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Michigan
Outcome Identification Project
Data for the Changes domain was gathered during Part 2 of the focus group sessions. Focus group participants were asked what system- and program-level changes are needed to accomplish the outcomes they had identified. As for the responses in the first two research domains, the responses in the changes domain emerged from the focus group discussion. In Part 2, however, participants were specifically asked to consider changes at the system- and program-levels. Table 9 summarizes participant responses in Part 2 of the focus group sessions.
Two themes emerged strongly regarding changes at the system-level: 1) the importance of increased interagency collaboration in achieving outcomes for children and families; and 2) the impact of funding issues in achieving outcomes. These two categories of responses received far more attention across all the focus groups than any other change discussed by participants.
The issue of interagency collaboration surfaced in focus group discussions a total of 61 times. In addition to general collaboration issues, this category includes collaborative planning, state-level collaboration, collaboration with private-sector providers, common ownership of kids, building interagency trust, establishing common outcomes across agencies, improved communication, and adjusting agency jurisdictions to match. The issue of collaboration was identified 28 times by stakeholders within mental health, 21 times by stakeholders outside of mental health, and 12 times by family members. While the number of family members identifying collaboration issues with regard to achieving outcomes is relatively less than other stakeholder groups, it should be noted that the issue of collaboration drew considerably more attention from family members than any other system-level response. Collaboration was the first system-level change discussed by minority parents who described collaboration as being "wherever you come into the system, that agency would make sure you get what services are needed."
Also addressing the issue of system-level changes necessary to achieve outcomes, CMH staff believed "true collaboration -- at the community level and at the state level" (as opposed to collaboration existing only on paper or in name only) is necessary to achieve outcomes. FIA state staff also spoke of "true collaboration", suggesting that incentives be built into the system to enhance true collaboration."
Speaking on the issue of collaboration, Probate Court administrators commented that, "there is no understanding of what each agency can/will do . . . we have different ways of working with kids and different approaches to problem solving." Probate court administrators felt that "more interagency training as to understanding each other's systems" was crucial and that from that effort successful interagency assessment teams could be established. FIA state staff also identified more training as a need, saying that "training opportunities should be structured for FIA child welfare staff and CMH staff to work more closely together to clarify misinformation about each other's system" and that "a common set of principles needs to be embraced by FIA and CMH." Many focus groups expressed the need for a shared vision across agencies.
This focus on collaboration and establishing a shared vision led to a discussion of funding issues in many focus group sessions. Funding issues surfaced a total of 38 times in focus group discussions in relation to changes needed to accomplish outcomes. This category includes issues of pooled funding, increased funding, funding family needs rather than programs, and documenting costs accurately. The FIA state staff expressed concern that "money drives the services rather than services driving the money," suggesting that funding should be directed toward a shared set of common outcomes across the state. Within the category of funding, families mentioned funding issues 3 times, stakeholders outside of mental health mentioned funding 10 times, and stakeholders within mental health mentioned funding a total of 25 times.
The significance of issues of collaboration and funding for focus group participants is evident when these categories are compared to the third most significant system-level change identified by participants, the establishment of standardized statewide practices for community mental health. By comparison, this category, which includes issues of uniform or standard services for community mental health throughout the state and clearer standards for those services, was identified only 12 times during focus group discussions.
The top three responses in program-level changes received similar attention across stakeholder groups. The three top changes identified for the program level include: 1) improved staff quality/training; 2) improved service access; and 3) support for kids, parents, families and caregivers. These results are summarized in Table 9.
The categories of improved service access and support for kids, parents, families, and caregivers, both received equal attention from participants with a frequency of mention of 29. Improved service access was described by participants as one-stop shopping for services, improved referral information, referral across agencies, quicker access to services, shorter waiting lists. This program-level change was mentioned 12 times by parents, 9 times by stakeholders outside of mental health, and 8 times by stakeholders inside of mental health. Relating issues of access to issues of collaboration, several stakeholder groups outside of mental health expressed frustration with problems of mental health service availability FIA field staff commented that mental health services should be provided for children and families "by helping people regardless of the diagnosis or without a diagnosable mental illness" and that these efforts should be focused on providing services within the community.
Support for kids, parents, families, and caregivers, which includes support beyond clinical services and the specific mention of increased respite care, was mentioned 18 times by family members, 9 times by stakeholders within mental health, and twice by stakeholders outside of mental health. Minority parents, for example, spoke of the importance of providing support beyond clinical services such as respite for parents who were keeping children in their homes. Another parent group spoke of the need for increased physical and emotional support for families. The support services discussed included transportation, advocacy and support groups, day care, and respite care. CMH staff spoke of the need to increase the range of services offered so that they went beyond clinical treatment and helped families become better able to meet the needs of their children.
The third program-level change to be emphasized by focus group participants is improved staff quality and training, with a frequency of mention of 27. This would include issues such as increased respect for and partnership with parents, training staff in becoming more holistic and collaborative, and training in a solution-focused, strength-based service planning and delivery perspective. Within this category of staff quality and training, 14 of the total 27 responses were generated by family members, 10 from stakeholders within mental health, and 3 from stakeholders outside of mental health. Much of the focus group discussion relating to improved staff quality and training centered around building staff ability to provide community-based services that are supportive of families. Participants both inside and outside of mental health discussed the need for training that is both family-centered and strength-based, so that the focus of treatment would be more solution-focused. Parent participants discussed the need for training that helps create an environment more responsive to parents and mental health professionals who view parents as partners. MDCH leadership suggested training that would help staff become more holistic and collaborative
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