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Defining Community Readiness for the Implementation of a System of Care

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Abstract

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.

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Notes

  1. Concept mapping analysis and results were conducted using The Concept System© software: Copyright 2004–2007; all rights reserved. Concept Systems Inc.

  2. The first three of these sites are funded by the Center for Mental Health Services, Child, Adolescent and Family Branch; the three sites in Florida are funded by Health Resources and Services Administration, Maternal and Child Health Bureau.

  3. High ratings indicate that a statement is highly important and most difficult to implement.

References

  • Behar, L. B. (1985). Changing patterns of state responsibility: A case study of North Carolina. Journal of Clinical Child Psychology, 14(3), 188–195.

    Article  Google Scholar 

  • Behar, L. B. (2002). Children’s mental health services: The challenge of changing policy and practice. In William. Reid & Stuart. Silver (Eds.), Handbook of mental health administration and management (pp. 149–162). New York, NY: Brunner-Routledge.

    Google Scholar 

  • Behar, L., Friedman, R., & Lynn, N. (2005). A study of service innovations that enhance systems of care. Selected readings in systems of care. Tampa, FL: The Research & Training Center for Children’s Mental Health, University of South Florida.

    Google Scholar 

  • Chinman, M., Inn, P., & Wandersman, A. (2004). Promoting accountability through methods and tools for planning, implementation, and evaluation. A technical report of the rand corp. Retrieved from www.rand.org/pubs/technical_reports/TR101/index.html.

  • Comprehensive Community Mental Health Services Program for Children and Their Families (2006). Child and Family Services Branch, the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, US.

  • Concept Systems (2006). The concept system, version 4.118. Ithaca, NY: Concept Systems Incorporated. Available at http://www.conceptsystems.com.

  • Department of Health and Human Services. (2006). The Comprehensive Community Mental Health Services Program for Children and Their Families. Retrieved from http://www.mentalhealth.samhsa.gov/cmhs/ChildrensCampaign/grantcomm.asp.

  • Edwards, R. W., Jumper-Thurman, P., Plested, B. A., Oetting, E. R., & Swanson, L. (2000). Community readiness: Research to practice. Journal of Community Psychology, 28(3), 291–307.

    Article  Google Scholar 

  • Fetterman, D. M., & Wandersman, A. (2005). Empowerment evaluation principles in practice. NY, USA: Guilford Press.

    Google Scholar 

  • Friedman, R. (2005a). Effective systems of care: A summary of implementation factors. Retrieved May 25, 2007 from University of South Florida, Florida Mental Health Institute Web site http://rtckids.fmhi.usf.edu/publications.html.

  • Friedman, R. (2005b). Transformation work group report. Retrieved April 10, 2008 from University of South Florida, Florida Mental Health Institute Web site http://rtckids.fmhi.usf.edu/publications.html.

  • Friedman, R. M., Greenbaum, P., Kutash, K., Boothroyd, R., & Wang, W. (2009). System of care implementation survey. Presentation at the 22nd Annual Research Conference, The Research and Training Center for Children’s Mental Health, University of South Florida, Tampa, FL.

  • Graham, A. L., Kerner, J. F., Quinlan, K. M., Vinson, C., & Best, A. (2008). Translating cancer control research into primary care practice: A conceptual framework. American Journal of Lifestyle Medicine, 2(3), 241–249.

    Article  Google Scholar 

  • Greene, J. C., & Caracelli, V. J. (Eds.). (1997). Advances in mixed-method evaluation: The challenges and benefits of integrating diverse paradigms. New directions for program evaluation (Vol. 74). San Francisco: Jossey-Bass.

    Google Scholar 

  • Hodges, S., Ferreira, K., Israel, N., & Mazza, J. (2007a, January). Lessons from successful systems. Retrieved June 6, 2008, from University of South Florida, Florida Mental Health Institute Web site from http://rtckids.fmhi.usf.edu/publications.html.

  • Hodges, S., Ferreira, K., Israel, N., & Mazza, J. (2007b, February). Locally identified factors for systems implementation. Retrieved June 6, 2008, from University of South Florida, Florida Mental Health Institute Web site http://rtckids.fmhi.usf.edu/publications.html.

  • Joint Commission on Mental Health of Children, Inc. (1969). Crisis in child mental health: Challenge for the 1970’s. New York, NY: Harper & Row.

    Google Scholar 

  • Kane, M., & Trochim, W. M. K. (2007). Concept mapping for planning and evaluation. Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  • Knitzer, J. (1982). Unclaimed children. Washington, DC: Children’s Defense Fund.

    Google Scholar 

  • Lourie, I. S. (2002). A history of community child mental health. In A. J. Pumariega & N. C. Winters (Eds.), The handbook of child and adolescent systems of care (pp. 1–17). San Francisco, CA: Jossey-Bass.

    Google Scholar 

  • Manteuffel, B., Katana, P., Petrila, A., Rosales-Elkins, D., & Stroul, B. (2006, July). Effective strategies for sustaining systems of care: Lessons learned. Presentation at the National Training Institutes, Orlando, FL.

  • Manteuffel, B., Stephens, R. L., & Santiago, R. (2002). Overview of the national evaluation of the Comprehensive Community Mental Health Services for Children and their Families Program and summary of current findings. Children’s Services: Social Policy, Research and Practice, 5(1), 3–20.

    Google Scholar 

  • New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Rockville, MD: Department of Health and Human Services. (Final report).

    Google Scholar 

  • Novak, J. D. (1998). The nature of knowledge and how humans create knowledge. In J. D. Novak (Ed.), Learning, creating, and using knowledge: concept maps as facilitative tools in schools and corporations (pp. 79–111). Mahwah, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Osher, T. W., & Huff, B (2007, October). Family driven care and practice system self assessment tool. Presentation to the Colorado House Joint Resolution 07-1050 Task Force, Denver, CO.

  • Padgett, S. M., Bekemeier, B., & Berkowitz, B. (2005). Building sustainable public health systems change at the state level. Journal of Public Health Management & Practice, 2, 109–115.

    Google Scholar 

  • Rosas, S. (2008, March). Concept mapping and scale development. Presentation to Concept Systems Research Association. Ithaca, NY.

  • Stroul, B., & Friedman, R. M. (1986). A system of care for children and youth with severe emotional disturbances. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center.

    Google Scholar 

  • Stroul, B., & Friedman, R. M. (1996a). A system of care for children and youth with severe emotional disturbances. Washington, DC: Georgetown University, Child Development Center, CASSP Technical Assistance Center. (Revised edition).

    Google Scholar 

  • Stroul, B., & Friedman, R. (1996b). The system of care concept and philosophy. In B. Stroul (Ed.), Children’s mental health: Creating systems of care in a changing society (pp. 3–21). Baltimore: Paul H. Brookes.

    Google Scholar 

  • Trochim, W. (1989a). An introduction to concept mapping for planning and evaluation. Evaluation and Program Planning, 12, 1–16.

    Article  Google Scholar 

  • Trochim, W. (1989b). Concept mapping: Soft science or hard art? Evaluation and Program Planning, 12, 87–110.

    Article  Google Scholar 

  • Trochim, W. (1993, November). Reliability of concept mapping. Presentation at the annual conference of the American Evaluation Association, Dallas, TX.

  • Trochim, W., & Linton, R. (1986). Conceptualization for evaluation and planning. Evaluation and Program Planning, 9, 289–308.

    Article  CAS  PubMed  Google Scholar 

  • Trochim, W., Milstein, B., Wood, B. J., Jackson, S., & Pressler, V. (2003). Setting objectives for community and systems change: an application of concept mapping for planning a statewide health improvement initiative. Health Promotion Practice, 8, 1–12.

    Google Scholar 

  • US Department of Health and Human Services. (1999). Mental health: A report of the surgeon general. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.

    Google Scholar 

  • Wandersman, A. (2009). System of care values in research and evaluation. Presentation at the 22nd Annual Research Conference, The Research and Training Center for Children’s Mental Health, University of South Florida, Tampa, FL.

Download references

Author information

Authors and Affiliations

  1. Child and Family Program Strategies, 1821 Woodburn Rd., Durham, NC, 27705, USA

    Lenore B. Behar

  2. Hydaker Community Consulting, Cullowhee, NC, USA

    William M. Hydaker

Authors
  1. Lenore B. Behar
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  2. William M. Hydaker
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Corresponding author

Correspondence to Lenore B. Behar.

Additional information

This report was developed under Contract 280-03-4200, Task Order Number 280-03-4200, funded by the Child, Adolescent and Family Branch, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, United States Department of Health and Human Services. The contents of this document do not necessarily reflect the views or policies of the funding agency and should not be regarded as such. A full report of the findings is available from the authors.

Appendix

Appendix

Highest Three Statements per Cluster Rated by Difficulty of Implementation and ImportanceFootnote 3

Cluster 1: Families & Youth as Partners

  • Families are provided with support and training so that they can participate fully and comfortably in system of care planning, implementation, oversight, and evaluation.

  • There needs to be training and support to help teach and educate families and professionals how to work together and respect and value each other’s expertise.

  • Families are willing to take on a lead role in taking vision to reality.

Cluster 2: Plan to Expand Services

  • It is important to have well trained culturally competent flexible personnel.

  • The community should dedicate sufficient resources to support cultural and linguistic proficiency.

  • Communities need to be provided with training and/or examples of what following the values and principles of the system of care might look like to see what a shift in thinking and practice it really is from how they currently serve children and families.

Cluster 3: Evaluation

  • The applicant should fully understand the magnitude of the evaluation component and the importance of data driven services.

  • Develop a method of sharing real time useful information to identify important system trends and to provide the requisite information for data based decision making.

  • There needs to be an understanding of and buy-in of the use of the research to help address what is working and what can be improved at in the community.

Cluster 4: Collaboration

  • The community partners have a willingness to share resources: knowledge, staff, dollars, understanding that it is through joint investment that joint success is achieved.

  • There needs to be a strong trusting working relationship among all collaborating parties.

  • Partners essential to the system of care must be fully on board and officially on board.

Cluster 5: Network of Local Partners

  • All community partners must work collaboratively to include strong parental engagement, blended and flexible funding, and shared success and liability.

  • An advisory or leadership board should be established that has at least 1/3 parent participation and they should have input on the writing of the proposal.

  • Make sure everyone—community partners, leaders, families, youth—understand the principles on which the new system will be built and share them, share the same values.

Cluster 6: Shared Goals

  • All community partners have a clear understanding of the required investment, and similar expectations regarding the Return of Investment (ROI).

  • There should be involvement of key budget staff to work with partners on funding issues, requirements, restrictions, and how to resolve the issues

  • Develop a process to better understand the realities of each of the major stakeholders so system change can occur by devising win–win situations rather than relying on good will alone.

Cluster 7: Accountability

  • There should be an understanding of blended or braided funding and the willingness among the community agencies to share resources.

  • It needs to be understood that sustainability of services developed should be part of the discussions beginning in the 1st year not waiting until the end.

  • There should be an agreement to share information across child-serving systems.

Cluster 8: Leadership

  • The concept of permanent system change needs to be understood and accepted as the end goal.

  • There must be a commitment from state and local policy makers and funders of services to participate in developing a viable system of care and revamping how services are provided and funded.

  • State and/or county support is needed—not only to support the proposed service delivery changes, but to support/allow flexibility for larger system change initiatives (proposed changes in funding structure, for example).

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Behar, L.B., Hydaker, W.M. Defining Community Readiness for the Implementation of a System of Care. Adm Policy Ment Health 36, 381–392 (2009). https://doi.org/10.1007/s10488-009-0227-x

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