Abstract
This article describes how a system of care operated by a county government agency used a fiscal crisis as the opportunity to reform its children’s system. A cross-system response to the crisis is outlined that includes a system of care framework coupled with a business model, inter-departmental collaboration and leadership, the use of strategic reinvestment strategies, and a quality improvement system that focuses on key indicators. Implementation of the system change is described with a specific focus on cross-system entry points, financing strategies that re-allocate funds from deep-end programs to community-based services, and management oversight through the use of performance indicators to monitor and support effectiveness. This article examines the results of the system change, including the diversion of youth from system penetration, the reduction in residential treatment bed days, the re-allocation of these savings to community-based services, and the outcomes of children who were diverted from residential care and served in the community. The article offers a number of recommendations for other communities contemplating system change.
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Armstrong, M. I., & Evans, M. E. (2010). Fostering an unnatural act: Does policy make a difference? Best Practices in Mental Health: An International Journal, 6(2), 27–38.
Black, M. (2008). Six Sigma Green Belt Presentation. Presentation to the Erie County Executive Office.
Bruns, E. J., Suter, J. C., Rast, J., Walker, J. S. & Zabel, M. (2006). Wraparound Fidelity Index, version 4. Results of an Initial Pilot Test. National Wraparound Initiative & Systems of Care. Presentation, retrieved from the web September 1, 2006 from: http://depts.washington.edu/wrapeval/docs/FINAL_WFI4poster.ppt
Hernandez, M., & Hodges, S. (2003). Crafting logic models for systems of care: Ideas into action. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, Department of Child and Family Studies.
Hodges, K. (1990). Child and adolescent functional assessment scale (CAFAS). Ypsilanti, MI: Department of Psychology, Eastern Michigan University.
Hodges, K. (2004). The child and adolescent functional assessment scale. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (pp. 405–441). Mahwah, NJ: Lawrence Erlbaum Associates.
Hodges, S., Friedman, R. M., & Hernandez, M. (2008). Integrating the components into an effective system of care: A framework for putting the pieces together. In B. Stroul & G. M. Blau (Eds.), The system of care handbook: Transforming mental health services for children, youth, and families (pp. 71–94). Baltimore, MD: Paul H. Brookes.
Pagkos, B., Milch, H., & Foschio-Bebak, C. (2009). EQUIP tool. Unpublished Work. Community Connections of New York, Inc.
Pires, S. A. (2002). Building systems of care: A primer. Washington, DC: Georgetown University Child Development Center.
Pires, S. A., Stroul, B. A., Armstrong, M. I., McCarthy, J., Pizzigati, K. A., Wood, G., et al. (2008). Financing strategies for systems of care. In B. Stroul & G. M. Blau (Eds.), The system of care handbook: Transforming mental health services for children, youth, and families (pp. 181–212). Baltimore, MD: Paul H. Brookes.
Stroul, B., & Friedman, R. M. (1996). The system of care concept and philosophy. In B. Stroul (Ed.), Children’s mental health: Creating systems of care in a changing society (pp. 3–21). Baltimore, MD: Paul H. Brookes.
Stroul, B. A. & Manteuffel, B. (2008). Sustaining systems of care. In B. Stroul & Blau, G. M. (Eds), The system of care handbook: Transforming mental health services for children, youth, and families (pp. 213–246). Baltimore, MD: Paul H. Brookes.
Stroul, B. A., Pires, S. A., Armstrong, M. I., Echo-Hawk, H., McCarthy, J., McNeish, R., Pizzigati, K., & Wood, G. M. (2009). Effective financing strategies for systems of care: Examples from the field—A resource compendium for financing systems of care: Second Edition. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, Research and Training Center for Children’s Mental Health. http://rtckids.fmhi.usf.edu/research/study03.cfm
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Armstrong, M.I., Milch, H., Curtis, P. et al. A Business Model for Managing System Change Through Strategic Financing and Performance Indicators: A Case Study. Am J Community Psychol 49, 517–525 (2012). https://doi.org/10.1007/s10464-012-9512-z
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DOI: https://doi.org/10.1007/s10464-012-9512-z