The concept of systems of care for children with serious emotional disturbance and their families is described in this article as an explicit organizational philosophy that emphasizes services that are family focused, individualized, provided in the least restrictive environment, coordinated among multiple agencies, and culturally competent. This conceptualization is contrasted with the view of systems of care as discrete interventions causally related to improving child-level outcomes. Systems of care are presented as mutable strategies for improving organizational relationships that are best judged by outcomes focused at the organizational level. Rethinking and expanding the theory of change underlying systems of care are recommended in order to support development of the knowledge base for understanding what systems of care are, what they are not, and what they can be expected to accomplish.
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