values driven systems of care: the bc scores experience children’s mental health research and...
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Values Driven Systems of Values Driven Systems of Care: the BC SCORES Care: the BC SCORES ExperienceExperience
Children’s Mental Health Research and Policy Conference
March 22, 2011
Holly Wald, PhD, Cynthia Zubritsky, PhD, Nancy Jaquette, LSW, Cecilia Mitchell, MSW
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BackgroundBackgroundSystems of Care have become a
foundation for many mental health systems,
Questions abound as to the degree to which communities implement these core values and the subsequent impact of these values on systems, communities and youth and families (Cook & Kilmer, 2004).
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Key Assumption Regarding Key Assumption Regarding System of CareSystem of Care
Behavioral health services for youth delivered in adherence to core values will promote positive outcomes
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Challenges in Assessing Adherence to Challenges in Assessing Adherence to Core ValuesCore Values
Variation in interpretation and operationalization of core constructs across communities
Widespread acceptance of SOC core values has resulted in a general acceptance of SOC elements (Stroul & Blau, 2010)
Studies have relied solely on family and provider reports of adoption and adherence (Brennan et al., 2002)
Low levels of inter-rater reliability in interviews (Hernandez et al., 2001)
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Core Value InterestCore Value InterestBC SCORES stakeholders were
interested in the extent of the adoption of these SOC core values by system partners, providers and community organizations and youth and family members.
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The needs of the child are identified and the family dictates the types and mix of services provided.
Youth Guided &
Family Driven
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Agencies, programs, and services are responsive to the cultural, racial, and ethnic differences of the populations they serve.
Culturally Compete
nt
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The location of services and decision-making responsibility is at the community level.
Community Based
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Core ValuesCore Values
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BC SCORESBC SCORES**Beaver County’s System of Care: Optimizing
Resources, Education and Supports)Targeting youth (10 to 21) who may be
involved with the legal system or who are experiencing disciplinary problems in school and have a mental health or co-occurring mental health and substance use disorder (COD).
Stakeholder interest in the extent of the adoption of these SOC core values by administrators and staff of providers and community organizations, as well as youth and family members.
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Key QuestionsKey QuestionsHave knowledge and attitudes of system
partners and providers related to core values changed when comparing perceptions prior to BC SCORES and currently?
Are there differences in perceptions of changes in core values when comparing types of organizations or type of respondent?
Have knowledge and attitudes of family and youth related to core values changed when comparing perceptions prior to BC SCORES and currently?
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MethodologyMethodologyOnline survey of providers
◦Administrators and staffOnline and paper surveys of
parents and youthProvider Focus GroupsFamily Focus Groups
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64 individuals completed the survey60% female / 40% male73% Caucasian / 27% Black44% director or supervisor / 56% staff
Administrators & Staff Administrators & Staff SurveySurvey
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Administrators & Staff Administrators & Staff SurveySurvey
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Survey Results: Survey Results: Administrators & Staff Administrators & Staff
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Survey Results: Survey Results: Administrators & Staff Administrators & Staff
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Survey Results: Survey Results: Administrators & Staff Administrators & Staff
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Survey Results: Survey Results: Administrators & Staff Administrators & Staff
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Survey Results: Survey Results: Administrators & StaffAdministrators & StaffComparison by Type of Comparison by Type of OrganizationOrganization
Behavioral Health
Juvenile Services
Children & Youth
Services
Other*
Before
Now Before
Now Before
Now Before
Now
Youth Guided & Family Driven
32.4% 54.3% 20.0% 50.0% 51.7% 67.5% 15.7% 72.5%
Culturally Competent 34.8% 73.5% 30.0% 55.0% 54.2% 59.1% 5.0% 71.4%
Community Based 20.7% 55.4% 12.5% 30.0% 45.9% 52.3% 0.0% 65.9%
Provider Specific Factors
30.3% 65.2% 22.5% 37.5% 47.9% 63.6% 16.3% 75.0%
*Other includes Schools, Family & Youth Service Agencies, & Community Organizations
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Survey Results: Survey Results: Administrators & StaffAdministrators & StaffComparison by PositionComparison by Position
Director/ Supervisor
Staff
Before Now Before Now
Youth Guided & Family Driven 26.2% 63.6% 31.8% 54.8%
Culturally Competent 28.6% 69.7% 32.3% 61.7%
Community Based 20.7% 62.1% 21.0% 43.3%
Provider Specific Factors 29.0% 68.1% 26.7% 55.8%
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Survey Results: Survey Results: Administrators & Staff Administrators & Staff
Community organizations indicated the greatest increase in the adoption of core values
Directors/Supervisors indicated seeing a greater increase in the adoption of core values than staff members
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Focus Group Results: Focus Group Results: Administrators & Staff Administrators & Staff
How changes in the System of Care How changes in the System of Care have Helpedhave HelpedCollaboration and communication has
improvedStaff listens to families – makes it
easier to engage themAgencies are more aware of natural
supports and natural supports are more aware of what agencies do
More families are able to get servicesFamilies have a lot more choicesTrainings have been very helpful
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Focus Group Results: Focus Group Results: Administrators & Staff Administrators & Staff
Areas in which Change is still Needed Areas in which Change is still NeededNeed to continue to improve
communication and broaden the scope of who’s included
Many organizations are similar and seem to be competing
Need more psychiatristsIn regards to marketing, need to make
sure everyone gets the informationMake sure information is presented in
a family friendly way
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Family & Youth SurveyFamily & Youth Survey35 individuals completed the survey68.6% female/31.4% male51.9% Caucasian/48.1% Black
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Survey Results: Families & Survey Results: Families & YouthYouth
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Survey Results: Families & Survey Results: Families & YouthYouth
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Survey Results: Families & Survey Results: Families & YouthYouth
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Survey Results: Family & Survey Results: Family & YouthYouthComparison by RespondentComparison by Respondent
Family Youth
Before Now Before Now
Youth Guided & Family Driven 45.7% 68.7% 50.0% 60.1%
Culturally Competent 35.8% 60.5% 53.6% 50.0%
Community Based 26.3% 61.8% 46.4% 65.0%
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Survey Results: Families & Survey Results: Families & YouthYouthThe greatest changes were
related to the values of Youth Guided & Family Driven and Community Based
Family members indicated a greater improvement than youth
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Focus Group Results: Families Focus Group Results: Families & Youth& Youth
How changes in the System of Care have How changes in the System of Care have HelpedHelpedGreater availability of services in the
communityFamilies communicate and help each
otherSystem of care has helped form linkages
between community-based providers◦Learn from each other ◦Refer to each other
Families are more aware of the services available to them
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Focus Group Results: Families Focus Group Results: Families & Youth& Youth
Areas in which Change is still NeededAreas in which Change is still NeededMore improvement related to
cultural competence is neededFamilies and youth need to have
more say and need to be listened toRecognize families as experts –
parents sometimes know what’s best for their child
More respect for families and youth
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Comparison of Survey Comparison of Survey ResultsResults
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Comparison of Survey Comparison of Survey ResultsResults
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Comparison of Survey Comparison of Survey ResultsResults
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Comparison of Survey Comparison of Survey ResultsResults
Providers indicated a greater increase in cultural competence
Families and youth indicated a greater increase in services being community based
Providers indicated a similar increase in the system of care being youth guided and family driven as families and youth
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Summary of ResultsSummary of ResultsThose involved in the System of Care are aware of
positive changes related to the Core ValuesResponses by providers show a 2 to 3 fold increase
in agreement with each of the Core ValuesFamilies and youth responses show, on average, a
20% increase in agreement with the Core Values Changes in the community based values highest
among community based service providers. Results of efforts to expand the inclusion of natural
supports to in the system of care may helped foster movement toward the adoption of system of care core values in the community based providers.
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Emerging IssuesEmerging IssuesCommunity based entities exhibit the
greatest increase over time on adoption of core values across all indicators.
Administrators consistently rated awareness and implementation of indicators for each of the core values higher than staff.
For provider specific responses, a lower percentage of survey respondents indicate regular provision of core values to families, provision of vision and mission statement to families, and inclusion of system of care core value into policies and procedures.
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QuestionsQuestions