Introduction

The behavioral health field is replete with challenges and uncertainties stemming from a variable mix of factors including rural-urban disparities, budget cuts to human services, resource deserts, and workforce challenges (Polaha et al. 2022; Montgomery et al. 2023). In any given year, 14–20% of young people are estimated to have mental, emotional, and behavioral (MEB) disorders (National Research Council and Institute of Medicine 2009) that adversely impact their functioning at home, in school, and in the community (Perou et al. 2013). Over time depression and anxiety have increased (CDC 2022). In the National Survey on Drug Use and Mental Health (NSDUH), for youth (12–17 years), the rate of major depression grew from 12.8% (2016) to 20.1% (2021). Suicide risks have also increased among adolescents (Substance Abuse and Mental Health Services Administration [SAMHSA] 2022). Yet, among youth surveyed in 2021, 59.4% (2.3 million) of youth with major depression had not received any treatment in the past 12 months (McCance-Katz 2020; SAMHSA 2022).

Although it has taken several innovative and collaborative interventions to develop child behavioral health services, there has often been limited elaboration of the actual implementation processes. Far too often, details about these processes were confined to the proverbial “black box” resulting in incomplete narratives and assumptions about program development and implementation (Callejas et al. 2010; Royse et al. 2016; Walloth 2016). It is important that we examine and understand the processes underpinning behavioral health interventions as they are central to the attainment of effective outcomes. Such knowledge is necessary for the transfer of learning, and the replication and sustainability of programs (Royse et al. 2016).

This manuscript focuses on System of Care (SOC) implementation and expansion efforts in a Midwestern state and the emergence of a learning collaborative. The learning collaborative refers to a network or community of professionals and stakeholders who connect for the purpose of learning, creating and sharing resources for knowledge and skill development. Learning collaboratives are typically established around a focused topic area. Members may have varied knowledge and skill levels yet they all contribute to the fundamental group processes of peer-to-peer sharing and learning (Russ et al. 2010; Lyren et al. 2016; Larsen et al. 2021).

In this Midwestern state, local coordinators, key contacts for the local SOC, participated in technical assistance through monthly consultation calls and quarterly meetings that provided an opportunity for discussions, continuing education, support among local SOC coordinators, and collaboration between the state and local SOCs. The manuscript examines the experiences and perspectives of SOC coordinators and the theoretical underpinnings and structure of their learning, skill development, and capacity building.

Overview of the system of care framework

To address well-documented unmet mental health needs of children and youth, the system of care (SOC) philosophy was developed, becoming the foundation for federal policy and funding (Stroul and Friedman 1986; Azar II 2020). The system of care philosophy was founded as an innovative response to address the limited availability and fragmented nature of mental health services and supports for children and adolescents with serious emotional disturbances. Knitzer (1982) who first proposed the philosophy, noted deficits and serious lapses in the work of various public agencies across the United States in attending to the needs of these children and youth. Few state departments of mental health had a policy focus and services specifically designed for children and youth. The system of care philosophy marks an approach aimed at optimizing various supports for these children and youth and their families. Child and youth serving agencies that did not have a primary mandate for mental health needed to be engaged. Building on Knitzer’s work Stroul and Friedman (1986) note that in contrast to continuum of care which implies “a range of services or program components at varying levels of intensity”, the system of care emphasizes “encompasses mechanisms, arrangements, structures or processes to insure that the services are provided in a coordinated, cohesive manner.” (p. 3). Instructively, system of care recognizes that other services such as education, child welfare, health, juvenile justice are complementary and necessary for the effectiveness of the mental health services. Stroul synthesized (2002) the fundamental components of the SOC as three core values and 10 guiding principles. The core values are:

  1. 1.

    family-focused and child and youth-centered,

  2. 2.

    community-based

  3. 3.

    culturally competent.

The guiding principles are:

  1. 1.

    Access to a comprehensive array of services addressing physical, socio-emotional and educational needs

  2. 2.

    Individualized services

  3. 3.

    Service provision in least restrictive, normative and clinically appropriate settings

  4. 4.

    Family partnership in service planning and delivery

  5. 5.

    inter-agency and cross-sector collaboration among service agencies

  6. 6.

    case management and services aligned with evolving needs

  7. 7.

    promotion of early identification and intervention to boost the likelihood of optimal outcomes

  8. 8.

    streamlining transitions from child to adult services over time

  9. 9.

    rights-based and promotion of advocacy

  10. 10.

    bias-free and culturally sensitive services

SOC values and principles evolved into a framework to support community-based coordinated networks that provide an array of effective services and supports for children and youth at risk for or with behavioral health challenges and their families (Stroul 2017; Azar II 2020). Overtime, SOC’s population of concern expanded, a broader service array included core services focused on effectiveness, care coordination emphasized fidelity, the evidence base grew, and the SOC framework was widely adopted, often integrated with other reforms (Stroul et al. 2010). Key SOC concepts included collaboration with families and youth across child service systems at the state and local levels (Pires 2010; Stroul et al. 2010, 2015).

SOC research has focused on the effectiveness of SOC expansion via federal funding (Kutash et al. 2011), implementation processes (Stroul et al. 2015; Karikari et al. 2021), necessary conditions for effective care coordination (Effland et al. 2011; Walker and Sanders 2011), and outcomes (Kutash et al. 2011; Azar II 2020). Further, technical assistance and related research examined the infrastructure of SOCs and implementation in various communities across the nation (Stroul et al. 2010; Behar and Hydaker 2012). Pires’ (2002, 2010) primers on building SOC emphasized the importance of leadership and constituency building, being strategic, and focusing on sustainability. Since Child Mental Health Initiative (CMHI) federal funding for local SOCs became available for state SOCs, the role of local (regional) SOC coordinators has not been specifically examined. Limited published research has addressed the necessary knowledge, skills, and roles of local coordinators in establishing SOCs.

In one Midwestern state that received state-level CMHI planning and expansion grants from SAMHSA, collaboration with and support of local SOC coordinators was strategically implemented. SOC coordinators played key roles in the overall development and local expansion of SOCs starting with their establishment, adoption of SOC values and principles, building effective community partnerships and focused committees, and infrastructure to support sustainability. Further, local SOC coordinators were expected to support and sustain family and youth involvement and ensure adherence to family-driven and youth-guided SOC principles (Doyle 2018). Within the SOC framework, local coordinators can be thought of as foot soldiers or community mobilizers serving as liaisons across multiple systems and engaging different constituents of the behavioral health system (Ouellette et al. 1999).

The current study

Drawing on a documentary review of SOC coordinators’ group discussions, the first purpose of this study was to increase understanding of SOC coordinators’ experiences and roles in the development of SOCs and to identify specific strategies they use. The second purpose was to examine the underlying theoretical framework and structure of the meetings. It is in relation to this purpose that the emergence of the learning collaborative was identified. The study provides valuable insight on the intricacies of SOC development.

Methods

The study employed an archival approach using records of three SOC coordinators’ forums conducted between 2017 and 2018. In total, 50 SOC Coordinators (11% male, 89% female, 93% white, ages: between 27 and 66 years) participated in these fora.

The data were analyzed using reflexive thematic analysis. The analytical process was iterative. For extended immersion and increased familiarity with the data, the data were read repetitively (Braun and Clarke 2006, 2021). Coding was done inductively, and analytic and reflexive memos were used to note key observations. Key features and extracts of the data were coded. The codes were sorted and categorized into meaningful themes. The focus was to ensure that there was a good fit between the data and the themes, and that they reflected the experiences and reality of the participants. The final step in the analysis involved the examination of themes for their viability. To ensure trustworthiness and rigor in the analysis, there were several peer debriefing meetings involving all the authors to discuss and review the themes derived from the analysis. There were also follow-up discussions involving some SOC coordinators who participated in the forums from which the data was derived.

This study was conducted under the ambit of a statewide SOC evaluation in a Midwestern state approved by the Institutional Review Board of the second author’s institution. Since the study was based on archived data, seeking direct consent from participants involved in the fora was not feasible. To maintain ethical compliance, the data were used with approval from the state agency that coordinated the forums and owns the data. To protect the privacy and confidentiality of participants in the fora, names have been anonymized.

Findings

Two broad findings emerged: (1) the inception of a learning collaborative for SOC coordinators and (2) the roles and experiences of SOC coordinators in developing SOCs. These findings are discussed in detail below with supporting illustrations.

Inception of a learning collaborative for SOC coordinators

By examining the nature and structure of coordinators’ meetings, we observed the emergence of a learning collaborative. Through the analysis the following components were identified: a socio-professional network comprising representatives of a state agency for behavioral health services and SOC coordinators from multiple counties around the state. Several of these coordinators worked in behavioral health or related fields such as foster care, child welfare, substance use and addiction treatment, suicide prevention, and special education.

Regarding process, forum facilitators, two SOC coordinators, who served as liaisons between local and state-level systems, used a zoom lens approach with three primary focal points—green light, yellow light, and red light—to facilitate discussions about SOC development. The lens provided a purposeful framework that set the tone for interactions. For the green light, participants were asked to share a “‘What’s Gone Right’ update that everyone can benefit from or be inspired by. For the yellow light, participants were asked to share “a need or challenge that is not a crisis and can be overcome easily or combined with a request for assistance from another coordinator.” Finally, for the red light, the focus was on “a challenge or concern that appears to be a system issue or requires assistance/collaboration with others to overcome.”

With the red light, green light, yellow light framework, various coordinators shared details about their activities and general experiences. From the pool of information, it was apparent that resource sharing was taking place and coordinators were gaining knowledge. In relation to that, opportunities for asset mapping and capacity development became evident.

Although there was no explicit mention of any particular theory or theories, from available data about the coordinators’ experiences and how the meetings were structured, we deduced that, overall, the learning collaborative was based on an eclectic framework comprising pedagogical, andragogical, and heutagogical elements. Notably, the learning collaborative was centered on relational, group-based and collaborative learning, using a non-course-based approach and drawing heavily on experientially informed case-studies as coordinators recounted their own experiences. Further, the learning collaborative was reflexive with a problem-centered approach and oriented towards developmental tasks needed by coordinators to fulfill their professional roles. It was more like, this is what has worked for me, or this is how I have dealt with the challenges, so why don’t you consider it. Key elements characterizing transformative learning experiences such as authentic relationships and learner-centeredness were evident (Pedersen 2010; Sammut 2014). Further, participants were open to introducing or discussing various subjects germane to SOC development, which allowed their discussions to evolve organically.

Figure 1 shows the components of the learning collaborative and their related associations (0 = SOC Learning Collaborative, 1 = Group composition (socio-professional network: SOC Coordinators, representatives of state/public agencies); 2 = information pool (information exchange and resource sharing); 3 = asset mapping and capacity development; 4 = Green Light, Red Light, Yellow Light lens). Figure 2 presents the outputs of the learning collaborative and shows that each succeeding sphere was contingent on the other. Figures 1 and 2 are both conceptual and illustrative. The inception of a learning collaborative through information and resource sharing, can translate into asset mapping and potentially result in capacity development. It is important to note that not all information shared amounted to or reflected sharing of resources.

Fig. 1
figure 1

Components of the learning collaborative

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Fig. 2
figure 2

Outputs of the learning collaborative

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The second broad finding—the roles and experiences of SOC coordinators in developing SOCs—offers specific examples of information and resources shared, and supporting evidence for our observations and conclusions about the learning collaborative and its processes.

Roles and experiences of SOC coordinators in developing SOCs

Setting up SOCs (SOC development)

Several participants discussed the challenge in setting up and managing SOCs. It was apparent that SOC development could be demanding, and the perseverance and tenacity of the coordinator were critical:

Cooridnator 1: [In our] county, we finally have a board. In the past year I tried to form a board twice and people said, “no time.” This November 2018 I tried the 3rd time and got 5 volunteers. We have held 3 meetings and redefined our mission, vision, and develop some general ideas for our strategic plan: -Reduce stigma, -provide healthy strategies to reduce negative impact on [mental illness]. –identify service providers (not physically in [our community] but that can serve our community)

Coordinator 2: I just relaunched SOC in (our) county and I have had two new meetings so far and plan to have [a] SOC meeting the last Tuesday of the month…

Coordinator 17: Since being awarded the grant in 2016 I have been trying to interact with both the prevention and SAPC [Substance Abuse Prevention Council]. The SAPC has been receptive and recently collaborated on an annual event, however the other prevention group has not been as receptive. I am curious to get feedback on how this relationship can improve.

As the above excerpts indicate, multiple engagements spanning a considerable amount of time, at least several months in one instance, were necessary to kick start the SOCs in some communities. Further, having to “relaunch” the SOC in a particular community suggested that initial attempts at starting the SOC may not have been successful or received the desired response. It is also evident from the above that it takes much more than having a grant or funds to build connections and establish a robust SOC. As shown above, Coordinator 17 reached out to colleagues for support in the form of feedback to help move the SOC development process forward.

Strategies for developing the SOC

SOCs often functioned through consortiums comprising members from different public service agencies (mental health, child welfare, juvenile justice, education), as well as faith-based organizations (Pires 2010). Other SOC members are people with lived experiences either as caregivers of people with serious emotional disturbances or the individuals themselves dealing with or recovering from mental illness (Jivanjee and Robinson 2007; Friesen et al. 2011). The SOC coordinators in the forums frequently discussed strategies for getting people involved in their SOCs. In response to Coordinator 1’s request for strategies to bring families and youth to the table”, colleagues from other communities suggested:

Coordinator 3 -: Food and childcare. Our agency also hosts Parent Cafes.

Coordinator 4: [The state SOC’s] YFSC [Youth and Family Subcommittee] and our chairs may be available to consult…we do have some family members in the state who could assist as well as youth.

Coordinator 5: I had a youth engagement pizza party a few weeks ago. I invited youth from the local schools and [a local university]. I was able to explain what SOC is and then answer questions. Then we played games.

Coordinator 6: I have been meeting with established youth clubs in our school systems. Met with one school last week and two youth will be attending our SOC Meeting next week… I just go out and meet with people.

These excerpts revealed a variety of common as well as unique strategies the coordinators employed. Having food or refreshments for meetings is a commonly used tactic to encourage participation. Having childcare and Parent Cafes, which are peer support groups for caregivers often utilized in behavioral health and child welfare settings, demonstrated an awareness of needs that could be impediments to engagement (Geiger and Schelbe 2021). Again, the inclusion of games by Coordinator 5, underscores the point about the variety of engagement strategies. It is important to note the attention to participant-centered and demographically appealing approaches. Coordinators also discussed how they utilized their other positions or affiliations to harness social capital:

Coordinator 3: We are also the Youth Service Bureau for our county. I have met with youth as resource teens. I am also one of the Human Trafficking 101 trainers and use that to meet people who may be interested [in the SOC].

Coordinator 7: I met with Mayor of [our city] to discuss integrating new youth council that is being developed in the county. We discussed having a mental/behavioral health advisory group to the local system of care.

Coordinator 8: I was able to make contact with the new Judge who is interested in becoming involved with the SOC.

Additional Challenges. Despite these efforts, additional challenges in developing SOCs were identified. On the composition of the consortiums, a coordinator shared that in their SOC there was some apprehension about the involvement of youth and families:

Coordinator 9: SOC members seem to like the way we’re going, but when I talked about youth and family subcommittee, I felt like they are not convinced YET about the value and how to do/form and maintain a youth and family subcommittee. (Parent Café [and local community mental health center] will help develop this committee). If anybody can share with me their experience forming the subcommittee I’d be very grateful, I believe other success stories can give me tools to talk more and instill hope in the project.

A number of implementation challenges were identifiable in the extract above: (1) limited knowledge about the value of youth and family involvement, and (2) a skill-based deficit about (a) how to initiate and (b) maintain youth and family involvement. Though this coordinator was committed to having youth and family play a role in the SOC, it appears that they had limited knowledge, experience, or the skills to address this critical challenge. However, they were comfortable requesting assistance from their colleagues. The transtheoretical model (stages of change) offers another plausible explanation for the situation presented in the extract above. While the coordinator contemplating and preparing to initiate change, the SOC members were not yet ready for that change (Prochaska et al. 2001).

SOC Sustainability. The coordinators also discussed other complex and structural SOC dynamics. For example, a coordinator posed the question, “How do you build the SOC if your agency that holds the grant has a different idea of SOC?” (Coordinator 17). This question bordered on issues pertaining to the fiscal agents and the goal or mission of the SOC. Though the SOCs typically functioned as coalitions working collaboratively, the issue about which agency holds the grant suggests there may be power imbalances that could be problematic. From the discussions, it became apparent that the grants funding SOC development were structured differently and “a lot of struggles can stem from who holds the grant” (Coordinator 6). Other coordinators expressed concerns about the sustainability of their SOCs following its development:

Coordinator 7: Something that I emphasize at the SOC meetings is that transition and change is a reality, so sustainable relationships between agencies and not just representatives from those agencies is stressed the most…My focus is getting the buy in and dedication

Coordinator 6: Whenever I think ‘sustainability’, I always automatically put the word ‘financial’ in front of it, and I feel lost on how to get there.

These perspectives show multiple factors are necessary for the development and sustainability of a SOC. In this particular context, SOC sustainability was a function of relational, as well as a financial elements. For the relational element, further distinction was made between relations among personnel from different agencies and inter-agency relationships. The importance of this distinction was that inter-agency relationships indicated connection at a deeper level. Often such relationships were formalized with memoranda of understanding and written into agency policies. Relationships at that level tended to last longer and continued even after those who initiated it move on. In contrast, a relationship that was only at the level of representatives was more likely to be short-lived and may end once the representatives involved moved on to new jobs with different entities or even assumed new roles within the same agency.

Successes and navigating challenges

SOC coordinators frequently discussed how they navigated challenges and their successes in developing a structure and operationalizing their SOC. There was considerable reliance on volunteers to accomplish tasks:

Coordinator 6: I struggled gaining volunteers for a Policies and Procedures Review Subcommittee, until I complimented people. I approached individuals who have experience, expertise, and drive, complimented those skills, and got three members! Building off strengths!!!

To build support for the SOC’s work, one coordinator stated, “I have found that the work group structure has been successful” (Coordinator 17). Regarding the difficulty in getting people to take on certain tasks, the benefits of participating in the SOC were not always clear to members or potential recruits and some coordinators often faced the question, “What’s in it for me?” (Coordinator 6). One participant shared:

Coordinator 7: I have been pushing that SOC is there not just for the youth and family that we serve, but also for the benefit of service provider promotion, growth, and development. I emphasize strength in numbers philosophy and that the best communities have the strongest relationships.

Other strategies offered by participants to increase appreciation of what SOCs represented and facilitate SOC goals included the making of “orientation packets [manuals]” for new members. The contents of these packets included “our important ‘catch you up’ info.” Some participants discussed having a more interactive approach involving discussions and presentations by the SOC members to get people and agencies acquainted with each other:

Coordinator 10: We don’t have an amazing grasp on this, but we do partner presentations at each monthly meeting. These are 15-minute presentations that include, who the agency is, who they are as the SOC representative, how the other partners in the room can collaborate with their agency, and then major gaps/needs, etc. We then have conversation about the presentation afterward…We also have cards on each seat that folks can write questions, concerns, future agenda items, etc. they can fill out.

Coordinators’ roles and activities

The SOC coordinator role was multi-dimensional. From the points presented above, it is evident that there were several tasks involved with setting up SOCs such as providing orientations, and recruiting community members and professionals. Beyond that, SOC coordinators were involved in brokering and resource sharing which included coordinating and promoting training opportunities:

Coordinator 10: We are focusing on getting habilitation specialists, respite providers and training and support providers for our counties up here.

Coordinator 11: Could we [our county] have a local First Responder conduct the Question Persuade Refer (QPR) training? [A question posed during discussions about suicide prevention].

Coordinator 12: Youth First [in a local area] is bringing [an expert in adolescent medicine and behavioral issues] in for a one-day training and already 125 people have registered. Even more exciting is that he is presenting for physicians the evening before on ‘Resilience and Youth: A Stress Informed Approach’

Resource provision activities also supported and reflected greater community engagement and communication across systems. For example, a coordinator shared that they, “just met with Assistant Superintendent, and he is ready to get his staff trained [in QPR]” (Coordinator 13).

Discussion

This study is the first to qualitatively examine the experiences and roles of SOC coordinators who support the development and expansion of local SOCs to address access to a full array of mental health services for youth and their families. In addition to identifying various utilized strategies, the study reflected the organic growth of a socio-professional SOC coordinator network leveraged to support coordinators in their work and facilitate establishing local SOCs.

The findings of this study provide validation for Stroul’s (2002) assertion that system of care development is inherently complex and challenging as it requires attention to several elements and mechanisms including training, financing, policy changes, and coordination across multiple levels and systems. The study provides valuable insight on the intricacies of SOC development. In sharing their experiences, the coordinators revealed the SOC to be a community-based, grassroots approach towards achieving better behavioral health services and promoting the general well-being of youth and families. Consistent with the definition, principles and vision of what a SOC should be, the findings show that though SOC principles may be explicitly articulated, and the vision clearly stated, setting up SOCs is challenging (Brannan 2003; Pires 2010; Kutash et al. 2011). Multiple strategies are necessary for the effective establishment of SOCs. For example, the approaches coordinators utilized or suggested for recruiting members were not actually the same as those they used in setting up their work groups (which can also be used in reference to various committees/subcommittees) or running the SOCs. The study shows that the process of setting up SOCs is not necessarily formulaic and critical attention needs to be given to the varying social and community contexts (Brannan 2003).

Recruiting and engaging representatives of local child service organizations, various community systems, and families is central to developing a SOC consortium that could address local access to child mental health services. However, coordinators shared challenges related to certain communities’ readiness in engaging different constituents for SOC development (Behar and Hydaker 2012; Karikari et al. 2021).

A notable challenge identified in this study was meaningful family and youth involvement. Families and youth bring much value to the SOC table. Stemming from their involvement with different service systems, families have unique insights into the complexities of SOCs (Hoover et al. 2018). With lived-experience in their children’s services, families are impacted by system-level issues, such as variability in access to effective services and service fragmentation (Reynolds et al. 2015). This makes them uniquely qualified to collaborate in developing system policies that can improve services for all youth. However, the findings, consistent with other studies, show some of the inherent tensions in the behavioral health field markedly, questions about the legitimacy of youth and families to engage in the behavioral health system in a different capacity other than being clients or consumers of services (Jivanjee and Robinson 2007; Spencer et al. 2010). Pires (2010) identifies this challenge in embracing youth and families as core members of SOCs to be one of the entrenched problems in the development of SOCs.

SOC Coordinators can be the bridge that connects the lived experience of families with membership in the local SOC consortium. The coordinator helps consortium members understand the role of youth and family members and their unique contributions. They make sure families are welcomed and feel safe. As consortium facilitators, they ensure that everyone at the table has a voice, are valued, and treated as equals. They can facilitate the integration of families by addressing logistical and technical barriers such as the scheduling and location of meetings, using formats and tools that enhance participation, and using language stripped off the jargons and technical frippery.

The findings highlight SOC coordinators’ need for training, technical assistance, and support to equip them with knowledge and skills to effectively develop SOCs. The central role the socio-professional network and learning collaborative played in addressing that need was apparent. Figure 3 illustrates how the learning collaborative serves as a bridge and implementation driver for SOC development. It also shows the possibility for positive circularity and recurrence of the process. The learning collaborative provided possible solutions for the challenges coordinators faced and their questions.

Fig. 3
figure 3

Coordinators’ learning collaborative as an SOC implementation driver

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Theoretical perspectives on the findings

The findings resonate with social capital theory and knowledge (intellectual) capital theory. We also find the theory of inventive problem-solving (TRIZ) relevant in explaining our findings. The theory of inventive problem-solving (TRIZ) (Alʹtshuller 1996) provides an overarching and generalized explanation for the findings. A core proposition of TRIZ is the universalizing or globalizing of problems and challenges. TRIZ posits that problems in innovation are universal and a common feature of the human experience as such analogs exist across fields and there is always a likelihood that others have already experienced whatever challenge you are facing and in cases where they developed solutions you can draw on or adapt their solutions for yours. For the current study, the findings show that the challenges certain coordinators encountered could be generalized. There were other coordinators who did not only find those challenges relatable but also proffered solutions they had employed. Social capital theory and knowledge (intellectual) capital theory help provide additional insight and appreciation for group dynamics in the learning collaborative (Covell and Sidani 2013).

In its many iterations, social capital, essentially, reflects the influence and impact of relationships including the tangible and intangible assets people gain by virtue of those relationships (Putnam 1993; Portes 1998; Palloni et al. 2001). In defining social capital, theorists have also highlighted the knowledge and information resources that are established through social connections (Grootaert and van Bastalaer 2002). The composite of knowledge, relevant practice experience, and expertise people possess is what is designated intellectual capital (Ahlgren 2011).

Social capital is often categorized as linking, bridging, and bonding. Linking social capital points to the connections between people among whom there is a formal hierarchical and power divide. Bridging social capital refers to connections among people who may be acquainted with each other yet belong to different groups or circles. An example will be connecting with people from different departments. Bonding social capital refers to connections among people within the same circles. There are high levels of similarity in terms of shared characteristics, including identity, situations and emotional connections (Aldrich and Meyer 2014; Grootaert and van Bastalaer 2002; Brisson et al. 2009). For the current study, bonding capital best describes the dynamics of the learning collaborative. The coordinators had a shared identity, and it is evident in their responses that they could all find the experience of developing SOCs relatable. Covell and Sidani (2013) adapted intellectual capital theory for nursing, termed nursing intellectual theory, noting how academic knowledge and practice experience are combined and utilized for clinical decision making and efforts to improve patient outcomes. In the current study, a similar basis is established for SOC development. Applying social capital theory and intellectual capital theory to the findings, we see how the learning collaborative fostered relationship building, information sharing, and knowledge acquisition for the purposes of SOC development. The learning collaborative presented coordinators encountering challenges an opportunity to draw on the experiences and knowledge of their colleagues.

Based on questions several coordinators often posed, routine early preparation or orientation for coordinators would be helpful. Training is vital in building knowledge, self-efficacy, and providing some insulation against the pressures and stress of facilitating change in the behavioral health field. This is especially important when one considers the variation in the coordinators’ backgrounds and experience prior to taking up the SOC coordinator role. Continued engagement in a learning collaborative would be beneficial to coordinators as they strive for further implementation and sustainability.

Limitations

It is possible the forums from which the data were derived—a digital online platform—may have limited the participation of coordinators who were not well-acquainted with it or had a greater preference for in-person discussions (Lunnay et al. 2015). Additionally, the state-local SOC structure featured in this study may be unique to that state, possibly limiting replication.

Yet, as is typical of qualitative studies, this study did not aim to generalize its findings. However, the findings are transferable and relevant to deepening understanding of the SOC coordinator role and the dynamics of SOC development. In that regard, the findings are transferrable to other SOC contexts and the behavioral health field. Further research is needed to examine the experiences of SOC coordinators and people involved in community mobilization efforts towards SOCs and behavioral health service system development.

Implications for behavioral health

The SOC model represents an effort at increasing communities’ understanding and appreciation of behavioral health issues and helping to decentralize the knowledge and practice of behavioral health. Research suggests decentralizing behavioral health is essential in reducing the stigma towards mental health and promoting service utilization (Stroul and Friedman 1986; Ouellette et al. 1999; Pires 2002). The local SOC coordinator role is vital for the attainment of this objective. There is a need to recognize and emphasize what SOC coordination indirectly supports other human service providers, community organizations and activities, school systems, children/youth and families, and access to behavioral health services. The coordinator can be a hub for cross-system communication. The findings show the potential of SOCs for transformative behavioral health practice.

The reported experiences offer clear indications of the skills and supports SOC coordinators need such as navigating different terrains, promoting the representation of diverse stakeholders including youth and families, and incorporating multiple perspectives to build cross-system collaboration and establish a coordinated network of behavioral health services and supports. The findings of this study demonstrates the synergetic value of learning collaboratives or communities in SOC development. The findings highlight both the explicit and implicit curricula that guide SOC coordinators in their work. Besides what conventional manuals and training may provide, through the learning collaborative that emerged from routine meetings, a socio-professional SOC coordinator network organically began in which coordinators supported each other by drawing their diverse knowledge and experiences. Advocacy for the creation of front porches in SOCs that allow for comfortable and nonjudgmental engagement between local residents and service providers should be extended or adapted for coordinators (Callejas et al. 2008, 2010). It is important to foster a space that allows for vulnerability as coordinators share their experiences, especially their challenges and needs, as they strive to develop SOCs (Callejas et al. 2008, 2010). The findings highlight key issues in the behavioral health field that need the attention of all stakeholders and provide an empirical base that can inform the training and support of SOC coordinators. On a broader scale, incorporating supportive learning collaboratives for change agents could be a dynamic strategy to support the effective implementation of system-wide changes or enhancements in behavior health services.