A systems perspective on research and treatment with abused and neglected children.
OBJECTIVE
To discuss two systems-level changes in the organization and financing of mental health and child welfare services that will increasingly affect abused and neglected children: the implementation of managed care processes and the incorporation of accountability mechanisms in the management of mental health and child welfare services, particularly the use of systematic outcomes assessments. A central goal of the paper is to identify critical research questions which will help us to understand the impact of these changes on maltreated children.


METHODS
These two systems-level changes are described, and ways they may affect maltreated children are addressed.


RESULTS
Both managed care and the growing focus on managing services by monitoring outcomes may positively or negatively affect maltreated children. Both of these trends are affecting the mental health and child welfare systems. It is likely that they will affect maltreated children's access to and the quality, cost, and outcomes of mental health and child welfare services.


CONCLUSIONS
Systematic research on the impact of these large-scale changes can increase the likelihood that these changes will benefit maltreated children. A number of critical areas are identified for future research.
Clyman
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Kempe Children's Center, Department of Pediatrics, University of Colorado School of Medicine, Denver 80218, USA.
D002648:Child; D002649:Child Abuse / Q000191:economics / Q000523:psychology / Q000628:therapy*; D002669:Child Welfare / Q000191:economics*; D003363:Cost Control; D006801:Humans; D008329:Managed Care Programs / Q000191:economics*; D011785:Quality Assurance, Health Care / Q000191:economics; D013598:Systems Theory