What Works : System Development Strategies Across Communities (original) (raw)
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Defining Community Readiness for the Implementation of a System of Care
Administration and Policy in Mental Health and Mental Health Services Research, 2009
Developing systems of care for children with emotional disorders requires changes in the organization and delivery of services. Using concept mapping, the authors conducted a study to define factors of a community's readiness to make such changes. Participants were from 25 of 27 federally-funded, advanced sites, plus a panel of experts. The participants completed three tasks: brainstorming, rating, and sorting. This process produced eight factors: Leadership, Network of Local Partners, Shared Goals, Collaboration, Families and Youth as Partners, Accountability, Evaluation, and Plans to Expand Services. Understanding factors that contribute to successful implementation should help communities identify and make needed changes.
Levels of System of Care Implementation: A National Benchmark Study
The Journal of Behavioral Health Services & Research, 2011
The results of a survey to measure the implementation of the systems of care (SOC) approach in a nationally representative sample of counties are presented. The results from 910 informants within 225 counties reveal a moderate level of implementation of SOC factors, with the level of poverty and population size influencing implementation. Furthermore, mental health informants generally tended to rate the implementation of systems of care greater than administrators associated with the school system, other family serving agency personnel or family members. Family members and school personnel tended to rate the implementation lowest, while staff from the other child serving agencies tended to rate the implementation closer to mental health administrators. A quarter of the counties (26%) surveyed rated themselves as having adequate levels of implementation on 11 or more of the 14 factors, while 75% rated themselves as having adequate levels of implementation on six or more of the 14 factors measured. Implications for federal policies regarding systems of care implementation are discussed. Levels of System of Care Implementation Since the early 1980s, when leaders in the field of children's mental health, including policy makers, practitioners, researchers, and advocates, began to make systems of care for children with serious emotional disturbances a national priority, much attention and interest have been paid to
Impact of a System of Care on a Community's Children's Social Services System
Journal of Child and Family Studies, 2005
We examined the impact that the Dawn Project system of care had on children's services in Marion County, Indiana. A series of semi-structured interviews were conducted in order to gain a broad understanding of stakeholder perspectives related to how system-level and other community leaders viewed system of care influences. Qualitative analyses uncovered several common themes including positive impact at the community level, challenges to implementation, and feelings of ambivalence related to program impact. Results were generally positive and suggested that most respondents saw core system of care principles beginning to emerge within the community related to the establishment of the care system. In addition, challenges to implementing the system of care also were uncovered, including some underlying resistance to system-level changes. Implications from our study highlight the importance of continuously working to enhance strengths and collaboration among systems, integrate and coordinate across systems and services, and authentically involve families at all levels.
Evaluating systems of care: Missing links in children's mental health research
Journal of Community Psychology, 2004
Systems of care (SOCs) have been developed throughout the country to meet the needs of children with severe emotional disturbances (SED) and their families. In these SOCs, multiple agencies and disciplines are expected to work together with informal community supports to address families' needs . A review of the literature on the impact of SOCs suggests: (a) communities' service delivery systems change; and (b) children experience modest improvements in symptomatology and functioning. At the same time, little is known about (a) which components of the SOC approach, at what levels, are necessary to impact child and family outcomes; (b) the degree to which SOCs affect other family members, beyond the target child; and (c) the impact of community contexts and supports in SOCs. Future research should improve measurement of key SOC constructs, examine the relation between specific levels of implementation and outcomes for the entire family, and investigate the impact of broader community systems and supports on families within SOCs.
The Journal of Mental Health Administration, 1996
In a previous article, rationale and procedures were presented for a model needs assessment of community-based services for children and youth with emotional and behavioral disorders and their families. In this article, the authors describe initial needs assessment planning activities, examine the implementation of the proposed model, provide a general overview of the results, and review how the community that conducted the assessment used the information to identify system development priorities and action plans. Quantitative data are provided on the population demographics and parent and direct service provider surveys. Qualitative data are presented on the semistructured interviews with key stakeholders and direct service providers.
Components of a System of Care: What Does the Research Say?
This document presents a review of recent research literature on eight components in a system of care for children with serious emotional disturbances. It is intended to be a guide and source of information to communities for building systems of care. Components include: residential services (psychiatric hospitals and residential treatment centers), outpatient services (psychotherapy), day treatment services, family preservation services, therapeutic foster care, crisis and emergency services, case management/individualized care, and family support services. The review of each component consists of definitions, summaries of outcome and empirically based efficacy studies, cost-effectiveness data, and (for most components) research needs. Generally, only studies published since 1988 were included. (Each chapter contains references.) (JDD)
Applied and Preventive Psychology, 1997
This article examines research on systems of care, which are acknowledged as the current dominant paradigm in the delivery of children's mental health services. The authors conclude that systems of care produce important systemlevel changes. Early results suggest that these systems changes do not impact clinical outcomes, however. One plausible explanation for this finding is that system interventions are too far removed from the actual delivered services, thereby limiting their potential impact. Moreover, numerous assumptions underlying the purported effectiveness of systems of care remain unvalidated. The authors propose that the primary direction to improving children's mental health services should be through effectiveness research, in contrast to continued large-scale investments in systems research and development. Recommendations are made for addressing methodological problems that researchers will confront and for developing policies encouraging future research on the effectiveness of children's mental health services.