Service access and service system development in a children's behavioral health system of care

Systems of care provide comprehensive services to children with emotional and behavioral disorders through a network of local agencies and providers that function as a multi-agency case review team. A primary objective in any system of care is to provide individuals with access to appropriate services. In the present study, access is defined as services received relative to those recommended by a multi-agency review team and barriers to services identified by that team. These indicators, which provide a system-level assessment of service access and function as a proxy for the development of the system of care, fill a gap in the existing literature for more system-level indicators of outcome. A total of 2073 children and youth are assessed upon entry into Rhode Island's behavioral health system of care and then followed for three months to determine the extent of services received relative to those recommended as well as barriers to services identified at service entry. Multi-agency reviews are conducted over an 8-year-period through three phases of system of care implementation-early in the establishment of the system of care, at the midpoint of implementation after substantial funding was received for service enhancements, and after full implementation of the system of care philosophy. The results indicate that, as a system of care matures, access increases significantly on both of these indicators, and that more and different types of children are served and agencies are involved in the system of care. The results are discussed for their implications for assessing systems of care through establishment of system-level empirical benchmarks of service system development.