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Implications
for Children's Mental Health
The shift in interest toward results-based accountability raises hopes that mental health systems will respond more flexibly to those they serve, that public faith in the ability of human service institutions to accomplish their intended purposes will be restored, and that communities will be better able to plan their support of children and families (Schorr, et al., 1994). A System of Care for Severely Disturbed Children and Youth (Stroul and Friedman, 1986) more clearly defined the concept of system of care and provided guidance in how to build systems that would allow children to receive services while remaining at home and in their communities. We believe the Ecology of Outcomes framework will both complement and expand the systems of care concept by helping policy makers and administrators establish strategies to build outcome information systems and incorporate outcome information into decisions that impact the planning and delivery of services to children and their families.
Having information available about what populations are being served, in concert with information about what services are being provided, can strengthen the position of public agencies in the emerging managed care environment. Managed behavioral health care plans are increasingly seeing themselves as information managers as importantly as care managers. Managed care entities must address the problem of tracking services. Moreover, the services tracked must equate to the dollars that are being managed. The benefits of managed care are its use of information technology in tracking clients, services and costs that have not been possible in public sector mental health systems. The information systems that will emerge within a managed care environment may move mental health systems toward defining and tracking their activities more clearly (Freeman and Trabin, 1994). The very task of gathering and using this information frames the work of managed care as a self-evaluation process. The current challenge for child-serving agencies is that managed care entities are overly focused on costs within its closed system of medically related services. In contrast, systems of care focus on child and family outcomes within an open system that includes all costs associated with child serving agencies. Systems of care that combine both cost and client outcomes will be better able to compete in future managed care environments.
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