Research in Progress

The mission of the Research and Training Center for Children’s Mental Health has been to increase the effectiveness of service systems by strengthening the empirical base for such systems through research and dissemination to key audiences. With its new, five-year research program, the Center expands its mission with an integrated research, training, and dissemination program targeted specifically at implementation issues for developing effective systems of care.

The Center’s new research program consists of six interrelated studies designed to produce knowledge about the development and implementation of effective and integrated systems of care for children and adolescents with serious emotional disturbances and their families. The studies have the potential to add important new knowledge about systems of care, and for adding knowledge important to our primary intended audience—state and local policy makers. The studies also will add knowledge that will likely result in a change in policy and/or practice that will benefit children and families.

Given the focus on a system of care as a complex system in which all of the key components are interrelated and consistent with systems theory, the research of the Center will be holistic, integrated, and pattern focused. Even when specific components of the overall system are the major focus of particular studies, these components will be viewed as part of a complex adaptive system, and in a community context.

The Center consulted with representatives of family organizations, state and local policy makers, and system of care researchers when designing these studies. The Center also drew from the literature not only in the traditional mental health fields and systems theory but also from fields such as anthropology, business administration, education, public administration, and public health. This participatory approach will enrich and strengthen the studies, and increase their responsiveness to the needs of the primary audiences for whom the research is intended. Research findings for each study will be disseminated rapidly, in varying formats, to their appropriate audience.

The studies are:

  • Study 1: National survey of systems of care implementation
  • Study 2: Holistic approaches to studying community-based systems of care
  • Study 3: Financing structures and strategies to support effective systems of care
  • Study 4: The school-based mental health services study
  • Study 5: Accessibility of mental health services: Identifying and measuring organizational factors associated with reducing mental health disparities
  • Study 6: The family voice study: Assessing the role of family organizations in developing family voice in systems of care

The first two studies will take a comprehensive look at how communities are implementing factors theorized by the Center to contribute to effective systems of care (see Study 1 for a list of these factors). The first study is a quantitative study, and will investigate the status of system of care implementation by systematically gathering survey data from a sample of 300 counties across the country. This survey will provide a valuable benchmark in terms of the status of the field, but is not designed to provide in-depth information on any particular community.

Using a multiple-case embedded case study design, the second study will provide an in-depth and holistic view of implementation factors and outcomes in 10 established System of Care communities around the country.

Studies 3-6 will take an in-depth look at particular implementation factors while maintaining a systemic and contextual perspective of those factors. The Center’s theory of how each of these factors operates will be elaborated upon and tested in a variety of ways. Respectively, the four factors to be examined in studies 3-6 are: (a) financing policy and practices, (b) collaboration, particularly between mental health and the schools, (c) access to high quality and effective care for children from racial/ethnic minority groups and their families, and (d) family voice and involvement.

Studies 3-6 also will contribute to the design and data collection methods used in Studies 1 and 2. While certain methods will be used widely, such as interviews of key informants, other methods will be unique to particular studies, such as a natural experiment in Study 4, the use of concept mapping in Study 5, and a social network analysis in Study 6.

The Center believes that effectiveness research, while it can take many forms, must ultimately include at least the following features:

  • a comprehensive description of the intervention, not as it was intended to be implemented, but as it is actually implemented for a particular population or system of care;
  • a thorough description of the population served and the broader socio-cultural, economic, and geographic context in which the intervention has been applied;
  • a theory of change that links the intervention with the intended outcomes;
  • a set of outcome indicators based on the theory of change; and
  • a strategy for ruling out alternative explanations for the outcomes, and for making at least a plausible case that the outcomes are linked to the intervention.

These six integrated research projects are designed, in the short run, to enhance knowledge about implementation of effective systems of care and, in the long run, to make it possible for children with serious emotional disturbances to live, learn, work, and thrive in their own communities.

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