The President's New Freedom Commission Report Achieving the Promise: Transforming Mental Health in America identifies 6 goals:

1. Americans understand that mental health is essential to overall health.
2. Mental health care is consumer and family driven.
3. Disparities in mental health services are eliminated.
4. Early mental health screening, assessment, and referral to services are common practice.
5. Excellent mental health care is delivered and research is accelerated.
6. Technology is used to access mental health care and information.

Implementing the vision expressed by these goals has become the major responsibility of the Substance Abuse and Mental Health Services Administration (SAMHSA), and all SAMHSA work must relate to these goals. To align our work most effectively, we need to understand the new language being used. In particular, what does “family driven” really mean? How will we know when it is being practiced? The Federation of Families for Children's Mental Health has been tasked with developing a working definition of “family driven.” This work is being led by Trina Osher and David Osher, who facilitated an expert panel meeting during the June Training Institutes in San Francisco . The panel was composed of family members, youth, providers, and administrators from system of care communities. In this article, we report on the status of this work, and invite your response and comment.

Initial draft definition

In making decisions, a family-driven system of care gives precedence to family and youth.

Family-driven systems of care actively demonstrate their partnerships with all families and youth by sharing power, resources, authority, and control. Family and youth experiences, their visions and goals, perceptions of strengths and needs, and guidance about what will make them comfortable steer decision making about all aspects of service and system design, operation, and evaluation. Family-driven systems of care are culturally competent environments in which family and youth voices are heard and valued, everyone is respected and trusted, and where families and youth feel it is safe for them to speak honestly. Family-driven systems of care ensure that families and youth have access to sound professional expertise so they have good information on which to base the choices they make.

Themes that emerged from the expert panel

Valuing Families and Youth

• Voice of families and youth are welcomed, heard, and responded to.
• EVERY family is included.
• System leaders, programs, and providers hear the ideas, concerns, and needs of families, and use families' input to make decisions and service changes.
• Families and youth are in the driver's seat and have a voice at the table.
• Youth and their families have a safe environment in which they can disclose their experiences, concerns, and ideas.

True Partnership with Families and Youth

• There is a genuine respect for families and youth.
• Power, resources, authority, control, and responsibility for outcomes are shared equally with youth and their families.
• Partnership is standard operating procedure: continual, and routine.
• No decisions are made without input from families and youth.
• Family and youth participation is supported and funded.
• Formal credentials get respect, but not special privilege.
• Comfort and trust zone for families, youth, and professionals are established.

Throughout the Systems

• Family-driven practice is evident in all systems, programs, teams, and services.
• Everyone takes responsibility for transforming systems to be family-driven.
• Risk management is a collective responsibility and aims to do what is in the best interest of families and youth.
• Procurements require, and treatment approaches incorporate, family-driven practice.

Training and Support

• Everyone gets initial and ongoing training and support to participate in a family-driven system of care.
• Family-driven practice is infused in pre-service training in all disciplines.

Cultural Competence

• Family-driven practice and cultural competence are inextricably linked.
• The cultures of families and communities provide the overarching framework for operating family-driven systems of care.

Conditions necessary to make the shift to family-driven systems of care

1. Families and youth have accurate, understandable, and complete information to make choices for improved planning for individual children.
2. Families and youth are organized to collectively use their knowledge and skills as an engine for systems change.
3. Families and youth embrace the concept of sharing decision-making and responsibility for outcomes with providers, and dare to risk doing it.
4. Providers embrace the concept of sharing decision-making and responsibility for outcomes with families and youth, and dare to risk doing it.
5. Providers take the initiative, and give themselves “permission” to change practice from provider-driven to family-driven.
6. Administrators allocate staff, training, and support resources to make family-driven practice work at the point where services and supports are delivered to children, youth, and families.
7. Peer support reduces isolation and strengthens family and youth voice.
8. Change in community attitude removes barriers created by stigma.

These initial definitions, themes, and conditions support a continued discussion for further defining and shifting to family-driven systems of care. We would like to invite you to provide input toward defining family-driven systems of care. Please let us know the perspective you are coming from (e.g., family member, youth, provider, public official, or administrator).