Background

A System of Care approach serves as an organizational framework and philosophy to strengthen the structure and delivery of mental health services by organizing child-serving systems in the System of Care to be family-driven and youth-guided in order to provide more effective coordinated interventions for children and adolescents with complex needs. The impact of this philosophy is evidenced by recent health care reforms including the movements toward value-based care, home and community-based care, and integration of behavioral health and primary care.

Research has consistently demonstrated improved clinical and functional outcomes when System of Care principles are applied. However, a gap remains: there is no universally accepted framework that reliably guides decision-making regarding service intensity needs while also serving as a validated tool for monitoring treatment outcomes. There are, however, service intensity assessment instruments* in the field that support the determination of mental health service needs across the lifespan of patients.

The youth-serving tools take into consideration pediatric developmental stages, complex and/or co-morbid health conditions, family and caregiver roles, and the nature of community supports in treatment and care planning and help identify a broad services array that should be universally available in a comprehensive continuum of care in order to effectively address the identified service needs of the population served. Notably, the effective use of service intensity instruments should be supported by training to ensure that users have the necessary knowledge and skills to properly utilize the instruments. It should be noted that other assessment instruments are useful in certain contexts but are limited by their reliance on diagnostic categorization and do not cover treatment intensity. However, they can be used to complement service intensity determination in mental health care planning.

To support national utilization of validated service intensity instruments in pediatric mental health care planning, AACAP recommends:

1. Providers in all youth-serving systems of care and payors utilize service intensity determination instruments to identify the mental healthcare service array and supports that best meet the needs of children, adolescents and their families.
2. Youth-serving systems adopt and utilize service intensity determination instruments to identify gaps in the service array and guide the development of a full continuum of pediatric mental health care services.
3. System of care administrators utilize service intensity determination instruments to measure individual and program outcomes.
4. State and federal policy makers mandate the utilization of service intensity determination instruments by youth-serving systems and insurance benefit utilization managers to support the appropriate clinically indicated allocation of mental health services and supports.

*Level of Care Utilization System, developed by American Association for Community Psychiatry Child and Adolescent Service Intensity Instrument-Child and Adolescent Level of Care Utilization System, co-developed by American Association for Community Psychiatry and the American Academy of Child and Adolescent Psychiatry.
Early Childhood Service Intensity Instrument, developed by the American Academy of Child and Adolescent Psychiatry.

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The American Academy of Child and Adolescent Psychiatry promotes the healthy development of children, adolescents, and families through advocacy, education, and research. Child and adolescent psychiatrists are the leading physician authority on children’s mental health.

Approved by Council June 2026