A Systems-Building Model for Children and Youth in State Custody
Michele R. Moser,
Andres J. Pumariega.
Objective: Children and youth in the child welfare and juvenile justice systems or at risk of entering them are
known to have high rates of mental health problems and psychiatric disorders. Many states are struggling with the provision
of mental health services for these important populations, both providing timely and adequate access to services as
well as providing evidence-based interventions to address their complex needs. The state of Tennessee developed a program
of regional Centers of Excellence (COEs) based within pediatric tertiary centers that provide clinical and consultative
services, and technical assistance to behavioral health providers and regional branches of the state child welfare
agency. These are oriented to improve access, quality, and effectiveness of care.
Methods: This manuscript briefly reviews the history and process of development for the Tennessee COEs for Children in
State Custody. It also outlines their evolving clinical and consultative activities, and activities to develop services infrastructure
on behalf of children in custody with complex behavioral health needs.
Results: The COEs have provided a significant number of direct consultative and clinical services that have been formally
evaluated as highly valuable by stakeholder agencies. They have also developed an infrastructure for training and dissemination
of best practices and evidence-based interventions oriented to the special needs of children in state custody.
Conclusions: The Tennessee COEs serve as a national model for the building and development of regional systems, both
for children in state custody and for other children and youth with complex mental health needs.
Keywords: Child and adolescent mental health, child welfare, state custody, systems of care.
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