When Orange County, NY received a “System of Care” grant in October 2008, our community set out on a collaborative and ambitious journey to transform the way we care for youth with serious mental health challenges, and their families. Since 1993, the Substance Abuse and Mental Health Services Administration’s Child Mental Health Initiative has funded 144 sites across the country, to improve and enhance services and supports for youth with social, emotional and behavioral challenges. Eighteen new communities received grants in 2008, including Chatauqua, Nassau and Orange counties in New York State. A new round of 20 funded communities were announced in October 2009, and included Onondaga County, Syracuse, New York. The six-year, nine-million-dollar initiative requires equal partnership between families, youth, and child-serving agencies (e.g. social services, courts, probation, mental health and schools), and shared, community decision-making instead of a traditional “top-down” approach. Grantees must work to ensure that their Systems of Care are family-driven, youth-guided, community-based, culturally competent, and sustained beyond the life of the grant.
The focus on “sustainability” separates System of Care from other grant programs, and, given our current economy, makes the initiative even more challenging. A federally funded System of Care is not considered a success unless the positive changes that are made during the six-year term continue after the grant dollars end. The funding serves as “venture capital” to enable communities to make long-term improvements that will lead to a more responsive and effective System of Care at the end of federal involvement. Because an intensive evaluation is involved, communities learn which services and supports are making a difference in the lives of youth and families and can direct resources accordingly. As agencies develop better ways of working together to provide effective care, cost-savings that result are re-invested back into the enhanced system and provide a means to sustain the changes. A community’s prospects to develop a successful System of Care increase greatly when the initiative is implemented not as a “mental health project”, but as a collaborative effort of many agencies that embrace community transformation, and that share ownership, decision-making, and resources towards that end.
State-wide policies and partnerships also play a role in sustainability. There are nine funded System of Care communities in New York State alone, including current grantees, and those that have finished their grant terms. Many New York communities are not currently funded by SAMHSA but have equally significant systems of care. It is important to realize that funded System of Care communities are not sustaining a “grant program” but endeavoring to make permanent the improvements that result in better outcomes for youth, and their families. Both funded and non-funded communities will benefit from overcoming the obstacles to sustainability that exist at both the local and state level. It is therefore critical that communities without federal grants are recognized for their systems of care and join with federally-funded communities to work together on relevant issues.
Many System of Care goals align directly with “The Children’s Plan of New York State” (http://www.omh.state.ny.us/omhweb/engage/), submitted in October 2008 to Governor Paterson and the Majority leaders of the Senate and the House. Signed by nine commissioners of separate child-serving state agencies, this thoughtful, forward-thinking plan recognizes that the well-being of our children is everyone’s responsibility. The plan seeks to reduce fragmentation between state agencies, ensure effective and integrated services and develop a culturally competent workforce “steeped in a new paradigm of integrated, family-driven care.” The Children’s Plan mirrors local System of Care efforts, provides a unified vision and identifies focus areas for the next five to ten years. Funded and non-funded New York communities would do well to embrace The Children’s Plan as an excellent starting place for their local System of Care sustainability efforts and advocacy.
Sustaining a quality System of Care requires hard work, flexible thinking and a willingness to set aside individual agendas. While local systems of care may be good, families and youth tell us that there are still things we can do better. Orange County has embraced the challenge of community transformation at a time when the economy makes it all the more difficult, but important to succeed. Despite the fiscal realities, we are optimistic that the commitment and partnerships, within and between communities, and at the state and federal level, will be sufficient for the task ahead. Our success is critical.
Angie Kays-Burden works at the Orange County Department of Mental Health in Goshen, New York.