Community Characteristics and Implementation Factors Associated with Effective Systems of Care
How are characteristics of communities associated with the implementation of the principles of systems of care (SOC)? This study uses multilevel modeling with a stratified random sample (N = 225) of US counties to explore community-level predictors of the implementation factors of the System of Care Implementation Survey. A model composed of community-level social indicators fits well with 5 of 14 factors identified as relevant for effective SOCs. As hypothesized, community disadvantage was negatively and residential stability positively associated with the implementation of SOC principles. Designation as a mental health professional shortage area was positively related to some implementation scores, as was the percentage of minority residents, while rurality was not significantly associated with any of the factors. Given the limitations of the study, the results should be interpreted with caution, but suggest that further research is merited to clarify these relationships that could inform efforts directed at promoting SOCs.
KeywordsTucker Lewis Index Community Disadvantage Residential Stability Serious Emotional Disturbance Implementation Factor
This research was partially supported by Grant H133B90004 from the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, the National Institute for Disability and Rehabilitation Research, and the National Institute of Mental Health (NIMH, R01 MH70680-01A). The opinions contained in this manuscript are those of the authors and do not necessarily reflect those of the U.S. Department of Education, the Center for Mental Health Services, SAMHSA, or NIMH.
- 1.Stroul BA, Friedman R. A System of Care for Children and Youth with Severe Emotional Disturbances. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center, 1986.Google Scholar
- 2.Stroul BA, Friedman R. The System of Care concept and philosophy. In: Stroul BA, ed. Children's Mental Health: Creating Systems of Care in a Changing Society. Baltimore, MD: Paul H. Brookes Publishing Co, Inc., 1996, pp. 591–612.Google Scholar
- 4.American Academy of Child and Adolescent Psychiatry. Systems of Care Information and Resources. 2009. Available at http://www.aacap.org/cs/root/member_information/practice_information/systems_of_care_information_and_resources. Accessed February 9, 2009.
- 5.Substance Abuse and Mental Health Services Administration. Systems of Care. (n.d.). Available at http://systemsofcare.samhsa.gov/. Accessed February 9, 2009.
- 6.Pires S. Building Systems of Care: A Primer. Washington, DC: National Technical Assistance Center for Children's Mental Health, Georgetown University Child Development Center, 2002.Google Scholar
- 10.Brannan AM, Baughman LN, Reed ED, et al. System of care assessment: Cross-site comparison of findings. Children Services: Social Policy, Research, and Practice. 2002; 5:37–56.Google Scholar
- 11.Center for Mental Health Services. Findings on the implementation of systems of care at 14 CMHS grant communities. EvalBrief: Systems of Care. 2004; 6:1–4.Google Scholar
- 14.Boothroyd RA, Greenbaum PE, Wang W, et al. Development of a measure to assess the implementation of children’s systems of care: The System of Care Implementation Survey (SOCIS). Journal of Behavioral Health Services and Research, 2011; 38(3).Google Scholar
- 15.Greenbaum PE, Wang W, Boothroyd RA, et al. Multilevel confirmatory factor analysis of the system of care implementation survey (SOCIS). Journal of Behavioral Health Services and Research, 2011; 38(3).Google Scholar
- 16.Kutash K, Greenbaum PE, Wang W, et al. Levels of system of care implementation: A national benchmarking study. Journal of Behavioral Health Services and Research, 2011; 38(3).Google Scholar
- 18.Bronfenbrenner U. The Ecology of Human Development: Experiments by Nature and Design. Cambridge, MA: Harvard University Press, 1996.Google Scholar
- 20.Andersen RM, Davidson PL. Measuring access and trends. In Andersen RM, Rice TH, Kominski GF (eds). Changing the U.S. Health Care System: Key Issues in Health Services, Policy, and Management. San Francisco: Jossey-Bass, 1996, pp.13-40.Google Scholar
- 21.Heflinger CA, Brannan AM. Rural Child/adolescent Mental Health Service Use (NIMH 1 R01 MH70680-01A2). Nashville, TN: Vanderbilt University, 2005.Google Scholar
- 31.US Bureau of the Census. Census 2000 Summary File 3: Technical Documentation. Washington, DC: US Bureau of the Census, 2002. Available at http://factfinder.census.gov/.
- 32.Community Health Status Indicators Project Working Group. Data Sources, Definitions, and Notes: Community Health Status Indicators 2008. Washington, DC: Department of Health and Human Services; 2008. Available at http://communityhealth.hhs.gov.
- 33.Inter-university Consortium for Political and Social Research. County Characteristics, 2000–2007 [United States]: Codebook. ICPSR20660-v2, Ann Arbor, MI: ICPSR, 2008.Google Scholar
- 35.Muthén LK, Muthén BO. Mplus User’s Guide Fifth Edition. Los Angeles, CA: Muthen & Muthen, 1998–2007.Google Scholar
- 38.Steiger JH, Lind JC. Statistically-based tests for the number of common factors. Paper presented at: Annual Meeting of the Psychonomic Society; May 1980; Iowa City, IA.Google Scholar