Mission: To strengthen the collaboration of state and local efforts to weave mental health supports and services into seamless systems of care for children, youth, and their families.
Vision: All Texas children and youth have access to high quality mental health care that is family-driven, youth-guided, community-based, culturally-grounded, and sustainable.
What is a System of Care?
System of care is a framework and philosophy for the transformation of child-serving systems. Established over 25 years ago to better meet the needs of children, youth, and young adults with mental health challenges and their families, this framework has been used across the country to build more accessible, responsive, and effective arrays of services and supports.
The Impact of System of Care
The system of care framework has been shown to result in:
- Improvements in child functioning;
- Reductions in internalizing and externalizing symptoms;
- Decreases in suicide attempts by 81%;
- Decreases in unlawful activities by 48%;
- Increases in school attendance by 18%; and
- Increases in the proportion of children receiving C grades or better by 28%.
System of Care Definition
A system of care is a spectrum of effective community-based services and supports for children, youth, and young adults with or at risk for mental health and related 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 function better at home, in school, in the community, and throughout life.
Systems of care are:
- Family-driven and youth-guided with the strengths and needs of the child and family determining the types and mix of services and supports provided.
- Community-based with the locus of services as well as system management resting within a supportive, adaptive infrastructure of structures, processes, and relationships at the community level.
- Culturally and linguistically competent with agencies, programs, and services that reflect the cultural, racial, ethnic, and linguistic differences of the populations they serve to facilitate access to and utilization of appropriate services and supports and to eliminate disparities in care.
Systems of care are designed to:
- Ensure availability and access to a broad, flexible array of effective, community-based services and supports for children and their families that address their emotional, social, educational and physical needs, including traditional and nontraditional services as well as natural and informal supports.
- Provide individualized services in accordance with the unique potentials and needs of each child and family, guided by a strengths-based, wraparound service planning process and an individualized service plan developed in true partnership with the child and family.
- Ensure that services and supports include evidence-informed and promising practices, as well as interventions supported by practice-based evidence, to ensure the effectiveness of services and improve outcomes for children and their families.
- Deliver services and supports within the least restrictive, most normative environments that are clinically appropriate.
- Ensure that families, other caregivers, and youth are full partners in all aspects of the planning and delivery of their own services and in the policies and procedures that govern care for all children and youth in their community, state, territory, tribe and nation.
- Ensure that services are integrated at the system level, with linkages between child-serving agencies and programs across administrative and funding boundaries and mechanisms for system-level management, coordination, and integrated care management.
- Provide care management or similar mechanisms at the practice level to ensure that multiple services are delivered in a coordinated and therapeutic manner and that children and their families can move through the system of services in accordance with their changing needs.
- Provide developmentally appropriate mental health services and supports that promote optimal social-emotional outcomes for young children and their families in their homes and community settings.
- Provide developmentally appropriate services and supports to facilitate the transition of youth to adulthood and to the adult service system as needed.
- Incorporate or link with mental health promotion, prevention, and early identification and intervention in order to improve long-term outcomes, including mechanisms to identify problems at an earlier stage and mental health promotion and prevention activities directed at all children and adolescents.
- Incorporate continuous accountability and quality improvement mechanisms to track, monitor, and manage the achievement of system of care goals; fidelity to the system of care philosophy; and quality, effectiveness, and outcomes at the system level, practice level, and child and family level.
- Protect the rights of children and families and promote effective advocacy efforts.
- Provide services and supports without regard to race, religion, national origin, gender, gender expression, sexual orientation, physical disability, socio-economic status, geography, language, immigration status, or other characteristics, and services should be sensitive and responsive to these differences.
Texas has embarked on establishing a statewide system of care. The system of care framework is already working in communities across the state, both urban and rural. Texas has implemented high-quality wraparound planning and family partners (family-to-family peer support) across all 254 counties. A statewide 1915(c) Medicaid waiver — the YES Waiver — provides non-traditional home and community-based services to children and youth at risk of out-of-home placement. Communities in the north, south, east, and west regions of the state have established community collaborations committed to improving the systems in which families access care.
That’s what Texas System of Care is all about. Texas partners are coming together to identify ways for local communities to address the needs of children and youth with serious mental health concerns using a system of care approach. But there is still more that needs to be done.
Texas System of Care has laid out a roadmap to continue to advance the vision, including the following activities:
- Building upon existing community assets and partnerships to improve mental health service access, quality, outcomes, and costs through a system of care framework;
- Identifying and strengthening policies and practices to support a strong system of care infrastructure;
- Expanding access to Wraparound services to families of children at risk or receiving residential mental health treatment, aimed at preventing or reducing out-of-home stays;
- Building readiness and organizational capacity for youth and young adult peer support;
- Increasing the capacity of the workforce to provide services that are culturally informed and reduce behavioral health disparities;
- Increasing family and youth voice in decision making at all levels;
- Providing statewide training in system of care values, principles, and best practices; and
- Building awareness and a strong voice for children’s mental health in Texas.
Texas Health and Human Services Commission and the Texas Institute for Excellence in Mental Health at The University of Texas at Austin lead the Texas System of Care, in collaboration with child-serving state agencies, family and youth advocacy organizations and other stakeholders within the Texas children’s mental health service delivery system.
Stroul, B., Blau, G., & Friedman, R. (2010). Updating the system of care concept and philosophy. Washington, DC: Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children’s Mental Health.
Substance Abuse and Mental Health Services Administration (April, 2018). The Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances Program: Report to Congress 2016. U.S. Department of Health and Human Services.