OBJECTIVE: This study compared six-month functional and symptom outcomes of children and adolescents with serious emotional disturbance who received services in an exemplary system of care with outcomes of children who received traditional care. The system of care offers a comprehensive and coordinated network of mental health and other necessary services. METHODS: The study used a randomized longitudinal experimental design. Baseline data on symptoms, functioning, and family characteristics were collected from 350 families selected from among those who sought services for children from community agencies in Stark County, Ohio. The families were randomly assigned to either the experimental group, which received services from the system of care, or the control group, which received usual care in the community. Six- month outcome measures of children's symptoms and functioning were compared for the two groups. RESULTS: Although access to care and the amount of care received increased under the system of care, no differences in clinical or functional outcomes were found between the group served in the system of care and the group who received usual care. CONCLUSIONS: The effects of systems of care are primarily limited to system-level outcomes such as access to and cost of care and do not appear to affect clinical outcomes such as functioning and symptoms.