Evolutionary drift in systems of care development.

While we agree that it is necessary to articulate a "clearly specified population" for the definition of systems of care, we believe that limiting systems of care to "children and youth with serious emotional disturbance and their families" is not in the best interest of most communities. Using this narrow population definition excludes the other 80-90% of the youth who have mental health challenges but have not risen to the highest level of need. If all children and their families receive the right amount of support from the system of care at the right time, they will avoid the need for more intensive and expensive services and supports later. This public health approach helps to build more stable communities and redirects scarce resources to interventions that are less costly than those needed for youth who already have developed serious emotional disturbances. The key to successfully supplying the "right amount at the right time" is to ensure that the system of care is truly needs driven, rather than agency or service system driven. A system of care for children, youth and their families should reflect community preferences and embrace a public health approach where all levels of need are served.