values driven systems of care: the bc scores experience

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

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).

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

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)

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.

The needs of the child are identified and the family dictates the types and mix of services provided.

Youth Guided &

Family Driven

Agencies, programs, and services are responsive to the cultural, racial, and ethnic differences of the populations they serve.

Culturally Compete

nt

The location of services and decision-making responsibility is at the community level.

Community Based

Core ValuesCore Values

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.

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?

MethodologyMethodologyOnline survey of providers

◦Administrators and staffOnline and paper surveys of

parents and youthProvider Focus GroupsFamily Focus Groups

64 individuals completed the survey60% female / 40% male73% Caucasian / 27% Black44% director or supervisor / 56% staff

Administrators & Staff Administrators & Staff SurveySurvey

Administrators & Staff Administrators & Staff SurveySurvey

Survey Results: Survey Results: Administrators & Staff Administrators & Staff

Survey Results: Survey Results: Administrators & Staff Administrators & Staff

Survey Results: Survey Results: Administrators & Staff Administrators & Staff

Survey Results: Survey Results: Administrators & Staff Administrators & Staff

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

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%

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

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

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

Family & Youth SurveyFamily & Youth Survey35 individuals completed the survey68.6% female/31.4% male51.9% Caucasian/48.1% Black

Survey Results: Families & Survey Results: Families & YouthYouth

Survey Results: Families & Survey Results: Families & YouthYouth

Survey Results: Families & Survey Results: Families & YouthYouth

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%

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

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

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

Comparison of Survey Comparison of Survey ResultsResults

Comparison of Survey Comparison of Survey ResultsResults

Comparison of Survey Comparison of Survey ResultsResults

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

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.

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.

QuestionsQuestions