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Michigan
Outcome Identification Project
A. Broad issues in the outcome domain
In the Outcome domain, focus group participants were asked what outcomes they believed the public mental health system for children should achieve. As in the Target Population domain, the responses were emergent from the content of the focus group discussions. Focus group responses to this research question can be grouped into three broad categories that mirrored the broad categories of the Priority Population domain: 1) child-focused outcomes, 2) family focused outcomes, and 3) community-focused outcomes. These results are summarized in Table 7.
Within the broad category of child-focused outcomes, three outcome categories were identified by focus group participants as the most important outcomes for children's mental health: 1) outcomes relating to functioning across life domains, 2) outcomes relating to restrictiveness of setting, and 3) outcomes relating to treatment goals.
Respondents indicated that outcomes relating to functioning across life domains were the most important priority among child-focused outcomes, with a frequency total of 66 across all focus groups. Functioning across life domains included outcomes relating to quality of life, coping skills, school functioning, and transitions to adulthood. The data illustrate that outcomes associated with improved functioning across life domains are strongly valued across all stakeholder groups with family members identifying this as an important outcome 25 times in focus group discussions, stakeholders within mental health identifying this as an important outcome 16 times , and stakeholders outside of mental health identifying improved functioning 25 times during the focus group discussions.
A parent speaking on the issue of functioning across life domains commented, "I would like to see a child that has reached adulthood with communication skills and the social skills and tools that they need to survive out there." A special education administrator suggested that an important outcome for children's mental health would be for children with varying degrees of emotional impairment to "have appropriate behavior across domains . . . behavior appropriate at school . . . the ability to participate in the community . . . the ability to be employed." An adolescent, speaking about the most important outcome for children's mental health said, "I think a sense of hope. I think that what should at least come out is a sense of hope that things can get better enough to keep you wanting to live and then go on from there to become healthier and happier in general."
Outcomes relating to restrictiveness of setting also received considerable attention from focus group participants, with a frequency of response of 18 across stakeholder groups. Outcomes in this category include children living successfully at home, children being served in their home community, and children living in less restrictive environments. Although outcomes relating to restrictiveness of setting were identified across stakeholder categories, this issue received the most attention from stakeholders outside of mental health, including FIA state staff, FIA field staff, special education administrators, and county commissioners, with a frequency of mention of 9. County commissioners, for instance, said that they believe an important outcome for children's mental health is that children become a part of the community and, as often as possible, are able to live safely at home. The commissioners also urged that an important goal is for "children [with behavior disorders and emotional impairment] to be understood by the general population and accepted in the community for what they can do." Stakeholders inside of mental health discussed outcomes relating to restrictiveness of setting with a response frequency of 8. For example, CMH direct service staff commented that an important outcome for children's mental health is that children can stay at home or in the community. Restrictiveness of setting was only explicitly identified as an outcome once by family members.
Finally, outcomes relating to achievement of treatment goals also emerged as a top response in the category of child-related outcomes, with a response frequency of 14 across all stakeholder groups. This category includes outcomes such as families meeting their treatment goals, symptom reduction, and treatment goals such as employment. It should be noted that achievement of treatment goals as an outcome had a response frequency of 8 for stakeholders inside of mental health and 3 each by family members and stakeholders outside of mental health.
Among family-focused outcomes, only one specific outcome showed significant preference over the others in this category. Focus group participants considered outcomes relating to improved family functioning as a significant priority for children's mental health. Improved family functioning was described by participants as family successes and the enhanced capacity of the family to provide a caring, stable, and safe environment. Family functioning as an important outcome was identified 23 times during the focus group sessions. In comparing the frequency of response on this issue across stakeholder categories, it was found that this outcome was mentioned much more frequently by stakeholders inside of mental health than by family members and stakeholders outside of mental health. In fact, 20 of the 23 times this outcome was mentioned, it came from participants within mental health. Family members mentioned this issue twice, and stakeholders outside of mental health mentioned it once. Interestingly, outcomes relating to improved family functioning received 89 priority votes from participants who identified priorities through the voting procedure. This was the highest number of priority votes received in any outcome category. It should be noted that 73 of the 89 priority votes came from stakeholders within mental health and the remaining 16 came from family members. Stakeholders outside of mental health did not specifically select this outcome as a priority.
As is evident in Table 7, community-focused outcomes received relatively little attention compared to the top child- and family-focused responses. Outcomes relating to family involvements in the community were identified 5 times during the focus group discussions and outcomes relating to community support of children and families were also identified 5 times.
B. Top priorities identified for the outcome domain
Using the frequency with which a certain response occurred as a determinant of priority of response, three target populations emerged as the top priorities for outcomes in children's mental health. These were: 1) outcomes relating to quality of life across domains; 2) outcomes relating to improved family functioning; 3) outcomes relating to restrictiveness of setting. Outcomes relating to quality of life across domains emerged as the top priority with a frequency count of 66. Outcomes relating to family functioning emerged second with a response frequency of 23, and outcomes relating to restrictiveness of setting was third with a frequency of mention of 18. Of these top priorities, outcomes relating to improved family functioning came from the broad category of family focused outcomes whereas outcomes relating to quality of life across domains and outcomes relating to restrictiveness of setting came from the broad category of child-focused outcomes.
Decisions about how to measure the occurrence of particular outcomes are important to the integration of outcome information with service planning and delivery processes. Once focus group participants had identified the outcomes they believed to be most important for children's mental health, they were asked to identify indicators of these outcomes. Indicators for the top three outcomes identified by focus group members are illustrated in Table 8.
As is evident in reviewing Table 8, the pattern of indicators identified by participants suggests that some indicators may be useful in providing information about more than one outcome. For example, indicators about out-of-home placements such as reduced residential days, reduced hospital days, and fewer out-of-home placements, can provide important information for assessing outcomes relating to restrictiveness of setting. In addition, similar indicators such as children living safely at home, reduced number of days out of home, and reduced out-of-home placements emerged in reference to outcomes relating to functioning across life domains and outcomes relating to improved family functioning. This suggests that indicators related to out-of-home placement may be useful in assessing all three of the priority outcomes identified by focus group participants. Similarly, outcomes relating to discipline at school, school attendance, and school success surfaced in the discussion of each of the priority outcomes. Indicators relating to involvement in the juvenile justice system were also identified for all of the priority outcomes.
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