Graduation Year

2011

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Curriculum and Instruction

Major Professor

Albert J. Duchnowski

Keywords

children's mental health, family driven care, implementation, model, system of care

Abstract

The engagement of families of children and adolescents with Serious Emotional Disturbance (SED) as full partners in individual treatment, organizational, and system level decision making has become an important focus for systems of care (SOCs) serving youth with emotional and behavioral challenges. SOCs typically include cross-agency partnerships with mental health, child welfare, juvenile justice, and education for the purpose of providing services and supports for youth with SED who have multi-agency needs. Implementation of a federal mandate requiring family driven care (FDC) within systems of care funded through the Children's Mental Health Initiative (CMHI) has revealed that most system of care leaders recognize the value of families as full partners in decision making at all levels of the system, strive to have meaningful family involvement, but are challenged by how to successfully engage families in this process.

The purpose of this research study was to explicate more fully the roles of families by examining the structures, processes, and relationships characteristic of family involvement in system level service planning and delivery decisions within established system of care communities and to develop a framework that depicts how SOCs engage families in system level decision making. A qualitative secondary analysis (QSA) was conducted, using data collected through Case Studies of System Implementation, a five-year research study that used a multi-site embedded case study design to examine system of care development. Six well-functioning SOCs throughout the country participated in the original study. Team-based data collection from these sites included 307 system documents (e.g., state- and local-level reports; evaluation, grant and budget information; organizational charts), direct observations (41), and semi-structured interviews with key stakeholders (209), as well as stakeholder completion of 113 ratings exercises related to factors critical to system development and implementation. Interviews were conducted with policy makers, administrators, judges, service managers, direct care staff, families, and youth (>18) across all partner agencies within the SOC. Findings from the original study revealed not only information on system development but an emerging theme of the important role of families in planning and implementing the SOC.

A team-based QSA was conducted to more thoroughly examine how families are engaged in system level decision making. Findings reveal the necessity of an engaged, locally developed, autonomous family organization that is regarded as an equal system partner, and at least one system of care leader who promotes FDC. Also present are collaborative activities such as training and coaching, evaluation, and grant writing; and family organization activities such as capacity building of families and strategic outreach to system partners. The SOCs also demonstrate specific relationship-building activities and exhibit a shared value of FDC throughout the system. A framework was developed to depict implementation of FDC based on study findings. The framework was then modified based on data collected during focus groups conducted with Lead Family Contacts, Principal Investigators, and Project Directors from system of care communities currently funded through the CMHI. Research results yield specific structures, processes, relationships, and a foundational shared value for FDC that are present in systems of care that engage families as partners in system level decision making.

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