The article discusses two systems-level changes in the organization and financing of mental health and child welfare services that will increasingly affect abused and neglected children: the implementation of managed care processes and the incorporation of accountability mechanisms in the management of mental health and child welfare services, particularly the use of systematic outcomes assessments. The paper attempts to identify critical research questions which will help clarify the impact of these changes on maltreated children. It is critical that mental health clinicians and child welfare practitioners contribute to the development of managed care and outcomes systems and effectively advocate for children and families to counteract the current emphasis on cost. Otherwise, stakeholders without clinical experience may be designing the next generation of services for maltreated children. Payors and managed care organizations that fund and organize services for maltreated children must be held accountable for the effects of their systems-level interventions. References