For the past 20 years, especially since the introduction of system-of-care philosophy and practices, there have been tensions between community-based and residential treatment providers that serve children, youths, and families in need of mental health care. Community-based mental health providers have voiced concern that their residential treatment colleagues keep children too long and fail to demonstrate the effectiveness of their services. Residential treatment providers have asserted that their community-based colleagues do not collaboratively support their efforts, assist with discharge planning, or provide intensive service options as necessary follow-up. Families and youth have often expressed mixed reactions and opinions about both sets of mental health providers, asking that all providers become more family driven and youth guided and encouraging them to create a more integrated array of services.

In this climate, made all the more complex as systems vie for limited resources, a group of residential and community-based mental health treatment providers, policymakers, families, and youths, under the auspices of the Center for Mental Health Services, began a dialogue in the fall of 2005 to discuss ways to improve relationships and practice. The result was the initiative now known as "Building Bridges."

From this dialogue, a group of national leaders in the field of children's mental health participated in the first Building Bridges summit in June 2006. Inspired by compelling youth and family voices, summit participants drafted and signed a joint resolution of common principles and a shared commitment to a comprehensive, flexible, individualized, strength-based, family-driven, and youth-guided array of culturally and linguistically competent services and supports. More than 20 national mental health organizations and 19 agencies have since endorsed the joint resolution.

Building Bridges calls for restructuring the relationships among residential mental health treatment and community-based providers, families, and youths. The paradigm promotes shared responsibility and shared commitment, regardless of service needs or treatment setting. Accordingly, post-summit activities included identifying residential treatment programs and communities across the country that are implementing innovative practices consistent with the principles of the joint resolution, and seeking input from families and youth about what they consider effective practices.

Among the many promising practices embraced by Building Bridges, the use of child and families teams is fundamental. Teams use a wraparound process that gives treatment planning and service delivery a sense of purpose and accountability. CFTs bring together the expertise of residential treatment and community-based providers and capitalize on the strengths of youth and families as part of a long-term recovery-oriented plan.

Residential treatment programs and their community partners across the nation are improving their efforts to ensure that treatment is family driven and youth guided by implementing practices advocated by Building Bridges such as CFTs; hiring family and youth advocates; developing youth and family advisory councils; providing education and support to increase self-advocacy skills; integrating cultural and linguistic competence; and implementing trauma-informed care, thereby reducing the need for restraint and seclusion.

Advocates and policymakers are recognizing that residential treatment is part of the service array and that coordination and collaboration are essential to improving outcomes.

Below are some ways in which community and residential treatment providers can support the work of Building Bridges:

Establish relationships and dialogue across all constituent groups, including families, youths, community-based mental health providers, residential treatment providers, advocates, and policymakers.

Develop protocols and practices to make entry into residential treatment and the transition back to the community a seamless, supportive, and coordinated process.

Support youths and families during their time in residential treatment programs with participation in community-based mental health programs and support services, thereby facilitating timely and smooth transitions home.

Continue to implement trauma-informed, family driven, youth guided, culturally and linguistically competent and evidence-based practices.

Support the development of and become active members of child and family teams.

Convene meetings and dialogues among constituencies to promote conversations about Building Bridges.

In September 2007, a second summit reinforced the initiative and set an agenda to promote reform across the country. Several workgroups were created, and several products have been developed or are in development: a document on innovative best practices in linking community-based and residential treatment services, a matrix of performance guidelines and indicators, a self-assessment tool for residential treatment and community providers, family and youth "tip sheets," and research to identify needed fiscal and policy reforms. Plans are underway to continue the important work of this initiative and bring the principles of Building Bridges to a national scale. By collaborating as partners, we can ensure that children, youths, and families thrive.