A systems perspective on research and treatment with abused and neglected children

Objective: To discuss two systems-level changes in the organization and fin ancing of mental health and child welfare services that will increasingly a ffect abused and neglected children: the implementation of managed care pro cesses and the incorporation of accountability mechanisms in the management of mental health and child welfare services, particularly the use of syste matic outcomes assessments. A central goal of the paper is to identify crit ical research questions which will help us To understand the impact of thes e changes on maltreated children. Method: These two systems-level changes are described, and ways they may af fect maltreated children are addressed. Results: Both managed care and the growing focus on managing services by mo nitoring outcomes may positively or negatively affect maltreated children. Both of these trends are affecting the mental health and child welfare syst ems. It is likely that they will affect maltreated children's access to and the quality, cost, and outcomes of mental health and child welfare service s, Conclusions: Systematic research on the impact of these large-scale changes can increase the likelihood that these changes will benefit maltreated chi ldren. A number of critical areas are identified for future research. (C) 1 999 Elsevier Science Ltd.