Systems of Care: Care Management Organizations of New Jersey

Objective: Monmouthcares and Atlantic Cape INK aim to stabilize the behavioral health needs of children and youth to keep them at home and in their communities. Monmouthcares aims to support and partner in planning with families and their children, so that goals of being successful at home, in school and in the community, are reached.

Description: MonmouthCares, Inc., is a private non-profit agency that is part of the New Jersey Division of Children’s System of Care (DCSC). They are a Care Management Organization that uses a wraparound model to help children and families.

The program addresses fragmentation of services, family leadership, sustainable community supports, gaps in services, and creating partnerships of child serving systems. The program supports family, youth leadership and culturally competent provision of care coordination through a Child and Family Team process to develop an Individualized Service Plan. The agency assists families with building Child and Family Teams that help families both identify strengths and develop strategies to meet their needs.

Cape Atlantic I.N.K. (Integrated Network for Kids) is a non-profit Care Management Organization that facilitates and coordinates care for children with the most complex emotional and behavioral needs in Atlantic and Cape May, New Jersey counties.

Children and adolescents are referred through a centralized access route operated by PerformCare, the Contracted System Administrator, designated by the NJ Division of Children’s System of Care to authorize services for children in need of mental health care. Through meetings coordinated by Cape Atlantic I.N.K., the members of the support network, the Child Family Team, develop an Individualized Service Plan. This ISP is based on the acknowledged strengths, needs, and interests of the child, his or her family, extended family and community. The CFT members are identified by the child and family with the support of the Care Manager. Team members can be a coach, a therapist, a neighbor, a relative, your faith-based provider, or a friend. The CFT provides a foundation for growth and sustainability for the young person.

The agency allows flexible scheduling, as well as working in the neighborhoods, homes, churches etc. better meets the needs of all. Hiring from the community, partnering providers with peers to support the African American community benefits engagement and enrollment of African American Community members. Also, free training is offered to all staff and families, together. Transparency, family orientation, and flexible schedules – to be in the community and meet the needs of families – have proven successful. Peers are paid employees of partnering family organization.

The System of Care is statewide with 15 local systems of care serving all 21 counties in New Jersey. Each local system is comprised of similar elements:

  • A statewide Contracted Systems Administrator (PerformCare),
  • A Care Management Organization that serves youth with a wide range of needs,
  • Mobile Response and Stabilization Services,
  • A Family Support Organization and local providers of mental health/supportive services.

Results/Accomplishments/Evidence: MonmouthCares is very successful in enrolling families and children in NJ Family Care — they have a greater than 94% success rate. View data, as it relates to NJ’s System of Care.

Population of Focus: Adolescents, Adults, Black or African American, Children, Elderly, Employees/staff, Hispanic or Latino, Homeless, Immigrants, Incarcerated/formerly incarcerated, Indigenous, Limited English Proficient, Migrant workers, Military/Veterans/Military families, Refugees, Sexual and gender minorities, Transition aged, White, Women

Setting: Community center, Community health center, Suburban

Level of Intervention: City, Community, County, Family, Individual

Background: Historically, systems of care have focused on improving access to and availability of services and on reducing service and funding fragmentation. In addition, systems of care have focused on improving the skills, knowledge, and attitudes of frontline service providers. Increasingly, systems of care are concerned about “treatment efficacy,” ensuring effective therapeutic interactions between practitioners and children in care and their families (Pires, 2002) and system reform.

The systems of care approach was originally created in response to concerns that:

  • Children in need of mental health treatment were not getting the services they needed
  • Services were often provided in restrictive out-of-home settings
  • Few community-based services were available
  • Service providers did not work together
  • Families were not adequately involved in their child’s care
  • Cultural differences were rarely taken into account (Stroul, 1996)

The systems of care approach is now being applied to other target populations who depend on public systems for services, including children, youth, and their families in the child welfare system.


Linda Havens, Director
MonmouthCares, Inc. Unified Care Management Org
185 Hwy 36, West Long Branch, NJ 07764

Alan Destefano, Executive Director
Cape Atlantic Integrated Network for Kids
200 South Shore Road Unit 4, Marmora, NJ 08223