Kentucky Cabinet for Health and Family Services

System of Care

Values

Community-based
Child-centered
Family-focused
Culturally competent

Principles

Comprehensive
Individualized
Provided in the least restrictive, appropriate setting
Coordinated at both system and service delivery levels
Involve family members and youth as full partners
Emphasize early identification and intervention

What is a system of care?
Why are systems of care needed?
Does Kentucky have a system of care?
What kinds of services are included?
How can I get additional information?

Q. What is a system of care?

A. A system of care is a coordinated network of community-based services and supports that are organized to meet the challenges of children and youth with serious mental health needs and their families. Families and youth work in partnership with public and private organizations so that services and supports are effective, and they build on the strengths of individuals and address each person's cultural and linguistic needs. A system of care helps children, youth and families function better at home, in school, in the community and throughout life.

The systems of care framework grew out of the work of the Child and Adolescent Service System Program (CASSP) in the field of children's mental health. CASSP emerged in the mid 1980s as a result of national recognition that the needs of youth with serious emotional disabilities were not being adequately met. In 1986, Stroul and Friedman proposed a system of care philosophy as a solution to these systemic problems. This framework is based on a set of guiding values and principles that establishes a foundation upon which to build systems of care (see the table below).

Through systems of care, families, youth, child-serving agencies and natural and community supports work collaboratively to plan for, design and implement community based services and supports to help youth and their families strengthen their assets and develop skills to allow them to remain in their communities and pursue healthy, productive lives.

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Q. Why are systems of care needed?

A. Youth with social, emotional and mental health challenges often experience difficulty across multiple areas of life (such as home, school and community). They are often involved with multiple systems simultaneously, including health, justice, mental health, education and child welfare, among others. They can also benefit from supports and relationships that naturally occur within communities, such as team sports, church-based activities, and connections with local business and tradespeople.

Despite the fact that families are involved with multiple organizations, many times these organizations do not work together to coordinate the services that they provide to youth and their families. For example, while youth might be attending special education classes at school, they may not have access to after-school or summer recreation programs. Families might not receive the support they need to care for their children, or may not know where to go to ask for help.

In systems of care, youth, families and local public and private organizations work in teams to plan and implement a tailored set of services for each individual youth's physical, emotional, social, educational and family needs. Teams may consist of representatives from mental health, health, education, child welfare, juvenile justice, vocational counseling, recreation, substance abuse, family and youth advocacy, or other organizations, as well as other people who play an important or supportive role in the youth and family's life. Teams find and build upon the strengths of the youth and his or her family rather than focusing solely on their problems. Teams work with individual families, including the children, and with other caregivers as partners when developing a plan for the youth and when making decisions affecting his or her care.

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Q. Does Kentucky have a system of care?

A. Kentucky responded to the national call for systems of care for youth with serious emotional disabilities in the late 1980s, with the statewide implementation of Kentucky IMPACT. IMPACT established a coordinated, interagency approach to service delivery and also provided funding for services not traditionally available, such as service coordination, mentoring, school-based services, and intensive in-home therapy.

Legislation was passed in 1990 that defined Kentucky IMPACT. This law also established the State Interagency Council and 18 Regional Interagency Councils to provide oversight and coordination of program implementation. A five-year evaluation of the IMPACT program revealed significant reductions in the psychiatric hospitalization of children; clinical gains in behavioral functioning; and improvements in family support, placement stability, and family satisfaction with services. Unfortunately, the evaluation also revealed limited coordination and integration between education and other child-serving agencies, the continued underidentification of students with emotional problems, and less positive school-related outcomes for these youth.

As a result, the Kentucky Department for Mental Health and Mental Retardation Services (DMHMRS) applied for and received a six-year Comprehensive Community Mental Health Services for Children and Their Families Program grant to expand its system of care for youth with severe emotional disabilities and their families, with particular emphasis on developing and promoting school-based interventions and family involvement. The grant was awarded to Kentucky in 1998, and this school-based mental health initiative – the Bridges Project – was implemented in 20 schools within the Appalachian region of the state. Fiscal year 2005 marked the last year that Bridges received federal funding, and many of the lessons learned through this grant are forming mental health and education policy, and shaping the makeover of school-based mental health services statewide.

Child and family outcome data from Bridges show the effectiveness of the model in increasing youth functioning, emotional and behavioral strengths and family functioning, while also decreasing clinical symptoms experienced by youth. In contrast to findings from the IMPACT evaluation, the Bridges model also yielded significant improvements in academic performance and decreases in school office referrals for enrolled youth. Additionally, the approach led to positive systemic outcomes for schools, such as improved school climate, decreased rates of suspension and expulsion, and improved family involvement in treatment and educational planning.

Despite these positive findings, youth enrolled in Bridges did not experience substantial decreases in substance use. Additionally, identification of co-occurring mental health and substance use disorders for youth enrolled in Bridges was only 4 percent, less than the 13 percent reported in the SAMHSA 1994-1996 National Household Survey of Drug Abuse. Furthermore, youth with severe emotional disabilities who had co-occurring substance use disorders exhibited significantly greater problems than those with no reported substance use, particularly in the areas of delinquent behavior and the need for restrictive placements. These findings suggested the need for integration of training in the assessment, identification and treatment of youth substance use issues within a positive behavior interventions and supports model.

Based on the data from IMPACT and Bridges, as well as the need to grow and improve the system of care in Kentucky, the DMHMRS applied for a second System of Care grant in 2003. The application proposed to replicate the school-based model of Bridges, expanding available mental health services, and focusing on youth who experience co-occurring mental health and substance use disorders. This grant – "Kentuckians Encouraging Youth to Succeed" (KEYS) – was awarded in 2004 and is being implemented in the north central region of Kentucky through a partnership between DMHMRS, NorthKey Community Care, Eastern Kentucky University, and the Kentucky Center for Instructional Discipline.

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Q. What kinds of services are included?

A. The Regional Mental Health/Mental Retardation Boards offer a wide range of mental health services. Not every region offers all services, however most regions do offer a fairly complete service array. Click here for a grid displaying available services by regions. Please note that services marked as available in a region may not be available in all counties within that region. A young person with a serious emotional disturbance and his or her family may be referred for one or more of these services or programs offered by the Regional MHMR Board, as shown below.

If needed, additional services and supports will be provided to the youth and family by other agencies or community partners represented on the youth's team. These may include, but are not limited to the services listed below.

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Q. How can I get additional information?

A. If you would like additional information about systems of care, please explore the websites below.

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