“If We're Going to Change Things, It Has to Be Systemic:” Systems Change in Children's Mental Health

Abstract

Communities that undertake systems change in accordance with the system of care philosophy commit to creating new systems entities for children and adolescents with serious emotional disturbance. These new entities are values-based, voluntary, and cross-agency alliances that include formal child-serving entities, youth, and families. Describing the scope and intent of one such implementation of systems of care, a mental health administrator commented, "If we're going to change things, it has to be systemic" (B. Baxter, personal communication, December 2, 2005). This paper explores the concept of "systemic" in the context of systems of care. Systems theory is used to understand strategies of purposeful systems change undertaken by stakeholders in established system of care communities. The paper presents a conceptual model of systems change for systems of care that is grounded in data from a national study of system of care implementation (Research and Training Center for Children's Mental Health in Case Studies of system implementation: Holistic approaches to studying community-based systems of care: Study 2, University of South Florida, Louis de la Parte Florida Mental Health Institute, Research and Training Center for Children's Mental Health, Tampa, FL, 2004). The model is based on Soft Systems Methodology, an application of systems theory developed to facilitate practical action around systems change in human systems (Checkland in Systems thinking, systems practice, Wiley, Chichester, 1999). The implications of these findings to real world actions associated with systems change in systems of care are discussed.

Systemic challenges in bipolar disorder management: A patient‐centered approach

“…Despite the abovementioned impressive efforts to build and prioritize large lists of BD patient concerns, and the growing use of systems approaches in psychiatric practice and research, we have not found published attempts to: (i) integrate patient concerns into a causal model, and (ii) involve patients in the model building. Systems thinking approaches illustrate that effects are often several steps removed from causes, and, because of interdependences, myriad “symptoms” can result from very few root causes which have the greatest leverage for system improvement once addressed.…”

Community and State Systems Change Associated with the Healthy Transitions Initiative

“…While none of the themes of the CSTI showed significant positive change for the communities taken as a group, two of the themes showed a trend toward significance, fiscal policies and sustainability, and accountability. Fiscal policies and sustainability is typically an extremely challenging area for system of care projects, 15,16,19,20 and this CSTI theme had the lowest grand mean score at T1. Considered individually, six of the ten communities made significant progress in this area between T1 and T2, while only one community experienced a significant decline.…”

“…15 Although expensive to administer, this approach to data collection results in finely grained information about each domain, as well as an indication of change over time. A related approach to assessment is found in the Case Studies of System Implementation (CSSI) developed by Hodges et al 16 This approach uses a multisite, embedded case study design to assess system change.…”

Systems of Care: New Partnerships for Community Psychology

“…Examples of specific methods/processes for implementation of SOCs, each with different points of emphasis, are provided by Foster-Fishman and Watson (2012), Armstrong et al (2012), and Hodges et al (2012). As these authors illustrate, the implementation of these complex community initiatives requires simultaneous attention to multiple levels of analysis, and the sequence of actions can have important implications for successful implementation.…”