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Michigan
Outcome Identification Project
MDCH's methodological approach for the Michigan Outcome Identification Project was developed collaboratively with the Department of Child and Family Studies, Florida Mental Health Institute at the University of South Florida. This project employed focus groups as the primary method for gaining an understanding of who the public mental health system should serve, what outcomes are desired for children and families receiving services, and how services and service systems can be modified to better serve children and families.
A focus group is a carefully planned discussion designed to learn about perceptions on a defined area of interest. The Michigan Outcome Identification Project focus groups were aimed at gaining insight into the perceptions of a wide range of stakeholders both within and outside of Michigan's public mental health system. One of the most important considerations in conducting focus groups is how to appropriately group participants. In order to understand group perceptions and encourage the generation of ideas, it is important that the environment of a focus group be tolerant and non-threatening. One of the ways this is accomplished is by creating groups in which participants perceive themselves as having common issues and concerns. For example, in addition to parent groups, a focus group with minority parents was held in an effort to better understand perceptions of minority parents that might be unique to that group. Working with MDCH and the Association for Children's Mental Health (ACMH), 16 stakeholder groups for public children's mental health were identified as having common issues and concerns. Focus group participants were identified on the basis of these stakeholder groups. The stakeholder groups which participated in the focus group sessions are shown in Table 1.
Two strategies were used to capture the geographic diversity of the State of Michigan. Focus groups for parents and Community Mental Health Center Direct Services Staff were held in Flint, Lansing, Mt. Pleasant, Cheboygan, and Sault Ste. Marie in an effort to involve participants from around the state. In addition, focus group sessions were scheduled in conjunction with the statewide conferences and regularly occurring meetings of some stakeholder groups in order to minimize the disruption to participants' schedules and maximize participation. Community Mental Health Children's Administrators, Family Independence Agency (FIA) Field Staff, FIA Executive Staff, Community Mental Health Executive Directors, Probate Court Judges and Administrators, County Commissioners, and Administrators of Special Education participated in such groups. The ACMH organized the focus groups and recruited participants from each of the stakeholder groups. The ACMH was responsible for both written and telephone contact with potential participants.
Before a focus group session began, the facilitator provided participants with an overview of the purpose and process of the Michigan Outcome Identification Project. In addition, the facilitator explained the focus group method and discussed the questioning routes for both Part 1 and Part 2 of the focus group session. Participants were reminded that their participation was voluntary and that they could leave the session at any time. Participants were told that the sessions were being taped for the purpose of ensuring the accuracy of what was said and that results from the focus group sessions would be reported in an aggregate form, identifying participants strictly on the basis of their stakeholder group. Participants were encouraged to offer their opinions and ideas freely and assured that the purpose of the focus group sessions was to hear all ideas rather than establish one idea as superior to another.
The focus groups were designed to last approximately 2.5 hours each, and discussion was divided into two parts. During Part 1 of the discussion, participants focused their attention on a series of three questions focused on who the children's mental health system should serve, what outcomes are most important for the children served, and what indicators can be identified for the outcomes. For the purpose of the focus group sessions, outcomes were defined as the result or impact of services provided for children and their families, and indicators were defined as measures which provide information about whether outcomes have been achieved. Focus group participants were asked to think about indicators in terms of "how you will know" when certain outcomes have been achieved. The questioning route for Part 1 is shown in Table 2. Asking this group of questions together helped ensure that input from participants regarding priority populations would be immediately followed by information on related outcomes and indicators.
While a group facilitator led discussion, a co-facilitator recorded participant responses onto flip charts. At the conclusion of Part 1, the co-facilitator provided a verbal summary of the group's responses for the domains under discussion, making reference to notes taken on the flip charts. Participants were given the opportunity to add, delete or amend flip chart notes. After responses were clarified, participants were asked to prioritize their responses by placing stickers (three per person) next to the priority populations, outcomes, and indicators they believed to be the most important.
Once priorities had been completed in Part 1 of the focus group discussion, the group was asked to proceed with Part 2, which focused on program- and system-level changes required for the child and family outcomes identified in Part 1. The questioning route for Part 2 is shown on Table 3. The summary of Part 2 was conducted and priorities determined following the same procedure as Part 1.
Return to The Michigan Outcome Identification Project Home Page
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