System of Care- Community for Early Signs and Symptoms


SOC-CESS, System of Care: Community for Early Signs and Symptoms is for youth ages 9-17 & their families. A System of Care (SOC) is a group of local organizations that wraps supports around youth & families.   SOC-CESS is in a SOC providing early screening and identification for youth who are potentially at risk for experiencing psychosis. The Missouri Department of Mental Health is working with three clinics to build up the local communities’ SOC. We have the goal of moving towards further expansion.  The three clinics are Ozark Center in Joplin, Compass Health Network in Jefferson City, and Burrell Behavioral Health Center in Springfield. 

SOC-CESS aims to intervene early by better preparing youth through evidenced- informed treatment.  We want youth to have a better understanding of themselves to lead more independent lives.  SOC-CESS will also assist individuals in learning how to manage their symptoms, which helps to reduce the chance of entering a crisis.  SOC-CESS services engage youth and families, with the goal of limiting the over use of behavioral health services.  We will also aim to prevent or reduce crisis which can reduce the burden of cost on these clinics over time.  Overall, we support and empower youth and families to live their lives and achieve their life goals.

Goals for SOC-CESS are:

1. To improve the overall functioning of youth who are at risk of early onset psychosis and their families.

​2. Embed family and youth leadership within local and state agencies. 

​3. To expand an enhanced SOC (System of Care) specifically as it relates to early identification and treatment for youth at risk of or experiencing early onset psychosis and families. 

System of Care


The National Technical Assistance Center for Children's Mental Health offers more information, resources, webinars, and publications about System of Care.   The core values and guiding principles are discussed in an article "Updating the System of Care Concept and Philosophy."

Core Values

Systems of care are:

1. Family driven and youth guided, with the strengths and needs of the child and family determining the types and mix of services and supports provided.

2. Community based, with the locus of services, as well as system management, resting within a supportive, adaptive infrastructure of structures, processes, and relationships at the community level.

3. Culturally and linguistically competent, with agencies, programs, and services that reflect the cultural, racial, ethnic, and linguistic differences of the populations they serve to facilitate access to and utilization of appropriate services and supports.

Guiding Principles

Systems of care are designed to:

1. Ensure availability of and access to a broad, flexible array of effective, evidence-informed, community-based services and supports for children and their families that addresses their physical, emotional, social, and educational needs, including traditional and nontraditional services as well as informal and natural supports.

2. Provide individualized services in accordance with the unique potential and needs of each child and family, guided by a strengths-based, wraparound service planning process and an individualized service plan developed in true partnership with the child and family.

3. Deliver services and supports within the least restrictive, most normative environments that are clinically appropriate.

4. Ensure that families, other caregivers, and youth are full partners in all aspects of the planning and delivery of their own services and in the policies and procedures that govern care for all children and youth in their communities, states, territories, tribes, and nation.

5. Ensure cross-system collaboration, with linkages between child-serving agencies and programs across administrative and funding boundaries and mechanisms for system-level management, coordination, and integrated care management.

6. Provide care management or similar mechanisms to ensure that multiple services are delivered in a coordinated and therapeutic manner, and that children and their families can move through the system of services in accordance with their changing needs.

7. Provide developmentally appropriate mental health services and supports that promote optimal social and emotional outcomes for young children and their families in their homes and community settings.

8. Provide developmentally appropriate services and supports to facilitate the transition of youth to adulthood and to the adult-service system as needed.

9. Incorporate or link with mental health promotion, prevention, and early identification and intervention to improve long-term outcomes, including mechanisms to identify problems at an earlier stage and mental health promotion and prevention activities directed at all children and adolescents.

10. Incorporate continuous accountability mechanisms to track, monitor, and manage the achievement of system of care goals; fidelity to the system of care philosophy; and quality, effectiveness, and outcomes at the system level, practice level, and child and family level.

11. Protect the rights of children, youth, and families and promote effective advocacy efforts.

12. Provide services and supports without regard to race, religion, national origin, gender, gender expression, sexual orientation, physical disability, socioeconomic status, geography, language, immigration status, or other characteristics; services should be sensitive and responsive to these differences. 1

Specialized Services


These services are currently being offered through Burrell Behavioral Health, Compass Health Network, and Ozark Center.  SOC-CESS is currently working to expand these services in different areas in Missouri.  


Biofeedback is a way to learn to adjust how your body responds to different situations, like slowing down your heart rate.  The skill taught in biofeedback helps you focus on making small changes in your body. It helps you recognize that you are able to make changes to the way your body feels and behaves.  Using these skills often improves the way you feel and what you can do.  Various forms of biofeedback therapy such as deep breathing, mindful meditation, progressive muscle relaxation, or guided imagery have been shown to be helpful in fighting stress-related responses.  Over 80% of studies related to biofeedback reported some level of improvement in symptoms as a result of biofeedback exposure (The Institute of Psychiatry at King’s College, London).

Symptoms that can be improved:

  • Anxiety

  • Attention Deficit Disorder

  • Attention Deficit/Hyperactivity Disorder

  • Chronic Pain

  • Depression

  • Sleep difficulties and disorders

  • Headaches

  • Hyperactivity

  • Rage

  • Stress



  • People who have used biofeedback report feeling good about being able to gain control over symptoms

  • The skills taught can be used anywhere, like school, work and at home

  • Fun, meaningful sessions.  Others receiving biofeedback report looking forward to their next appointment

  • Noninvasive (not harmful to the body)

  • Might reduce or eliminate the need for medications

  • Could be a treatment option for those who don’t do well with medications

  • May be an option when medications haven’t worked well

  • A possible alternative to medications for some conditions during pregnancy

  • Helps people take charge of their health

Virtual Reality

Virtual Reality is a world built in a computer that individuals use special goggles to view.  These worlds have been carefully made to support therapy for anxiety disorders.  The individual is exposed to a feared situation in a safe, controlled environment. A growing body of evidence indicates that Virtual Reality is an effective tool for treating a number of issues such as anxiety, and has lasting effects that can be generalized to the real world.

Therapy using virtual reality can help treat issues such as anxiety, panic attacks, social anxiety, phobias and post-traumatic stress disorder. This treatment is typically less costly and takes less time than other treatments for anxiety disorders.

Programs for children:

  • Fear of bridges

  • Fear of flying

  • Fear of heights

  • Fear of storms

  • Fear of public speaking

Relaxation suites:

  • Aquarium – features several virtual aquariums and calm underwater worlds. Can be used as an aide to many traditional relaxation techniques.

  • Calm craft – Child navigates through a fantasy underwater world while collecting photographs of sea creatures. This teaches children how to control their breathing to gain greater control of their bodies. 

  • Muscle relaxation – features a virtual therapist office. Used to target specific muscle groups.

Virtually Better Inc. has developed evidence-based, state-of-the-art technology to effectively treat a variety of frequently experienced anxiety symptoms.

Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS)

The goal of SPARCS is to help individuals build on their strengths and ability to recover from tough times.

SPARCS was made for young people who have lived through trauma and who continue to live with high levels of stress.  This therapy focuses on enhancing resilience through the development of important self-regulation, problem-solving, decision-making and communication skills.


  • A group for young people between the ages 12 and 22 years old

  • The group is 16 sessions that are designed to help young people who have experienced trauma

A pilot study conducted by the Illinois Department of Children and Family Services showed significant improvement in overall functioning with positive changes in:

  • interpersonal relationships

  • conduct behavior

  • hyperactivity

Group and Family- Based Cognitive Behavioral Therapy 2


A therapy offered to youth aged 12-17 who are at risk of developing psychosis. This therapy can help youth develop a better understanding of their experiences and sharpen their reasoning skills to prevent stressful paranoid thoughts.

Caregivers, such as parents and grandparents will have an opportunity to learn CBT skills and skills to communicate with youth about difficult experiences.  They will practice these skills with an actor in order to receive real-time feedback. 

GF-CBT includes: 15 CBT skills group sessions and 15 individual sessions for youth, and 15 CBT skills groups sessions for caregivers.


GF-CBT may help with concerns such as:

  • Worrying that other people are watching you, talking about you, or intend to hurt you.

  • Becoming more socially isolated.

  • Feeling confused about what is real and what is imaginary.

  • Holding beliefs that other people find unusual.


Some topics covered in GF-CBT:

  • How do people develop suspicious beliefs?

  • What thinking patterns are typical for paranoia?

  • What are my thinking patterns and can I change them?

  • How to reality test beliefs?

  • How to use CBT strategies to deal with stressful thoughts and experiences?

  • How to help each other deal with stressful thoughts and experiences?

  • How to develop and maintain positive relationships with peers and family members?

Prolonged Exposure

Proven to be effective at addressing trauma, and is best for young people between the ages of 12-22.  Many people who have experienced a trauma try to avoid thoughts and feelings associated with that event such as situations, places, and certain activities. 

  • Imaginal exposure is where you imagine your fears from trauma to help learn how to confront them in a safe way. 

  • In-vivo exposure is where you confront situations that you avoid because you become afraid of them after your trauma. 

There are between 6-8 therapy sessions, and each lasts 90 minutes.  With the support of your therapist, you will first work through imaginal exposure.  You will tell your trauma story three times during each session, and these will be recorded for you to listen to while at home. 


  • Re-living the trauma in imagery may help you to gain control over the memories.

  • Thoughts may be less likely to pop up at a time you don’t want them to.

  • Flashbacks, nightmares and intrusive thoughts that many trauma survivors experience may occur less often.

  • After you re-live the trauma many times, memories may be less upsetting.

Individuals will be asked to take their recordings home with them to listen to them throughout the week.  By doing these steps a few things happen:

  • You may be able to process and make sense of the experience.

  • You may realize that thinking about a traumatic experience is not dangerous, and neither is being upset or anxious.

  • You may become less afraid of other situations that remind you of your trauma.

  • You may learn that you can handle your fear and anxiety and you feel better about yourself.

  • You may learn that when you confront memories or situations you have avoided, the fear and distress go down.

During in-vivo exposure, individuals are again asked to go to a place that will increase your anxiety and remain in that place until you are able to calm yourself.  This is started out slowly and then increased as you continue therapy. 


Neurofeedback is a type of therapy that maps the activity of the brain to understand how different patterns of activity might affect emotions and behavior.  It has been used to treat several common disorders such as ADHD, depression, anxiety, traumatic brain injury, and even stroke. 

During a neurofeedback session, sensors are placed on the scalp.  These sensors measure the electrical activity in certain parts of the brain.  This electrical activity is displayed on a computer, and a clinician uses the feedback to explain how changes in brain activity may relate to changes in thoughts and feelings.


Neurofeedback is a form of brain training developed to help people improve brain functioning.  Just as the body responds to physical training, it is hoped that learning to better regulate activity in certain parts of the brain will improve the regulation of thoughts and emotions.  As the process is painless, patients are excited to learn about one of the most complex organs of the human body–the brain. 

The strength of your brainwaves are measured through brain mapping.  Your brainwaves show how certain functions of the brain are operating and why we feel or act the way we do. 

This is a form of brain training developed to help people improve brain functioning.  A computer displays instant feedback that helps a person learn to control their brain activity.  The instant feedback guides the brain toward generating healthy brain activity.  Just as the body responds to physical training, the brain can be trained to change its activity in helpful ways.  As the process is painless, patients are excited to learn about one of the most complex organs of the human body—the brain.



  • Not harmful to the body

  • No medications

  • May work in persons when traditional therapy and medications have failed

  • Individuals have reported success in treating depression, anxiety and Attention Deficit Hyperactivity Disorder

  • Indications support successful treatment for treating Post Traumatic Stress Disorder and Autism

  • Successful in treatment of health concerns such as traumatic brain injury, stroke, pain disorder, chronic fatigue, seizure disorders and sleep disorders

  1. Stroul, B., Blau, G., & Friedman, R. (2010). Updating the system of care concept and philosophy. Washington, DC: Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children’s Mental Health.

  2. Landa, Y., Mueser, K. T., Wyka, K. E., Shreck, E., Jespersen, R., Jacobs, M. A., Griffin, K. W., van der Gaag, M., Reyna, V. F., Beck, A. T., Silbersweig, D. A. and Walkup, J. T. (2016), GF-CBT for youth at risk for psychosis. Early Intervention in Psychiatry, 10: 511-521. doi: 10.1111/eip12204

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This project, publication/report/etc. was developed [in part] under grant number 1H79SM063402-01 from the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). The views, policies, and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA or HHS.

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