Paper
Friday, July 23, 2004
A Study of the Implications of Policy Implementation and the Development of Collaboration in Systems of Care
Mary E. Evans, RN, PhD, FAAN and Jason W. Beckstead, PhD. College of Nursing, University of South Florida, Tampa, FL, USA
| Learning Objective #1: Identify methods for studying collaboration among human service agencies |
| Learning Objective #2: Describe the relationship between policy instruments used to establish systems of care and resulting level of collaboration |
Objective: The purpose was to add to knowledge regarding collaboration in systems of care (SOC) for multi-need children and families as a step in testing relationships among policy approaches used to establish SOC, development of collaboration and outcomes experienced by children and families. Design: This cross-sectional, mixed methods study had 2 phases. Population, Sample, Setting, Years: The population was 50 states and Washington, DC. A sample of 10 states was selected through cluster analysis for site visits and key informants identified within sites. Concept studied: The major concept is collaboration among child-serving organizations. Methods: Phase 1 comprised a survey of state directors of children's mental health (N=51) requesting information on policy approaches used to establish SOC. Phase 2 comprised visits to 10 states and data collection from families through focus groups and by semi-structured interviews with case managers, administrators, and policy makers. The Interagency Collaboration Scale was administered to respondents except family members (N=261). Findings: Analysis indicated one site had significantly lower scores on attitudes toward collaboration than other sites. Qualitative data provided an explanation for this finding and were used to examine support of the study's hypotheses. Hypotheses supported related to higher levels of collaboration with capacity building or system change approaches and adequate resources. The hypothesis about superiority of a grassroots approach was not supported. Conclusions: Some ways of establishing SOC may be more effective than others in fostering collaboration. Implications: Findings supported the use of mixed methods to facilitate understanding factors promoting collaboration. This study provided initial data regarding measurement of inter-agency collaboration leading researchers to add information about leadership in future studies. Finally, practicing nurses in all positions, particularly those working with vulnerable populations, need to be concerned about identifying and fostering factors that promote inter-agency collaboration.
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