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Cited by 42Psychiatric care and mental health servicesAdolescent and Pediatric HealthcareChild and Adolescent Health

Clinical Update: Child and Adolescent Behavioral Health Care in Community Systems of Care

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Larson, Justine, Kazura, Allesandra, Fortuna, Lisa, French, William P., Hodas, Gordon R., Metz, Peter, McGinty, Kaye, Bellonci, Christopher +23 more·2023·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2022.06.001
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Abstract

OBJECTIVE: The objective of this Clinical Update is to review the principles, structures, processes, and outcomes of community systems of care as they pertain to the delivery of behavioral health care to children and adolescents METHOD: A search of the literature on this topic from 2002 was initially conducted in 2016 and repeated in 2019 and 2021, yielding 1,604 English-language citations. These citations were supplemented by references suggested by topic experts and identified through Web searches, increasing the yield to 1,684 total citations, of which 1,184 were unduplicated. After sequential review by Update authors at title/abstract and then full-text levels, the citations were winnowed to 156 based on relevance to the topic. RESULTS: The systems of care approach, arising in the 1980s, expanded child and adolescent behavioral health care from the core services of psychotherapy, medication management, inpatient psychiatric services, and residential treatment to include home- and community-based treatment and support services; promotion, prevention, and early intervention programs; and specialized services for very young children and youth and young adults of transition age. These services and supports are delivered by a large multidisciplinary workforce and are governed by key principles, including a biopsychosocial case conceptualization; family-driven, youth-guided, strengths-based, and trauma-informed care. Services in the least restrictive setting; continuity of care across transitions; a public health framework for service delivery; promotion of wellness and resilience; and elimination of health disparities. Challenges to systems of care implementation include funding availability, workforce shortages, deficiencies in cross-systems collaboration, and variability in insurance coverage. Although controlled studies have failed to provide convincing evidence of favorable outcomes from the whole systems of care approach, uncontrolled research has demonstrated increased access to care, positive clinical and functional outcomes, improved family functioning, and reductions in costs, particularly when research is focused on specific behavioral health problems, specific interventions such as Wraparound care, or highly specified groups of youth. CONCLUSION: Health professionals who are educated in the systems of care approach can improve access to and quality of behavioral health care for children and adolescents with behavioral health needs.

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Authors
Larson, J., Kazura, A., Fortuna, L., French, W. P., Hodas, G. R., Metz, P., McGinty, K., Bellonci, C., Lee, T., Lohr, W. D., Sharma, P., Zachik, A., Varma, C., Kamarauche, A., Adade, O. A., Bender, E., Brown, K. A., Concepcion, M., Naylor, M. W., Pandhi, S., Ugorji, O., Abright, A. R., Becker, T., Diamond, J., Hayek, M., Keable, H., Ripperger-Suhler, J., Vasa, R., Bukstein, O. G., Rockhill, C., & Walter, H. J.
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2023-04
Volume
62
Issue
4
Pages
367-384
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2022.06.001
OpenAlex
W4281710185
Cited by
42
References
5
Citations by year
2026: 17 · 2025: 11 · 2024: 9 · 2023: 5
FWCI
5.72
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Substance Abuse and Mental Health Services Administration
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
  • Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
Keywords
systems of care, community-based treatment, home and community-based services, trauma-informed care, strengths-based care, biopsychosocial model, continuity of care, transition to young adulthood, public health framework, health disparities, workforce shortage, insurance coverage, health care access, wraparound care, family functioning, cost reduction
MeSH terms
Adolescent, Adolescent Behavior, Child, Child Behavior, Child, Preschool, Delivery of Health Care, Humans, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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