The Relationship between Policy Instruments and Collaboration in Systems of Care for Children with Serious Emotional Disturbance

2.50
Hdl Handle:
http://hdl.handle.net/10755/156864
Type:
Presentation
Title:
The Relationship between Policy Instruments and Collaboration in Systems of Care for Children with Serious Emotional Disturbance
Abstract:
The Relationship between Policy Instruments and Collaboration in Systems of Care for Children with Serious Emotional Disturbance
Conference Sponsor:Sigma Theta Tau International
Conference Year:2002
Conference Date:July, 2002
Author:Evans, Mary, PhD
P.I. Institution Name:University of South Florida
Title:Professor and Director of Research
Objective: The purpose of this research was to examine the relationship between the policy mechanism used to establish systems of care for children with serious emotional and behavioral disorders and the resulting level of collaboration among child-serving agencies. Design: A two phase mixed methods design was used. Phase I was a national survey of directors of children's mental health in the 50 states regarding the mechanism and principles used to establish systems of care. These data were submitted to cluster analysis. Phase II consisted of site visits to the 5 exemplar states to collect data on collaboration at various levels such as direct service, regional and state levels. Population, Sample, Setting, Years: The population comprised systems of care for children with emotional and behavioral problems in all 50 states. The sample for phase II was the five exemplar sites (Hawaii, Minnesota, Mississippi, Nevada and Oklahoma) one each representing the five clusters or approaches to establishing systems of care. This was a three-year study. Variables Studied: The independent variable was the policy instrument (i.e., legal mandates, inducements, system change interventions, or capacity building) used to establish the system of care. The dependent variable was collaboration at three service levels, client regional and state. Methods: The methods in Phase I included a mail survey, review of policy instruments and abstraction of state information to a level of complete consensus among the five-team members. Phase II methods were site visits involving observation, interview of key informants, focus groups, and administration of Greenbaum and Brown's Collaboration in Systems of Care Scale. Findings: States have used five different approaches to establishing systems of care. Collaboration among child-serving agencies varied depending on the policy instrument that was used and on the location of the persons evaluating the collaboration with bottom up approaches resulting in higher levels of collaboration than top down approaches. Those approaches that provided inducements were more likely to result in higher collaboration scores than those involving legal mandates, particularly mandates without resources. A number of factors facilitating or inhibiting collaboration were identified. The facilitating factors fell into three groups: attitudinal factors such as shared vision, behavioral factors like information sharing, and structural and organizational factors like shared power and responsibility. The inhibiting factors included attitudinal factors such as territorial or turf issues, behavioral factors such as not inviting families to meetings, and structural and organizational factors like conflicting policies or mandates. Conclusions: The policy mechanism used to establish systems of care is an important variable related to the level of collaboration established among agencies. This is important because level of collaboration is considered a prerequisite for positive system and child level outcomes from these systems of care. A number of discrete facilitating and inhibiting factors related to collaboration in systems of care have been identified. Implications: There are research, education, and policy implications of this research. The research implications include support for backward mapping (beginning the study at the level where the maximum impact of a policy is expected) and case study approaches to understanding policy initiatives. Backward mapping has seldom been used by nurse researchers, but may prove useful when they are conducting policy analysis studies. Educational implications focus on preparing nurses for collaborative roles in interdisciplinary and interagency teams. Curricula can be devised to include information on the facilitating and inhibiting factors in order to promote higher levels of collaboration among health and social service personnel. The policy implications include the importance of studying intermediate variables such as collaboration before undertaking child and family outcome studies because if low levels of collaboration exist, it is unlikely that the desired child and family outcomes can be obtained. Also, policy instruments make a difference in the amount of collaboration that results from system of care initiatives and nurses who are involved in establishing systems of care must be aware of these differences. Finally, many nurses function as case managers and care coordinators, the point at which backward mapping begins, and they may benefit from understanding the relationships among policy instruments, collaboration, and what they are able to accomplish with persons in their caseload.

Repository Posting Date:
26-Oct-2011
Date of Publication:
Jul-2002
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleThe Relationship between Policy Instruments and Collaboration in Systems of Care for Children with Serious Emotional Disturbanceen_GB
dc.identifier.urihttp://hdl.handle.net/10755/156864-
dc.description.abstract<table><tr><td colspan="2" class="item-title">The Relationship between Policy Instruments and Collaboration in Systems of Care for Children with Serious Emotional Disturbance</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2002</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">July, 2002</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Evans, Mary, PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of South Florida</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Professor and Director of Research</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">mevans@hsc.usf.edu</td></tr><tr><td colspan="2" class="item-abstract">Objective: The purpose of this research was to examine the relationship between the policy mechanism used to establish systems of care for children with serious emotional and behavioral disorders and the resulting level of collaboration among child-serving agencies. Design: A two phase mixed methods design was used. Phase I was a national survey of directors of children's mental health in the 50 states regarding the mechanism and principles used to establish systems of care. These data were submitted to cluster analysis. Phase II consisted of site visits to the 5 exemplar states to collect data on collaboration at various levels such as direct service, regional and state levels. Population, Sample, Setting, Years: The population comprised systems of care for children with emotional and behavioral problems in all 50 states. The sample for phase II was the five exemplar sites (Hawaii, Minnesota, Mississippi, Nevada and Oklahoma) one each representing the five clusters or approaches to establishing systems of care. This was a three-year study. Variables Studied: The independent variable was the policy instrument (i.e., legal mandates, inducements, system change interventions, or capacity building) used to establish the system of care. The dependent variable was collaboration at three service levels, client regional and state. Methods: The methods in Phase I included a mail survey, review of policy instruments and abstraction of state information to a level of complete consensus among the five-team members. Phase II methods were site visits involving observation, interview of key informants, focus groups, and administration of Greenbaum and Brown's Collaboration in Systems of Care Scale. Findings: States have used five different approaches to establishing systems of care. Collaboration among child-serving agencies varied depending on the policy instrument that was used and on the location of the persons evaluating the collaboration with bottom up approaches resulting in higher levels of collaboration than top down approaches. Those approaches that provided inducements were more likely to result in higher collaboration scores than those involving legal mandates, particularly mandates without resources. A number of factors facilitating or inhibiting collaboration were identified. The facilitating factors fell into three groups: attitudinal factors such as shared vision, behavioral factors like information sharing, and structural and organizational factors like shared power and responsibility. The inhibiting factors included attitudinal factors such as territorial or turf issues, behavioral factors such as not inviting families to meetings, and structural and organizational factors like conflicting policies or mandates. Conclusions: The policy mechanism used to establish systems of care is an important variable related to the level of collaboration established among agencies. This is important because level of collaboration is considered a prerequisite for positive system and child level outcomes from these systems of care. A number of discrete facilitating and inhibiting factors related to collaboration in systems of care have been identified. Implications: There are research, education, and policy implications of this research. The research implications include support for backward mapping (beginning the study at the level where the maximum impact of a policy is expected) and case study approaches to understanding policy initiatives. Backward mapping has seldom been used by nurse researchers, but may prove useful when they are conducting policy analysis studies. Educational implications focus on preparing nurses for collaborative roles in interdisciplinary and interagency teams. Curricula can be devised to include information on the facilitating and inhibiting factors in order to promote higher levels of collaboration among health and social service personnel. The policy implications include the importance of studying intermediate variables such as collaboration before undertaking child and family outcome studies because if low levels of collaboration exist, it is unlikely that the desired child and family outcomes can be obtained. Also, policy instruments make a difference in the amount of collaboration that results from system of care initiatives and nurses who are involved in establishing systems of care must be aware of these differences. Finally, many nurses function as case managers and care coordinators, the point at which backward mapping begins, and they may benefit from understanding the relationships among policy instruments, collaboration, and what they are able to accomplish with persons in their caseload.<br/><br/></td></tr></table>en_GB
dc.date.available2011-10-26T15:12:54Z-
dc.date.issued2002-07en_GB
dc.date.accessioned2011-10-26T15:12:54Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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