Study 2: Case Studies of System Implementation: Holistic Approaches to Studying Community-based Systems of Care

The systems of care concept has been described as an explicit organizational philosophy that is intended to create and provide access to an expanded and coordinated array of community-based services and supports for children with serious emotional disturbance and their families. Although systems of care have been found to positively affect the structure, organization and availability of services, the implementation of systems of care is significantly challenged by a lack of research on the factors that contribute to system development and how these factors interact to establish well-functioning systems.

This study investigated how system implementation factors, considered holistically and in relation to one another, contribute to the development of systems of care, and tested the Center's theoretical premises about systems of care implementation. Rather than focusing on any one implementation factor, the study team conducted a holistic investigation of how system implementation factors are organized in relation to one another. This holistic approach will contribute to knowledge about how local systems-of-care communities achieve outcomes for children with emotional and behavioral problems and will advance efforts to serve this priority population and will provide a better understanding of effective theories of change for systems of care.

The research questions related to this study were:

  • How do local communities use the systems of care implementation factors to achieve outcomes for a local population of children with serious emotional disturbance?
  • Are system implementation factors used in specific or unique combinations to develop local systems of care?
  • How does local context influence systems of care development?
  • Why and under what conditions are specific system implementation factors critical to successful systems-of-care development?
  • What conditions support or impede the development of systems of care?
  • Are there system implementation factors not identified in the Center’s model that communities use to develop their systems of care?

Working within a systems theory framework, this study tested these questions to better understand how system implementation factors contribute to a local community's ability to develop systems of care, and integrate these factors into system development efforts. A key element of systems theory is the interdependence and interlinking of various components or subsystems within a theory. Systems theory emphasizes not only inputs and outputs but also dynamic processes and feedback loops which impact the relationship between the different components and the ultimate outcomes of the systems.

In addition to the implementation factors and systems theory, the concept of theory of change also guided this project. For this study, a theory of change is defined as an articulated set of strategies undertaken by local communities in order to drive change in organizational policies, regulations, and funding mechanisms; guide the development of community-based services and supports; and shape practice for individual children with serious emotional disturbance and their families.

This study investigated:

  • Fundamental mechanisms of system implementation
  • How factors contributing to system implementation interact to produce well functioning systems serving children with serious emotional disturbance and their families
  • How system implementation factors are used in specific or unique combinations to develop local systems of care
  • How local context influences system-of-care development
  • What structures and processes contribute to the implementation of systems of care
  • If system of care implementation is marked by identifiable change agents or triggering conditions
  • What conditions support or impede the development of systems of care

It is expected that the results of this study will help both established and potential systems of care to identify strategies for successful system implementation within their local contexts. Findings of each phase will be shared with professional and family audiences through workshops, presentations, issue briefs, newsletter articles and published papers. This effort will be extended to cross-site findings as results become available.

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