Improving community-based mental health care for children: a commentary.

In their article, "Improving Community-Based Mental Health Care for Children," Garland and colleagues explore and confront quality issues that are endemic to outpatient specialty mental health care for children in the United States. Their article presents evidence supporting the lack of effectiveness of usual care and draws on implementation science to explore areas for improving the quality of outpatient mental health care for young people. This commentary accepts these basic arguments and strategies, explores policy options that support the suggested reforms, and examines evidence-based programs in a broader context that draws on the systems of care approach. Specific issues addressed in this commentary include workforce capacity, policy options for improving care quality, provider incentives, systematic implementation supports, strategies to incorporate evidence-based approaches into practice, youth-guided and family-driven care, and the need to expand the definition of evidence-based practice to include the concepts of community-defined evidence and practice-based evidence.

Sustaining and expanding systems of care to provide mental health services for children, youth and families across America.

The Substance Abuse and Mental Health Services Administration has been instrumental in supporting the development and implementation of systems of care to provide services to children and youth with serious mental health conditions and their families. Since 1993, 173 grants have been awarded to communities in all 50 states, Puerto Rico, Guam, the District of Columbia, and 21 American Indian/Alaska Native communities. The system of care principles of creating comprehensive, individualized services, family-driven and youth-guided care and cultural and linguistic competence, supported by a well-trained and competent workforce, have been successful in transforming the field of children's mental health and facilitating the integration of child-serving systems. This approach has achieved positive outcomes at the child and family, practice and system levels, and numerous articles have been published using data collected from system of care communities, demonstrating the effectiveness of this framework. This article will describe lessons learned from implementing the system of care approach, and will discuss the importance of expanding and sustaining systems of care across the country.