In 1991, pointing out the benefits of a more decentralized and integrated service system for children and families in this country, we wrote, "Perhaps it is idealistic to expect the country can create a new and vital service system during the next 10 to 20 years."1 We nevertheless expressed the hope that there would be "bold and systemic change in the way services are provided."
The 2 years since our piece was written constitute a fifth of the minimum amount of time that we allotted for our hope of genuine change to come to fruition. It also happens that those 2 years have witnessed fiscal constraints at all levels of government that have been significantly more severe than the ones that formed the backdrop to our piece in 1991. To a degree fiscal necessities create incentives for agencies and systems to work collaboratively, but as we also wrote, "changing service
Blum BB, Blank S. Children's Services in an Era of Budget Deficits. Am J Dis Child. 1993;147(5):540. doi:10.1001/archpedi.1993.02160290046023