Rosenblatt Abram
Department of Psychiatry, University of California, San Francisco, 401 Parnassus Box CPT, San Francisco, CA 94143-0984, USA.
Eval Program Plann. 2010 Feb;33(1):14-7. doi: 10.1016/j.evalprogplan.2009.06.002. Epub 2009 Jun 9.
The system of care approach as a strategy for serving children and adolescents with serious emotional disturbance (SED) is by any measure a success with one exception: there is controversy regarding the scientific evidence documenting that the services provided through systems of care improve the symptomatic and functional outcomes of the youth and their families served when compared to the services provided through more traditional service systems. This paper traces this essential problem to challenges in the definitions of systems of care, particularly the level at which systems of care are conceived to exist and the impact of these challenges on the collection of relevant and meaningful data that could otherwise create a cumulative science regarding systemic interventions for youth with SED. In many regards, systems of care are often viewed in the context of programs of care that are predominantly evaluated within program evaluation rather than system evaluation perspectives. This article elucidates the problems created by the varying definitions of systems of care for the development of a cumulative practice and policy relevant research base pertaining to children and adolescents with serious emotional disturbance. Alternative strategies for future research are discussed in the context of alternative definitions of the system of care concept.
作为一种为患有严重情绪障碍（SED）的儿童和青少年提供服务的策略，照护系统无论从哪方面衡量都是成功的，只有一个例外：对于科学证据存在争议，这些证据表明，与通过更传统的服务系统提供的服务相比，通过照护系统提供的服务能改善所服务的青少年及其家庭的症状和功能结局。本文将这一关键问题追溯到照护系统定义方面的挑战，特别是照护系统被认为存在的层面，以及这些挑战对收集相关且有意义的数据的影响，否则这些数据本可形成关于针对患有SED的青少年进行系统干预的累积科学。在许多方面，照护系统常常是在照护项目的背景下看待的，而这些项目主要是从项目评估而非系统评估的角度进行评估。本文阐明了照护系统不同定义给建立与患有严重情绪障碍的儿童和青少年相关的累积实践及政策研究基础所带来的问题。在照护系统概念的替代定义背景下讨论了未来研究的替代策略。
