Community and State Systems Change Associated with the Healthy Transitions Initiative

  • Janet S. Walker
  • Nancy Koroloff
  • Shawn J. Mehess


People engaged in efforts to improve services to emerging adults with serious mental health challenges have reached the conclusion that service change at the program or agency level is not sustainable without related changes at the systems or policy level. This article focuses on one set of efforts to create intentional system change at both the community and state levels. These changes were pursued by states and communities that received grants under the federally funded Healthy Transitions Initiative (HTI), with the aim of creating more effective services for emerging adults with serious mental health conditions. The article reviews the development of a measure to assess systems change efforts at the state and community levels and describes the findings that emerged when the measure was used to assess the change that occurred in the HTI sites over a period of approximately three and a half years.


System Change Fiscal Policy Mental Health Condition Social Network Analysis Standardize Root Mean Square Residual 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by funding from the National Institute of Disability and Rehabilitation Research, United States Department of Education, and the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, United States Department of Health and Human Services (NIDRR grant H133B090019). The content does not necessarily represent the views or policies of the funding agencies. The authors would like to thank the stakeholders who provided their insights and feedback for this work, as well as those who participated in the research study.

Conflict of Interest

The authors report no conflicts of interest.


  1. 1.
    Davis M, Koroloff N, Ellison M. Between adolescence and adulthood: Rehabilitation research to improve services for youth and young adults. Psychiatric Rehabilitation Journal 2012; 35(3): 167–170.CrossRefPubMedGoogle Scholar
  2. 2.
    Burke-Miller J, Razzano L, Grey D, et al. Supported employment outcomes for transition age youth and young adults. Psychiatric Rehabilitation Journal 2012; 35(3): 171–180.CrossRefPubMedGoogle Scholar
  3. 3.
    McKay C, Osterman R, Shaffer J, et al. Adapting services to engage young adults in ICCD clubhouses. Psychiatric Rehabilitation Journal 2012; 35(3): 181–188.CrossRefPubMedGoogle Scholar
  4. 4.
    Bickman L, Heflinger CA. Seeking success by reducing implementation and evaluation failures. In: LB Bickman, D Rog (Eds). Children’s Mental Health Services; Research, Policy and Evaluation. Thousand Oaks, CA: Sage, 1995, pp. 171–205.Google Scholar
  5. 5.
    Brannan AM. Ensuring effective mental health treatment in real-world settings and the critical role of the family. Journal of Child and Family Studies 2003; 12: 1–10.CrossRefGoogle Scholar
  6. 6.
    Behrens T, Foster-Fishman P. Developing operating principles for systems change. American Journal of Community Psychology 2007; 39: 411–414.CrossRefPubMedGoogle Scholar
  7. 7.
    Parsons B. The state of methods and tools for social systems change. American Journal of Community Psychology 2007; 39: 405–409.CrossRefPubMedGoogle Scholar
  8. 8.
    Kreger M, Brindis C, Manuel D, et al. Lessons learned in systems change initiatives: benchmarks and indicators. American Journal of Community Psychology 2007; 39: 301–320.CrossRefPubMedGoogle Scholar
  9. 9.
    Ackoff R, Rovin S. Redesigning Society. Stanford, CA: Stanford Business Books, 2003.Google Scholar
  10. 10.
    Foster-Fishman P, Nowell B, Yang H. Putting the system back into systems change: A framework for understanding and changing organizational and community systems. American Journal of Community Psychology 2007; 39: 197–215.CrossRefPubMedGoogle Scholar
  11. 11.
    Foster-Fishman P, Behrens T. Systems change reform: Rethinking our theories, methods, and efforts in human services reform and community-based change. American Journal of Community Psychology 2007; 39: 191–196.CrossRefPubMedGoogle Scholar
  12. 12.
    Lindblom C. The science of “muddling through.” Public Administration Review 1959; 19: 79–88.CrossRefGoogle Scholar
  13. 13.
    Emshoff J, Darnell A, Darnell D, et al. American Journal of Community Psychology 2007; 39: 255–267.CrossRefPubMedGoogle Scholar
  14. 14.
    Foster-Fishman P, Droege E. Locating the system in system of care. Evaluation and Program Planning 2010; 33: 11–13.CrossRefPubMedGoogle Scholar
  15. 15.
    Brannan AM, Brashears F, Gyamfi P, et al. Implementation and development of federally-funded systems of care over time. American Journal of Community Psychology 2012; 49: 467–482.CrossRefPubMedGoogle Scholar
  16. 16.
    Hodges S, Ferreira K, Israel, N. “If we’re going to change things, it has to be systematic:” Systems change in children’s mental health. American Journal of Community Psychology 2012; 49: 526–537.CrossRefPubMedGoogle Scholar
  17. 17.
    Morrissey J, Johnsen M, Calloway M. Evaluating performance and change in mental health systems serving children and youth: Interoroganizational network analysis. Journal of Mental Health Administration 1997; 24(1): 4–7.PubMedGoogle Scholar
  18. 18.
    Davis M, Koroloff N, Johnsen M. Social network analysis of child and adult interorganizational connections. Psychiatric Rehabilitation Journal 2012; 35(3): 265–272.CrossRefPubMedGoogle Scholar
  19. 19.
    Walker J, Sanders B. The Community Supports for Wraparound Inventory: An Assessment of the Implementation Context for Wraparound. Journal of Child and Family Studies 2011; 20(6): 747–757.CrossRefGoogle Scholar
  20. 20.
    Walker J, Koroloff N. Grounded theory and backward mapping: Exploring the implementation context for wraparound. Journal of Behavioral Health Services and Research 2007; 34(4): 443–458.CrossRefPubMedGoogle Scholar
  21. 21.
    R Core Team. A language and environment for statistical computing. Foundation for Statistical Computing. Available online at Updated 2013. Accessed February 18, 2014
  22. 22.
    Raudenbush SW, Bryk AS. Hierarchical Linear Models. Second Edition. Thousand Oaks, CA: Sage Publications, 2002.Google Scholar
  23. 23.
    Snijders TAB, Bosker RJ. Multilevel Analysis: An Introduction to Basic and Advanced Multilevel Modeling, 2nd Edition. London: SAGE, 2012.Google Scholar
  24. 24.
    Honaker J, King G, Blackwell M. Amelia II: A program for missing data. Journal of Statistical Software 2011; 45(7): 1–47. Available online at Accessed February 18, 2014.
  25. 25.
    Rosseel, Y. Lavaan: An R package for structural equation modeling. Journal of Statistical Software 2012; 48(2): 1–36. Available online at Accessed February 18, 2014.
  26. 26.
    Chen F, Curran PJ, Bollen KA, et al. An empirical evaluation of the use of fixed cutoff points in RMSEA test statistic in structural equation models. Sociological Methods & Research 2008; 36: 462–494.CrossRefGoogle Scholar
  27. 27.
    Bentler PM, Bonett DG. Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin 1980; 88: 588–606.CrossRefGoogle Scholar
  28. 28.
    Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling 1999; 6: 1–55.CrossRefGoogle Scholar
  29. 29.
    Barr DJ, Levy R, Scheepers C, et al. Random effects structure for confirmatory hypothesis testing: Keep it maximal. Journal of Memory and Language 2013; 68: 255–278.CrossRefGoogle Scholar

Copyright information

© National Council for Behavioral Health 2014

Authors and Affiliations

  • Janet S. Walker
    • 1
  • Nancy Koroloff
    • 1
  • Shawn J. Mehess
    • 1
  1. 1.Research and Training Center for Pathways to Positive Futures, Regional Research InstitutePortland State UniversityPortlandUSA

Personalised recommendations