Research Agenda

Study 3: Financing Structures and Strategies to Support Effective Systems of Care

Over the past 15 years, states have increasingly relied on Medicaid to pay for health and mental health services. According to the 2003 State Survey of the Health Care Reform Tracking Project , 38 of the 50 states reported involvement in managed care activities that affected behavioral health services for children and their families. This trend mirrors reforms over the past two decades in the national health care delivery system.

The theoretical framework of the Center is that there are critical implementation factors, which when put into place, support communities in their efforts to build effective systems of care to serve the needs of children and adolescents with serious emotional disturbances and their families. One set of these factors relates to the financing structuresand strategies that communities build into their theories of change and implementation plans.

The current study will be the first to thoroughly investigate cross-agency financing structures and strategies, and will provide important information about finance policies that can assist communities across the country. This study has two primary research objectives: (a) using a case study design, we will test the validity of the theory that our hypothesized financing structures and strategies will support effective systems of care (b) we will investigate how these financing components operate separately and collectively within a community and systemic context, to create effective financing policy. The study also will investigate whether each financing component contributes to positive system-level outcomes.

This study hypothesizes that effective financing mechanisms will:

  • redirect spending from “deep-end” restrictive placements to home and community-based services and supports, consistent with systems-of-care values;
  • support and provide incentives for evidence-based and promising practices;
  • support a wide-ranging, diverse network of providers;
  • support voice and choice for families when planning services; and
  • Support a strong family and youth voice in policy development and system management.

The financing study will use a participatory action research approach and a multiple-case embedded design, and will collect data from 10 case study sites: (a) five communities identified as having effective financing structures and strategies, and (b) five communities having potential effective financing structures and strategies but being at a relatively low level of implementation. Three additional high implementing sites will be nominated by a panel of experts. Preliminary sets of financing indicators, system level outcomes, data collection methods, and a data analysis plan have been identified for each critical financing component. Narrative data, including interviews and direct observation, will be analyzed for emergent themes. As the case studies are conducted, the financing team will refine the data collection methods, tools, and protocols.

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