Mario Hernandez

Building Upon the Theory of Change for Systems of Care

The concept of systems of care for children with serious emotional disturbance and their families is described in this article as an explicit organizational philosophy that emphasizes services that are family focused, individualized, provided in the least restrictive environment, coordinated among multiple agencies, and culturally competent. This conceptualization is contrasted with the view of systems of care as discrete interventions causally related to improving child-level outcomes. Systems of care are presented as mutable strategies for improving organizational relationships that are best judged by outcomes focused at the organizational level. Rethinking and expanding the theory of change underlying systems of care are recommended in order to support development of the knowledge base for understanding what systems of care are, what they are not, and what they can be expected to accomplish.

Evidence-based Treatments in the Field: A Brief Report on Provider Knowledge, Implementation, and Practice

This study examined familiarity, perceived effectiveness, and implementation of evidence-based treatments for children in community settings. A sample of service providers in agencies affiliated with federal programs to improve childrens mental health services was identified using a snowball sampling procedure. Forty-four percent of the sample (n = 616) responded to a Web-based survey designed to collect data on evidence-based treatments. High familiarity with, relatively high-perceived effectiveness, and generally high use of evidence-based treatments were reported. Partial implementation of treatment protocols within the context of few agency mandates and widely ranging supports for the implementation of evidence-based treatments was found. Results support the inclusion of more complex models of diffusion, dissemination and implementation in research, and development efforts for evidence-based treatments.

How organizational culture influences outcome information utilization

This article reports the results of a study of organizational culture and the local-level utilization of the client outcome information data that is generated as part of a continuous evaluation of the Texas Childrens Mental Health Plan. An in-depth study of utilization patterns was conducted at four local mental health authorities. Findings demonstrate that using outcome information in organizational decision making is grounded in the organizational culture of the information users. Developing a better understanding of the organizational culture in which a quality improvement process is implemented can provide insight into what strategies an organization might undertake to improve readiness for implementation.

Use of the System-of-Care Practice Review in the National Evaluation Evaluating the Fidelity of Practice to System-of-Care Principles

Evaluating the fidelity of service practices to system-of-care principles (SOC) represents a challenge in the human service field. The inadequate infusion of SOC principles into direct services could limit the usefulness of this approach. In this study we compare practice-level variables between well-developed SOC and traditional service systems and test the hypothesis that the adoption of SOC principles at the organizational level was associated with greater implementation of SOC at the practice level. Sites implementing SOC for at least 5 years are compared to sites providing mental health services using a traditional service delivery model. The study administered the SOC Practice Review (SOCPR) protocol. The SOCPR represents a case study approach that employs interviews and document reviews to arrive at ratings of SOC principles.This methodology proved to be an effective tool in interpreting the meaning of child and family experiences that emerged from the SOC.The findings were generally significant and support the hypothesis. Overall, SOC sites scored significantly higher (p < .05) than non-SOC sites in the child-centered and family-focused, community-based, and cultural competence domains.The implication is that SOC principles can be tested at the level of practice.

The ecology of outcomes: System accountability in children's mental health

This article provides a conceptual and practical framework called the Ecology of Outcomes. Based on this framework, agencies that serve children and families build and use outcome-oriented information systems to respond to their clients in a more flexible manner. The goal is to improve promising programs by involving stakeholders in outcome identification and in utilization of results. Problems addressed include the emphasis human services place on rules compliance, lack of feedback to program staff to allow for midcourse correction, and lack of input by key stakeholders in the identification of outcomes to be measured. The following components of the framework are described: principles of outcome accountability, prerequisites and building blocks, implementing an outcome information system, and utilizing the results. Key elements of the framework are the integration of outcome information into a service systems decision-making process and the inclusion of client, stakeholder, and provider satisfaction information.

A Historical Perspective on National Child Mental Health Policy

This country has never had a formalized child mental health policy, if one uses the definition of child mental health policy as the existence of governmental commitment to ensure the availability of appropriate mental health services to children (birth-21 years) and their families. Over the past century, the field of childrens mental health has borrowed policy from child welfare, juvenile justice, special education, and adult mental health, but attempts to form a comprehensive policy have been inadequate in scope and follow-through. The latest attempts at the creation of such a policy through the managed behavioral healthcare revolution and the federal governments Child and Adolescent Service System Program and Child Mental Health Services Initiative have been no more successful than past efforts in creating meaningful policy. Until a comprehensive policy is forged, childrens mental health services will remain informal, incomplete, and piecemeal, making it difficult for children with mental health problems and their families to receive appropriate services.

A Developmental Framework for Collaboration in Child-Serving Agencies

Collaboration for the purpose of interdependent problem solving represents a fundamental reform of services for children with serious emotional disturbance and their families, which have typically been categorical, poorly coordinated, costly, overly restrictive, and frequently provided outside of the childrens home communities. This article presents a developmental framework for collaboration that is based on the experience of families, service providers, administrators, and community members who have been involved in local collaborative processes in their own communities. The framework provides those interested in building collaboration a clear identification of the stages of collaborative development, defining characteristics of each stage, collaborative activities typical of that stage, and identification of the catalyst for change to the next stage. The results of this project indicate that while well-developed professional collaboration is a necessary component of collaboration, it is not sufficient in and of itself. The sites participating in this project related their experiences in building collaborative processes to both the development of strong interagency collaborations and the development of family participation. Their experience indicates that these two processes must be fully developed and woven together to achieve the goal of true collaboration.

Issues and Strategies for Studying Latino Student Dropout at the Local Level.

Latino student dropout is a national concern that must also be addressed strategically in local communities. Although national studies are important for pointing out areas of concern, local studies can provide more specific information for local policy development and implementation. This paper presents an example of local community-initiated needs assessment that addresses issues of Latino access to education. Focus groups and interviews were held with Latino students, parents, and community leaders as well as teachers and administrators. Issues and strategies of the needs assessment process are presented, which include involving key stakeholders, engaging community members as research partners, and engaging school personnel. General findings are presented and linked to accomplishments of the needs assessment process, such as increasing community awareness of issues and building commitment to implement strategies identified to reduce Latino student dropout.

Developing community alternatives to group home placement for SED special education students in the Ventura County System of Care

Interagency planning and resource development were used to improve available services for severely emotionally disturbed special education students who were in or at-risk of being placed in residential care. Augmented local school-based and regional day treatment services were financed by a Ventura County Social Services Agency trust fund and delivered cooperatively by the County Mental Health Agency and local education agencies. Revenues generated by the new service positions were planned to restore the trust fund. Outcomes following service implementation included: (a) an average reduction of 3.5 youths in the expected number of youths in group home placement per month; (b) a total reduction of

Creating a front porch in systems of care: Improving access to behavioral health services for diverse children and families

290,011 in the expected annual cost of placement; and (c) generation of