Impact of Team Structure on Achieving Treatment Goals in a System of Care

Abstract

Although some evidence suggests that providing treatment via service coordination teams is related to improved outcomes among youth in a system of care, the aspects of team structure that contribute to treatment effectiveness are not well understood.This study draws on team membership and attendance data to identify and describe the structure of service coordination teams in the Dawn Project, a system-of-care initiative in Indianapolis, Indiana.This analysis examines three dimensions of team structure—size, form, and role composition—as well as the effect of these dimensions on the young people's program disposition.The results suggest that service coordination teams are most likely to be effective in achieving the team's treatment goals when they consist of four to eight members and include the youth and multiple family members. More generally,the findings underline the importance of considering team structure as an important force in shaping the effectiveness of service coordination programs and the potential utility of social network methods for studying these effects.The implications for management of service coordination teams and for future research on service coordination teams are discussed.ERIC R. WRIGHT, PhD, is an associate professor in the School of Public and Environmental Affairs at Indiana University—Purdue University Indianapolis (IUPUI), and director of health policy at the Center for Urban Policy and the Environment. His current interests include health policy, HIV/AIDS prevention, and mental health and social services for adults and children with serious mental health challenges. LISA A. RUSSELL, PhD, is associate director of research for ETR Associates. Her current interests include child maltreatment, domestic violence, and mental health. JEFFREY A. ANDERSON, PhD, is the director of the Center for Urban and Multicultural Education and an associate professor and area coordinator for special education programs in the School of Education at IUPUI. His current research interests include creating models of school-based interagency collaboration to improve prevention and early intervention of emotional and behavioral challenges in students. HAROLD E. KOOREMAN, MA, currently conducts research in health policy and wraparound services for children at the Center for Urban Policy and the Environment. DUSTIN E. WRIGHT, MS, conducts research in health policy, mental health services for adults and children with serious mental illness, and HIV/AIDS prevention at the Center for Urban Policy and the Environment. Address: Eric R. Wright, School of Public and Environmental Affairs, Indiana University—Purdue University Indianapolis (IUPUI), BS 4059, 801 W. Michigan St., Indianapolis, IN 46202; e-mail: ewright@iupui.edu

Medical Sociology and Health Services Research: Past Accomplishments and Future Policy Challenges

“…For example, the fragmented and unstable nature of today's health care organizations has led to the rapid adoption of clinical care teams to integrate services. Health services researchers have described and studied these teams using sociological theories of group processes and social interaction, ranging from social network conceptualizations of teams (Pescosolido, Wright, and Sullivan 1995) to more process-related dynamics (Wright et al 2006). Similarly, sociological theory is central to research on the social dynamics of provider-patient interaction, focusing on how organizational factors influence providers' attitudes toward patients and the approaches they take in communication and services delivery (Waitzkin 1991).…”

Service Process and Quality in Therapeutic Foster Care: An Exploratory Study of One County System

“…Furthermore, caseworkers may be unable to assist foster care youth and their families because of poor training and knowledge (Inkelas & Halfon, 2002). Under such circumstances, foster care workers could benefit from interdisciplinary collaborative team processes designed to support effective collaboration between systems of care and TFC services (Wright, Russell, Anderson, Kooreman, & Wright, 2006).…”

Predicting Outcomes Among Adolescents With Disruptive Disorders Being Treated in a System of Care Program

“…The purpose of this secondary analysis differed from the purpose of the DPES (a) by focusing only on adolescents ages 12 to 17 years with disruptive disorders and their caregivers and (b) by examining the degree to which changes in adolescent personal strengths and family functioning predicted changes in adolescent behavioral and social functioning. On the other hand, the DPES focused on youths ages 5 to 17 years and examined (a) the degree to which demographic variables, referral source, Medicaid status, presenting problems, and restrictiveness of living arrangement predicted changes in clinical functioning (Allen et al, 2006); (b) the impact of SOC treatment on changes over time in restrictiveness of living arrangements and on rates of recidivism of program completers (Anderson, McIntyre, & Somers, 2004); (c) the impact of team structure on achieving treatment goals (Wright et al, 2006); and (d) patterns of clinical improvement over time in both children and adolescents (Anderson et al, 2008).…”

“…By using strengths-based, child-centered, family-driven, individualized, and culturally competent care, SOC programs are designed to integrate and coordinate social services and resources in order to improve the behavioral and social functioning (i.e., behavior problems and functional impairment) of participating youths (Davis-Brown et al, 2012; Stroul & Blau, 2010). Moreover, in recent studies these strengths-based approaches for delivery of mental health services, such as SOC, have yielded moderately improved outcomes for children and adolescents (i.e., youths) compared to traditional mental health programs (Anderson, Wright, Kelley, & Kooreman, 2008; Copp, Bordnick, Traylor, & Thyer, 2007; Grimes et al, 2011; Manteuffel, Stephens, & Santiago, 2002; Stambaugh et al, 2007; Walrath, Ybarra, & Holden, 2006; Wright, Russell, Anderson, Kooreman, & Wright, 2006).…”