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Community Characteristics and Implementation Factors Associated with Effective Systems of Care

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Abstract

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.

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References

  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.

  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 

  3. American Academy of Child and Adolescent Psychiatry. Practice parameter on child and adolescent mental health care in community Systems of Care. Journal of the American Academy of Child and Adolescent Psychiatry. 2007; 46:284–299.

    Article  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 

  7. Walrath C, Garraza LG, Stephens R, et al. Trends in characteristics of children served by the Children's Mental Health Initiative: 1994–2007. Administration and Policy in Mental Health and Mental Health Services Research. 2009; 36:361–373.

    Article  PubMed  Google Scholar 

  8. Hodges S, Ferreira K, Israel N, et al. Systems of care, featherless bipeds, and the measure of all things. Evaluation and Program Planning. 2010; 33:4–10.

    Article  PubMed  Google Scholar 

  9. Vinson NB, Brannan AM, Baughman LN, et al. The system-of-care model: Implementation in twenty-seven communities. Journal of Emotional and Behavioral Disorders. 2001; 9:30–42.

    Article  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 

  12. Hodges S, Hernandez M, Nesman T. A developmental framework for collaboration in child-serving agencies. Journal of Child and Family Studies. 2003; 12:291–305.

    Article  Google Scholar 

  13. Hoge MA, Howenstine RA. Organizational development strategies for integrating mental health services. Community Mental Health Journal. 1997; 33:175.

    Article  PubMed  CAS  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).

  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).

  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).

  17. Bronfenbrenner U. Toward an experimental ecology of human development. American Psychologist. 1977; 32:513–530.

    Article  Google Scholar 

  18. Bronfenbrenner U. The Ecology of Human Development: Experiments by Nature and Design. Cambridge, MA: Harvard University Press, 1996.

    Google Scholar 

  19. Aday LA, Andersen RA. A framework for the study of access to medical care. Health Services Research. 1974; 9:208–220.

    PubMed  CAS  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 

  22. Jones DL, Heflinger CA, Saunders RC. The ecology of adolescent substance abuse service utilization. American Journal of Community Psychology. 2007; 40:345–358.

    Article  PubMed  Google Scholar 

  23. Haas JS, Phillips KA, Sonneborn D, et al. Variation in access to health care for different racial/ethnic groups by the racial/ethnic composition of an individual's county of residence. Medical Care. 2004; 42:707.

    Article  PubMed  Google Scholar 

  24. Gresenz CR, Stockdale SE, Wells KB. Community effects on access to behavioral health care. Health Services Research. 2000; 35:293.

    PubMed  CAS  Google Scholar 

  25. Kirby JB, Kaneda T. Neighborhood socioeconomic disadvantage and access to health care. Journal of Health and Social Behavior. 2005; 46:15–31.

    Article  PubMed  Google Scholar 

  26. Litaker D, Koroukian SM, Love TE. Context and healthcare access: Looking beyond the individual. Medical Care. 2005; 43:531.

    Article  PubMed  Google Scholar 

  27. Gilman SE, Kawachi I, Fitzmaurice GM, et al. Socio-economic status, family disruption and residential stability in childhood: Relation to onset, recurrence and remission of major depression. Psychological Medicine. 2003; 33:1341–1355.

    Article  PubMed  CAS  Google Scholar 

  28. Bures RM. Childhood residential stability and health at midlife. American Journal of Public Health. 2003; 93:1144–1148.

    Article  PubMed  Google Scholar 

  29. Ricketts TC. The changing nature of rural health care. Annual Review of Public Health. 2000; 21:639–657.

    Article  PubMed  CAS  Google Scholar 

  30. Reschovsky JD, Staiti AB. Access and quality: Does rural American lag behind? Health Affairs. 2005; 24:1128–1139.

    Article  PubMed  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.

  34. Freedman VA, Grafove IB, Schoeni RF, et al. Neighborhoods and disability later in life. Social Science & Medicine. 2008; 66:2253–2267.

    Article  Google Scholar 

  35. Muthén LK, Muthén BO. Mplus User’s Guide Fifth Edition. Los Angeles, CA: Muthen & Muthen, 1998–2007.

  36. Bentler PM. Comparative fit indexes in structural models. Psychological Bulletin. 1990; 107:238–246.

    Article  PubMed  CAS  Google Scholar 

  37. Tucker LR, Lewis C. The reliability coefficient for maximum likelihood factor analysis. Psychometrika. 1973; 38:1–10.

    Article  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.

  39. McDonald RP, Ho M. Principles and practice in reporting structural equation analyses. Psychological Methods. 2002; 7:64–82.

    Article  PubMed  Google Scholar 

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Acknowledgment

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.

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Authors and Affiliations

  1. Department of Human and Organizational Development, Peabody College, Vanderbilt University, 230 Appleton Place, Box #90 Peabody, Nashville, TN, 37203, USA

    Laurel M. Lunn MS & Craig Anne Heflinger PhD

  2. Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, MDC-56, Tampa, FL, 33612, USA

    Wei Wang PhD

  3. Department of Child and Family Studies, MHC 2434, Louis de la Parte Florida Mental Health Institute, University of South Florida, 13301 Bruce B. Down Blvd, Tampa, FL, 33612-3708, USA

    Paul E. Greenbaum PhD

  4. Department of Child and Family Studies, MHC 2335, Louis de la Parte Florida Mental Health Institute, University of South Florida, 13301 Bruce B. Down Blvd, Tampa, FL, 33612-3708, USA

    Krista Kutash PhD

  5. Department of Mental Health Law and Policy, MHC 2719 Louis de la Parte Florida Mental Health Institute, University of South Florida, 13301 Bruce B. Down Blvd, Tampa, FL, 33612-3708, USA

    Roger A. Boothroyd PhD

  6. Department of Child and Family Studies, MCH 2312a, Louis de la Parte Florida Mental Health Institute, University of South Florida, 13301 Bruce B. Down Blvd, Tampa, FL, 33612-3708, USA

    Robert M. Friedman PhD

Authors
  1. Laurel M. Lunn MS
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  2. Craig Anne Heflinger PhD
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  3. Wei Wang PhD
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  4. Paul E. Greenbaum PhD
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  5. Krista Kutash PhD
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  6. Roger A. Boothroyd PhD
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  7. Robert M. Friedman PhD
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Correspondence to Laurel M. Lunn MS.

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Lunn, L.M., Heflinger, C.A., Wang, W. et al. Community Characteristics and Implementation Factors Associated with Effective Systems of Care. J Behav Health Serv Res 38, 327–341 (2011). https://doi.org/10.1007/s11414-011-9244-0

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  • DOI: https://doi.org/10.1007/s11414-011-9244-0

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