Background<\/h2>\n \n \n \n

The SOC approach was first developed and implemented for children with serious emotional disorders and their families. In 1984, Congress appropriated funds to the Substance Abuse and Mental Health Services Administration (SAMHSA) for the Child and Adolescent Service System Program to plan for serving this population, and soon after, to support implementation through the Children\u2019s Mental Health Initiative.2<\/sup><\/a><\/p>\n<\/div>\n \n \n \n <\/div>\n<\/div>\n\n\n

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The system of care approach<\/h3>\n

Core values<\/strong><\/p>\n

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  1. Family and youth-driven<\/li>\n
  2. Community-based<\/li>\n
  3. Culturally and linguistically competent<\/li>\n<\/ol>\n

    \u00a0<\/strong>Guiding principles<\/strong><\/p>\n

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    1. Comprehensive array of services and supports<\/li>\n
    2. Individualized, strengths-based services and supports<\/li>\n
    3. Evidence-based practices and practice-based evidence<\/li>\n
    4. Trauma-informed<\/li>\n
    5. Least restrictive natural environment<\/li>\n
    6. Partnerships with families and youth<\/li>\n
    7. Interagency collaboration<\/li>\n
    8. Care coordination<\/li>\n
    9. Physical health-mental health integration<\/li>\n
    10. Developmentally appropriate services and supports<\/li>\n
    11. Public health approach<\/li>\n
    12. Mental health equity<\/li>\n
    13. Data-driven and accountability<\/li>\n
    14. Rights protection and advocacy<\/li>\n<\/ol>\n

      \u2014Innovations Institute,\u00a0\u201cThe Evolution of the System of Care Approach\u201d<\/a><\/p>\n<\/div>\n \n \n \n <\/div>\n<\/div>\n\n\n

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      The SOC approach has been implemented to varying degrees across the country in diverse geographic contexts, governance structures, and political climates, with almost every state having received some federal funding<\/a> to implement or expand this approach. Over the years, additional federal and philanthropic funds have supported implementation and related reform across states and communities, including through the federal Administration for Children and Families, SAMHSA, The Annie E. Casey Foundation, and the Robert Wood Johnson Foundation.3<\/sup><\/a><\/p>\n

      Over the past 40 years, SOC work moved upstream with a broader population focus and prevention strategy that aligns with today\u2019s public health approach. While it offers many benefits, the SOC approach has not been scaled in some jurisdictions due to barriers such as limited resources, competing priorities, lack of dedicated leadership and vision over time, or resistance to system-level change.<\/p>\n<\/div>\n \n \n \n <\/div>\n<\/div>\n\n\n

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      Why use the system of care approach?<\/h2>\n \n \n \n

      States, counties, territories, and tribes recently have increased their commitments to engage in cross-system, comprehensive solutions, especially amid rising attention to the behavioral health crisis facing children and older youth<\/a>. This enhanced focus to coordinate child safety and well-being services followed the COVID-19 pandemic and tracks growing interest in prevention among response systems like child welfare and juvenile justice. It also aligns with long-standing awareness of the benefits of safely reducing entries into foster care and reducing the number of children boarding at psychiatric hospitals. SOC also is an effective approach to address Medicaid\u2019s Early and Periodic Screening, Diagnostic, and Treatment benefit<\/a>, due to the shared focus on prevention and comprehensive services.<\/p>\n

      The SOC approach can address gaps in service delivery by prioritizing coordinated care that reduces fragmentation and duplication, and creating shared accountability for quality and oversight of programs and services. While the framework is customizable, successful implementation depends on a jurisdiction\u2019s ability to: 1) scale home- and community-based services to meet families where they are; 2) maximize multiple funding streams effectively; and 3) have shared accountability across systems for meeting outcomes.<\/p>\n

      Partnership is central to the SOC approach. In many states, child welfare is one of several system partners at the table, along with behavioral health, Medicaid, juvenile justice, education, health systems, developmental disabilities, and other community providers and local stakeholders. Partners build relationships and identify shared values and goals to build a strategy that meets the unique needs of the children and families in their communities. In addition, it is critical for state agencies to partner with children, families, and older youth, as all bring to the table levels of expertise gained through personal experience. “System of care is not a program,\u201d explained Millie Sweeney, director of learning and workforce development for the Family-Run Executive Director Leadership Association. \u201cIt is a way of working with youth and family. It is a partnership. It is changing the way you work.”<\/p>\n<\/div>\n \n \n \n <\/div>\n<\/div>\n\n\n

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      The system of care must sit outside of and be separated from any system that has the power and authority to compel families to be part of it, because if you really want true engagement, families have to choose to be in it, and they have to have some ability to guide what it is they\u2019re doing, how they\u2019re engaging, and what they\u2019re engaged in. So it\u2019s really critical that this be outside of the child welfare and justice systems.<\/p>\n<\/blockquote>\n

      — Joseph Ribsam, Director, Child Welfare and Juvenile Justice Policy, The Annie E. Casey Foundation<\/cite><\/figcaption>\n <\/div>\n\n <\/div>\n<\/figure>\n\n\n
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      Benefits of the system of care for child welfare<\/h2>\n \n \n \n

      Many families involved in child welfare are enrolled in Medicaid or the Children\u2019s Health Insurance Program (CHIP). In 2019, more than 40% of children ages 3 to 17 enrolled in Medicaid or CHIP who were also involved with the child welfare system had a behavioral health diagnosis.4<\/sup><\/a> There are also high rates of psychotropic medication use among children in the child welfare system, which requires effective coordination, monitoring, and oversight \u2014 all of which can be supported through a system of care approach.5<\/sup><\/a><\/p>\n

      Leveraging Medicaid to support children and their families is an important sustainability strategy, as Medicaid eligibility is independent of system involvement. Medicaid can support the delivery of covered services beyond the period of a youth or family\u2019s engagement with the child welfare system. Working together and embedding SOC values and principles throughout policy and operations helps ensure that children and families are partners in policy, system, and program design, and decision-making.<\/p>\n

      A properly implemented SOC approach can help achieve the following:<\/p>\n