Lyons goes on to propose a vision of how to manage the tensions, emphasizing a commitment to prevention and service system management strategies. In this chapter he touches on the concepts of the youth's and the family's voice in the system of care. With this analysis he builds a foundation for his concept of total clinical outcome management. He devotes a chapter to an expansion of the variables that impinge on children's mental health by discussing many social factors that are critical to building healthy communities and then proposes innovative strategies for mobilizing communities to create jobs and take charge of social institutions, allowing all parents and youths to feel ownership in their communities. He presents his vision of total clinical outcome measurement with an erudite discussion of the dilemmas of program evaluation and proposes models of measurement that are comprehensive, standardized, and manageable. In this section he promotes his Child and Adolescent Needs and Strengths instrument for children and youths with mental health challenges (CANS-MH), the manual for which is included in the appendix. Finally he looks at the implications of applying total clinical outcome measurement to existing elements of the service system and to an evolving system of care. In this last section he touches on the role of families in systems of care generally as well as in the specific process of outcome management.