A Systems-Building Model for Children and Youth in State Custody

Objective: Children and youth in the child welfare and juvenile justice systems or at risk of entering them are known to have high rates of mental health problems and psychiatric disorders. Many states are struggling with the provision of mental health services for these important populations, both providing timely and adequate access to services as well as providing evidence-based interventions to address their complex needs. The state of Tennessee developed a program of regional Centers of Excellence (COEs) based within pediatric tertiary centers that provide clinical and consultative services, and technical assistance to behavioral health providers and regional branches of the state child welfare agency. These are oriented to improve access, quality, and effectiveness of care. Methods: This manuscript briefly reviews the history and process of development for the Tennessee COEs for Children in State Custody. It also outlines their evolving clinical and consultative activities, and activities to develop services infrastructure on behalf of children in custody with complex behavioral health needs. Results: The COEs have provided a significant number of direct consultative and clinical services that have been formally evaluated as highly valuable by stakeholder agencies. They have also developed an infrastructure for training and dissemination of best practices and evidence-based interventions oriented to the special needs of children in state custody. Conclusions: The Tennessee COEs serve as a national model for the building and development of regional systems, both for children in state custody and for other children and youth with complex mental health needs.