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Presented at the 19th Annual Research Conference

Leverage Points in System of Care Implementation

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Session Number: 30 Room: Salon I

Presentation Type: symposium

Chair: Sharon Hodges Discussant: Michael Agar

Synopsis: Leverage points can be thought of as places within a complex system where relatively small shifts in one aspect of the system affect big changes across the system. This symposium will report initial findings of a five-year study of system of care implementation that is part of the Research and Training Center for Children’s Mental Health. The papers presented in this symposium will frame systems of care as complex adaptive systems -- complex in that they are made up of multiple interconnected elements and adaptive in that there is action and reaction among these elements over time. The use of ethnographic field methods, identification of key leverage points in system of care implementation, and specific examples of leveraging used by established systems of care will be presented.

Date: Thursday, February 23, 2006

Session Time: 4:45 PM - 5:45 PM

Presentation Time: 4:45 PM - 5:45 PM

Leveraging Implementation in Established Systems

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Presenting: Kathleen Ferreira

All Authors for this paper: Kathleen Ferreira

Presentation Type: element of symposium

Synopsis: How are leverage points identified within a system of care, and how are they used to propel a system forward? This paper will examine leverage points used by system planners and implementers in established systems of care and will focus on how complex systems can use leverage points to maximize the impact of their system change efforts. The presentation will provide specific examples of leverage points used by system planners and implementers in Placer County, CA and Region III Behavioral Health Services in Kearney, NE and the relative effectiveness of these leverage points in relation to system goals. Findings across these sites will be compared and contrasted.

Changing Complex Systems: Leveraging Change in Systems of Care

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Presenting: Nathaniel Israel

All Authors for this paper: Nathaniel Israel

Presentation Type: element of symposium

Synopsis: The initial organization and ongoing adaptation observed in systems of care are consistent with principles from complex systems theory. However, it is often difficult to know how these principles apply to understanding how systems of care evolve to successfully serve families and children. This presentation will focus on the application of leverage points to understanding the evolution of established systems of care. Leverage points can be defined as places where relatively small shifts in one aspect of the system can produce big changes across the system. Descriptions of shifts that create change in systems of care will be provided, as well as information on the probabilistic effectiveness of actions taken at different leverage points. Proposed adaptations of the leverage points framework necessary to describe change in systems of care will be discussed.

Applying Case Study Design to Study System Implementation

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Presenting: Jessica Mazza

All Authors for this paper: Jessica Mazza

Presentation Type: element of symposium

Synopsis: Case Studies of System Implementation uses a multiple-case embedded case study designed to investigate the process of establishing and sustaining systems of care. Using a national nomination process, two established systems were selected to participate in Phase I of this study. This paper will describe how this multi-method approach was used to build understanding of the structures and processes key to local system implementation. The discussion will describe the use of document review, direct observation, individual brainstorming and rating exercises, and semi-structured interviews for the purpose of providing organizational and individual level data about critical factors in local system development and assessment of progress toward system goals.

Conclusions

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Presenting: Sharon Hodges

All Authors for this paper: Sharon Hodges

Presentation Type: element of symposium

Synopsis: The concept of leverage points is significant to systems of care implementation for a number of reasons. The complex adaptive nature of systems of care makes it difficult for system planners and implementers to know which system interventions will produce desired change. The identification of leverage points specific to systems of care can illuminate key strategies for system implementation and allow planners and implementers to better relate these strategies to the results of their efforts. The well being of children with serious emotional disturbance and their families depends on access to and availability of appropriate services and supports. It is critical that system planners and implementers maximize the impact of their system development efforts.

Systems of Care as Complex Adaptive Systems

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Presenting: Allison Pinto

All Authors for this paper: Allison Pinto

Presentation Type: element of symposium

Synopsis: Systems of care are by definition complex, both in their goal of providing seamless multi-agency services and supports for children and families and in the multiple and varied local contexts in which these systems are implemented. Complexity theory provides a helpful framework for understanding the process of system of care implementation. It posits that complex adaptive systems are characterized by connectivity, interdependence, feedback and emergence. This paper will present an analysis of the system-of-care construct as a complex adaptive system in terms of these four key characteristics. Implications for systems-of-care research will be highlighted in terms of the need for research methods that focus on dynamic relationships and processes. Ethnographic approaches will be presented as a valuable means of studying complexity and the complex structures and processes of systems of care.