Research Agenda

Study 1: National Survey of Systems of Care Implementation

This study is noteworthy both for taking an in-depth look at systems of care and the context in which they operate, and for taking a comprehensive, holistic look at every factor that the Center believes are related to the implementation of effective systems of care (see below). Currently, there are no national data available on the overall status of community-based systems of care, or on the degree to which the Center’s proposed systems-of-care factors are being applied within communities. Without such data, it is difficult to assess progress or deterioration in efforts to implement effective systems of care, or to know how to target information and technical assistance in order to strengthen systems of care. With such information, the ability to provide meaningful assistance to communities in the development and implementation of their systems of care is greatly enhanced. Therefore, the main purpose of this study is to provide the first and only national data on system of care implementation in a disproportionate stratified probability sample of 300 counties across the United States.

The theoretical framework guiding each study includes the following 13 implementation factors believed to contribute to effective systems of care; the current study assesses the distribution and mean level of these factors at the national, community, and Center levels:

  • Transformational leadership
  • Strong foundation in the values/principles of systems of care
  • A clear description of the local population of concern
  • A clear and widely held theory of change
  • Implementation plan
  • A plan for interagency and cross-sector collaboration
  • A comprehensive financing plan
  • Clear outreach mechanisms and pathways to care
  • Families provided with choice and voice
  • Individualized, culturally competent and comprehensive treatment approaches
  • A skilled provider network
  • Performance measurement system
  • Accountability system at the provider level

At the national level, the study will assess the extent to which the above implementation factors are being followed, and the relationships among them. Where possible, identification of which factors are associated with which functional indicators of system performance will be assessed. The new knowledge generated by this study can help guide efforts to improve systems of care implementation.

  • At the local community level, the study will provide a self-diagnostic tool for administrators and policymakers to assess the level of implementation of factors for their systems of care, and make possible meaningful local comparisons with national and similar peer community data. At the Center level, study results will be used to facilitate site selection, and issues and research questions for other Center studies. Sites that are found to fall within the upper and lower quartiles of the distributions of implementation factors will provide an initial pool of potential sites for the explanatory case studies in Study 2.
  • Functional outcomes for the children also will be assessed. These outcomes will be measured at the community- or system-wide level versus the program or individual-level because the effectiveness of systems of care must be considered for all of the children that the system serves.
  • Specific functional outcomes that will be measured include:
  • the proportion of children in out-of-home placements;
  • the proportion of enrolled children who are arrested and subsequently involved with the juvenile justice system; and
  • the proportion of children with mental health needs who are receiving services.

Data from the survey will provide a baseline for the Center to use in evaluating its impact. In the last year of the Center grant, the survey will be repeated, and those results will provide a measure of the changes implemented nationally, and will be a measure of the impact of the Center during this five-year period. By presenting data on the status of counties with regard to implementation factors, results can help identify needs in the field, and guide dissemination and technical assistance efforts. Findings will also provide a baseline for assessing changes in implementation status, and for selecting counties for inclusion in other Center studies. Further, the study will provide a foundation for additional research on the relationship between implementation factors and outcomes.

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