From complexity to reality: providing useful frameworks for defining systems of care

Because systems of care are not uniform across communities, there is a need to better document the process of system development, define the complexity, and describe the development of the structures, processes, and relationships within communities engaged in system transformation. By doing so, we begin to identify the necessary and sufficient components that, at minimum, move us from usual care within a naturally occurring system to a true system of care. Further, by documenting and measuring the degree to which key components are operating, we may be able to identify the most successful strategies in creating system reform. The theory of change and logic model offer a useful framework for communities to begin the adaptive work necessary to effect true transformation. Using the experience of two system of care communities, this new definition and the utility of a theory of change and logic model framework for defining local system transformation efforts will be discussed. Implications for the field, including the need to further examine the natural progression of systems change and to create quantifiable measures of transformation, will be raised as new challenges for the evolving system of care movement.