Families of children with emotional, mental, or behavioral needs, as well as like-minded professionals, have been advocating for family participation in designing and shaping services in systems of care for approximately 15 years. In the past, families were often blamed for children’s problems and rarely valued for their expertise and ability to participate in systems of care. More recently, families are increasingly integral to effective systems of care. Families are being accepted for their knowledge and ideas about how to improve services to their children and how to strengthen the service delivery system. Growing numbers of participants in systems of care are viewing family-provider collaboration as a central component of relevant and respectful delivery of services. This monograph addresses the process and practice of family-provider collaboration. The Promising Practices in Family-Provider Collaboration monograph is one of several monographs supported by the Center for Mental Health Services (CMHS), and is part of the Comprehensive Community Mental Health Services for Children and Their Families Program (known also as the Child Mental Health Initiative). This monograph focused on systems of care currently receiving grant assistance from CMHS. These are referred to as Child Mental Health Initiative sites.

Under the leadership of the Child, Adolescent and Family Branch of the Center for Mental Health Services, 44 grants have been awarded to sites across the United States who applied for funds to improve systems of care for children. CMHS has a clear directive to Child Mental Health Initiative sites that they implement family-provider collaboration within their systems of care. This directive provides a unique opportunity for communities to work at collaboration when offering services to children with emotional, behavioral, and mental disorders and their families. As the federal grant guidelines state, successful implementation of systems of care at the Child Mental Health Initiative sites depends on "the full involvement and partnership of families in: (1) the planning, development, implementation, management and evaluation of the local service system; and (2) the care of their children and adolescents" (U.S. Department of Health and Human Services, 1998). While the authors hope this monograph is useful to a range of participants in a wide variety of systems of care, it is particularly intended for communities, both current and future, who are looking for strategies to increase family participation in systems of care and to expand family-provider collaboration. Several questions central to this monograph include:

In the first section, we provide an overview of and background to family-provider collaboration. In addition to addressing the ways in which participants in systems of care have viewed families of children with emotional, behavioral, and mental health needs in the last few decades, we discuss components of family-provider collaboration. The final pages of this section offer conclusions concerning family-provider collaboration generated by conversations with participants in systems of care.

The second section looks closely at the role of families at four different Child Mental Health Initiative sites offering services to children with emotional, behavioral, and mental disorders and their families. Drawing on the experiences of the PEN-PAL and FACES Projects in North Carolina, the K’e Project on the Navajo Nation, the Napa County System of Care and the Sonoma County System of Care in California, and the East Baltimore Mental Health Partnership in Maryland, we identify several processes that directly contribute to family-provider collaboration and family-centered services.

At the same time, family-provider collaboration is never a given. Participants in systems of care have found that meaningful and ongoing movement away from attitudes and actions that blame and devalue families can be difficult to accomplish and sustain. Systems and people change slowly. Frequently, participants within a service system change at different paces and in various rhythms. Delivery of services that used to be straightforward and obvious may seem complicated and ambiguous. Discomfort and tension may seem too often present.

Family-provider collaboration occurs when participants in systems of care are ready to work at change. In addressing four sites in an in-depth manner, and in featuring 13 profiles, we sought to maintain geographic and cultural balance; provide examples of promising practices (and not exemplary or "perfect sites"); and feature Child Mental Health Initiative sites that each offer different and unique insights. The four in-depth descriptions of family-provider collaboration focus on the process each of the sites has worked with to move toward collaboration. A summary follows:

Site directors and family coordinators emphasized the benefit of local family organizing to the delivery of services. Strong ties to local families and organizations support an awareness of strengths, needs, and social norms within particular communities.

• On the Navajo Nation in New Mexico, Arizona, and Utah, staff at the K’e Project work in a context where Navajo philosophy and culture are more predominant than the assumptions and beliefs embedded in non-Navajo approaches. The K’e Project is a profound example of one system of care that values family-centered services. In particular, Navajo traditional approaches to healing:

• understand the family as central to a child’s health and well-being;
• view the child’s mental, behavioral, and emotional health as intricately connected to the social, economic, and spiritual health of the child and of the family; and
• insist on a strengths-based approach in recognizing and responding to a child’s health needs.

• Families and providers in Napa and Sonoma Counties offer the following lessons to family-provider collaboration:

• collaboration requires concentrated commitment, attention, and effort;
• integrating family members into service delivery requires attention to implementation;
• in working at collaboration, families and providers must be aware of the support (or lack of it) for collaboration on the part of other agencies; and
• the CMHS grant structure provides extremely useful leverage for Child Mental Health
• Initiative sites working at collaboration.

• Mutual respect and collegiality are key components of East Baltimore’s efforts at collaboration. In particular, East Baltimore has learned that family-provider collaboration requires:

Definition. Family-provider collaboration in systems of care is the process that participants (including family coordinators and advocates, therapists, administrators, social workers, and case managers) in systems of care engage in to improve services for children and their families, and requires:

In conversations with participants in systems of care, and through visits to Child Mental Health Initiative sites, three components of collaboration repeatedly surfaced. We believe the following three aspects of families and providers working together are minimally necessary for collaboration:

• shared vision and goals,
• shared power in decision-making at all levels, and
• long-term commitment to the process of developing collaboration.

Collaboration occurs in a range of different ways and at a variety of levels in systems of care. Family-provider collaboration is simultaneously dependent on the existence of shared vision and goals, shared power, and long-term commitment, as well as on how families receiving services in that community define "improved services." Little research has been done on family-provider collaboration so many basic questions are yet to be resolved. Following are a few suggestions for beginning a research agenda in this area: