Values Driven Systems of Care: the BC SCORES Experience Children’s Mental Health Research and Policy Conference March 22, 2011 Holly Wald, PhD, Cynthia Zubritsky, PhD, Nancy Jaquette, LSW, Cecilia Mitchell, MSW

Background Systems of Care have become a foundation for many mental health systems, Questions abound as to the degree to which communities implement these core values and the subsequent impact of these values on systems, communities and youth and families (Cook & Kilmer, 2004).

Key Assumption Regarding System of Care Behavioral health services for youth delivered in adherence to core values will promote positive outcomes

Challenges in Assessing Adherence to Core Values Variation in interpretation and operationalization of core constructs across communities Widespread acceptance of SOC core values has resulted in a general acceptance of SOC elements (Stroul & Blau, 2010) Studies have relied solely on family and provider reports of adoption and adherence (Brennan et al., 2002) Low levels of inter-rater reliability in interviews (Hernandez et al., 2001)

Core Value Interest BC SCORES stakeholders were interested in the extent of the adoption of these SOC core values by system partners, providers and community organizations and youth and family members.

The needs of the child are identified and the family dictates the types and mix of services provided. Youth Guided & Family Driven

Agencies, programs, and services are responsive to the cultural, racial, and ethnic differences of the populations they serve. Culturally Competent

The location of services and decision-making responsibility is at the community level. Community Based

Core Values Youth Guided & Family Driven Community Based Culturally Competent

BC SCORES* Beaver County’s System of Care: Optimizing Resources, Education and Supports) Targeting youth (10 to 21) who may be involved with the legal system or who are experiencing disciplinary problems in school and have a mental health or co-occurring mental health and substance use disorder (COD). Stakeholder interest in the extent of the adoption of these SOC core values by administrators and staff of providers and community organizations, as well as youth and family members.

Key Questions Have knowledge and attitudes of system partners and providers related to core values changed when comparing perceptions prior to BC SCORES and currently? Are there differences in perceptions of changes in core values when comparing types of organizations or type of respondent? Have knowledge and attitudes of family and youth related to core values changed when comparing perceptions prior to BC SCORES and currently?

Methodology Online survey of providers ◦ Administrators and staff Online and paper surveys of parents and youth Provider Focus Groups Family Focus Groups

64 individuals completed the survey 60% female / 40% male 73% Caucasian / 27% Black 44% director or supervisor / 56% staff Administrators & Staff Survey

Survey Results: Administrators & Staff

Survey Results: Administrators & Staff Comparison by Type of Organization Behavioral Health Juvenile Services Children & Youth Services Other* BeforeNowBeforeNowBeforeNowBeforeNow Youth Guided & Family Driven 32.4%54.3%20.0%50.0%51.7%67.5%15.7%72.5% Culturally Competent 34.8%73.5%30.0%55.0%54.2%59.1%5.0%71.4% Community Based 20.7%55.4%12.5%30.0%45.9%52.3%0.0%65.9% Provider Specific Factors 30.3%65.2%22.5%37.5%47.9%63.6%16.3%75.0% *Other includes Schools, Family & Youth Service Agencies, & Community Organizations

Survey Results: Administrators & Staff Comparison by Position Director/ Supervisor Staff BeforeNowBeforeNow Youth Guided & Family Driven 26.2%63.6%31.8%54.8% Culturally Competent 28.6%69.7%32.3%61.7% Community Based 20.7%62.1%21.0%43.3% Provider Specific Factors 29.0%68.1%26.7%55.8%

Survey Results: Administrators & Staff Community organizations indicated the greatest increase in the adoption of core values Directors/Supervisors indicated seeing a greater increase in the adoption of core values than staff members

Focus Group Results: Administrators & Staff How changes in the System of Care have Helped Collaboration and communication has improved Staff listens to families – makes it easier to engage them Agencies are more aware of natural supports and natural supports are more aware of what agencies do More families are able to get services Families have a lot more choices Trainings have been very helpful

Focus Group Results: Administrators & Staff Areas in which Change is still Needed Need to continue to improve communication and broaden the scope of who’s included Many organizations are similar and seem to be competing Need more psychiatrists In regards to marketing, need to make sure everyone gets the information Make sure information is presented in a family friendly way

Family & Youth Survey 35 individuals completed the survey 68.6% female/31.4% male 51.9% Caucasian/48.1% Black

Survey Results: Families & Youth

Survey Results: Family & Youth Comparison by Respondent FamilyYouth BeforeNowBeforeNow Youth Guided & Family Driven 45.7%68.7%50.0%60.1% Culturally Competent 35.8%60.5%53.6%50.0% Community Based 26.3%61.8%46.4%65.0%

Survey Results: Families & Youth The greatest changes were related to the values of Youth Guided & Family Driven and Community Based Family members indicated a greater improvement than youth

Focus Group Results: Families & Youth How changes in the System of Care have Helped Greater availability of services in the community Families communicate and help each other System of care has helped form linkages between community-based providers ◦ Learn from each other ◦ Refer to each other Families are more aware of the services available to them

Focus Group Results: Families & Youth Areas in which Change is still Needed More improvement related to cultural competence is needed Families and youth need to have more say and need to be listened to Recognize families as experts – parents sometimes know what’s best for their child More respect for families and youth

Comparison of Survey Results

Providers indicated a greater increase in cultural competence Families and youth indicated a greater increase in services being community based Providers indicated a similar increase in the system of care being youth guided and family driven as families and youth

Summary of Results Those involved in the System of Care are aware of positive changes related to the Core Values Responses by providers show a 2 to 3 fold increase in agreement with each of the Core Values Families and youth responses show, on average, a 20% increase in agreement with the Core Values Changes in the community based values highest among community based service providers. Results of efforts to expand the inclusion of natural supports to in the system of care may helped foster movement toward the adoption of system of care core values in the community based providers.

Emerging Issues Community based entities exhibit the greatest increase over time on adoption of core values across all indicators. Administrators consistently rated awareness and implementation of indicators for each of the core values higher than staff. For provider specific responses, a lower percentage of survey respondents indicate regular provision of core values to families, provision of vision and mission statement to families, and inclusion of system of care core value into policies and procedures.

Questions