Nebraska Medicaid Program

Current Initiatives

Children's Mental Health and Substance Abuse Statewide Infrastructure Grant (SIG)

Outcomes from
Existing Systems of Care

Systems of Care Facts

Federal Context for Children’s SIG

The President’s New Freedom Commission on Mental Health of 2003 established a bold direction for mental health care in the United States.

The goals of the Commission include:

  • To help Americans understand that mental health is essential to overall health
    • Implement a national campaign to reduce the stigma of seeking care
  • To understand that mental health is consumer and family driven
    • Develop an individualized plan of care for every adult and child with a serious emotional disturbance
    • Create a comprehensive state plan
  • To eliminate disparities in mental health services
    • Improve access to quality care and resources in rural areas
    • Develop culturally competent treatments, services, care and support
  • To make early mental health screening, assessment, and referral common practice
    • Promote mental health of young children
    • Improve and expand school mental health programs
    • Screen for co-occurring mental and substance abuse disorders and link with treatment strategies
  • To make sure that excellent mental health care is delivered and research is accelerated
    • Improve and expand evidence-based services and supports
  • To use technology to access mental health care and information
    • Use health technology and telehealth to improve access of mental health care in remote areas

Federal agencies have begun to develop approaches for implementing the Commission’s recommendations. One initiative, through the Department of Health and Human Services Substance Abuse and Mental Health Administration is the Mental Health Transformation State Incentive Grant Program. Key features of this grant program include:

  • Grants are intended to support major systemic changes at the state level
  • Grants have a special focus on prevention of mental illnesses as well as treatment.
  • Grants focus on interagency collaboration. Changes must create sustainable mechanisms and structures that will improve collaboration and address the overlap among different systems (e.g., mental health, child welfare, education, corrections, and substance abuse).
  • Grants emphasize the use of a public health approach with mental health issues

The Children’s Mental Health and Substance Abuse State Infrastructure Grant (SIG) is an example of the Substance Abuse and Mental Health Administration’s (SAMHSA) efforts to implement the President’s Freedom Commission recommendations. This grant initiative is designed to change state level infrastructure to support community-based systems of mental health and substance abuse to improve the lives of children and families.

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Outcomes from Existing Systems of Care


Since the inception of the Comprehensive Community Mental Health Services for Children and Their Families program in 1992, a national evaluation has been coordinated by ORC Macro International, Inc. and its partners: the Louis De La Parte Florida Mental Health Institute University of South Florida, and the Federation of Families for Children’s Mental Health. Phase II of the evaluation includes Families First and Foremost in Lancaster County, Nebraska, along with 13 other grantees funded in October 1998.

Selected Outcomes from Lancaster County include:

  • Child strengths increased over time. In Lancaster County 38% of youth demonstrated an increase in behavioral and emotional strengths in the six months following enrollment in the system of care. This grew to 40% after 18 months. Among other 1998-funded communities, 47% showed an increase of child strengths 30 months after enrollment.
  • Problems with child functioning decreased over time. Locally, a 27% decrease in an aggregate child functioning score was recorded after 18 months. This is comparable with a 28% decrease after 30 months in 1998-funded communities.
  • Symptoms of child psychopathology decreased over time. Almost one-half (47%) of the youth in the Lancaster County system of care experienced a decrease in symptoms of psychopathology after 18 months compared with 57% who exhibited decreased symptoms after 30 months among other 1998-funded communities.
  • Delinquent behavior decreased over time. Approximately 70% of the youth reported engaging in delinquent acts in the six months prior to enrolling in the Lancaster County system of care. That figure decreased to less than 40% after 18 months.
  • Average grades improved over time. In Lancaster County , almost half (46%) showed an improvement in grades with the average grade rising from a "D" to a "C". Among similar communities, 44% improved their average grade.


Center for At-Risk Children’s Services 2004. Families First and Foremost: CMHS Grant Final Report. Lincoln, NE: University of Nebraska--Lincoln, Center for At-Risk Children’s Services

ORC Macro International, Inc. 2004. CMHS National Evaluation: Comparison of Aggregated 1998-Funded Communities and Families First and Foremost. Atlanta, GA.: ORC Macro, Inc.

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Systems of Care Facts

The phrase "Systems of Care" (SOC) is often used to characterize federally funded programs designed to help youth with emotional disorders (or at-risk of developing emotional disorders) and their families. A SOC is:

A comprehensive spectrum of mental health and other necessary services which are organized into a coordinated network to meet the multiple and changing needs of children and their families

A system of care incorporates a broad array of services and supports that is organized into a coordinated network, integrates care planning and management across multiple levels, is culturally and linguistically competent, and builds meaningful partnerships with families and youth at service delivery and policy levels. Linkages between agencies and systems are imperative because children with emotional disorders require a variety of services and supports to meet their complex needs.

Guiding Principles for a System of Care

Services/Supports should be:

  • Comprehensive
  • Individualized
  • Outcome focused and strengths based
  • Provided in the least restrictive and most appropriate setting
  • Involve families and youth as partners
  • Emphasize early identification and intervention

Core Values

  • The SOC should be child centered and family focused, meaning that the services provided should be guided by the specific needs of the family
  • The SOC should be community based
  • The SOC should be culturally competent and responsive to the cultural, racial, and ethnic differences of the populations that they serve

Basic Tenets of SOC

  • It is an organizing framework (not a model to be replicated) with inherent flexibility to fit various communities needs
  • SOC change and evolve over time to adapt to changing needs in the community/state
  • It is a developmental process and most communities have a SOC even if it is early in its infancy

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