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A system of care is a wide range of mental health and related services and supports that work together to meet the multiple and changing needs of children. It is designed to help children and youth with serious emotional disturbance and their families get the services they need in or near their homes and communities. In systems of care, local public and private organizations work in teams to implement and coordinate a set of services unique to that child that looks at the physical, emotional, social, educational and family needs. Teams include family members and representatives from each agency or service the child receives. It can also include “informal supports” such as Big Brothers, the YMCA and other supports that help the child. Teams focus on the strengths of the child and the family. In October 1999, the Tennessee Department of Mental Health and Developmental Disabilities received a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services (CMHS). The grant was awarded to states to assist them in developing local systems of care. It was originally for a five-year period but was extended to states for a sixth year. States provide matching funds each year. The purpose of the Tennessee grant project, the Nashville Connection, is to foster the growth and successful implementation of systems of care for children with serious emotional disturbance and their families who reside in Davidson County. The local site is a demonstration site at which newly developed system of care policies and practices are implemented and from which data is drawn to evaluate their effectiveness. Family Service Coordinators help the children and families to develop the skills needed to manage their lives and advocate for their needs. Mental Health Liaisons work in the schools with the children and also provide behavioral health education, training and consultation for teachers and school staff. Goals include:
DMHDD subcontracts with three local vendors for service implementation, national evaluation activities, data system development, training and consultation. The grant partners involved are Tennessee Voices for Children (child and family advocacy, training and support), Centerstone Community Mental Health Centers, Inc., (school-based mental health liaison services) and Vanderbilt Institute for Public Policy Studies (national and local evaluation). Partners that agree on the need to make systems of care work for children and families include:
The Importance of Developing Systems of Care It is estimated that:
The State’s Role in Developing a System of Care
A statewide council made up of representatives from all child-serving agencies and family members oversees the system of care initiative in Tennessee. The purpose of the council is to identify and address gaps in the services available and to remove barriers to coordinated mental health service delivery. DMHDD has been the major source of state funding for the Nashville Connection project since its inception in 1999. Without the financial backing of the department and concentrated efforts by the department to attain interdepartmental support, the local project would not have been sustained for a sixth year. The Departments of Education and Children’s Services joined with TDMHDD to help fund and continue services for the current state fiscal year. The department has not only been instrumental in the implementation of the Nashville Connection grant but also demonstrates a commitment to the expansion of system of care values and principles throughout the state. It has provided assistance in the planning and development of local systems of care in Memphis, Columbia and Knoxville. Departmental staff has consulted with system of care developers in these areas during their planning processes and provided technical assistance, training, and knowledge gained through “lessons learned” from the implementation of the Nashville Connection grant. 
Positive outcomes expected from implementation of systems of care:
Helping Families with Systems of Care In many of our Tennessee communities, services for young people with serious emotional disturbance are unavailable, unaffordable, or inappropriate. As a result, children with these health problems may end up involved in the court system. Sometimes parents give up custody of their child in order to get services. When children and their families do receive help, it is often confusing. There may be several different providers, and each of them may have a different approach and differing treatment plans. A child’s entire life is affected by serious emotional disturbance. This generally indicates that a child with serious emotional disturbance and his/her family may need many types of services from a variety of sources such as schools, mental health providers, and other social service providers. Frequently, organizations do not work together to plan and coordinate the services that children with serious emotional disturbance and their families need. For example, while a child may be attending special education classes in the school, he/she may not have access to after-school recreation programs or tutoring. Lack of transportation prevents some families from accessing services they need and want. A coordinated, accountable child and family-centered system of care prevents many of these situations from happening and seeks to eliminate barriers and address gaps in the service system. It is responsive to the challenges children will encounter as they grow, develop and enter into adulthood. For more details about the Nashville Connection project, click
The Nashville Connection:
A Local System of Care For further information regarding the TDMHDD System of Care, please contact Lygia Williams, or: Millie Sweeney, Nashville Connection Project
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