Change agents throughout our country are transforming service delivery systems – they are changing how human services, health, and mental health provide care. Some of these transformations go by the name of Medical Home and others call themselves Systems of Care. Regardless of the name, transforming systems is a difficult process. As you undertake transformation in your community, knowing where to go for resources and which models are the best fit can pave the way for successful change.
Defining Systems Transformation
At its most basic, systems transformation is changing the way that a service delivery system does its business in order to improve outcomes for its participants. How is that different from systems building, you might ask? ((For a general overview of what is involved in a good systems building effort, please see our previous blog: Why Should We Focus on Building Systems Versus Programs?)) Well, most systems transformation models attempt to pull together and integrate the disparate parts of a particular set of service delivery systems under a new set of values – a new set of guiding principles, or philosophy, for all the service delivery systems with a shared population focus. These new principles usually describe the quality of the services that the entire big new system should offer. Having outlined the guiding principles, most systems transformation models then get into the concrete systems building activities that are needed to bring about the new guiding principles.
Systems Transformation Models
There are many models out there for systems transformation. It is true that most originate from a particular health or human services sector,
but it is also true that most models can be and are adapted to other systems with relative ease. For example, the Systems of Care model of systems transformation was first developed with the population of children with serious emotional disorders in mind and later expanded to all systems that serve children and their families.
The medical home model, also referred to as the Patient-Centered Medical Home (PCMH) approach envisions comprehensive primary care through the creation of a partnership between patients, physician and in certain situations patient’s families. This model of systems transformation allows for better health care, increased satisfaction and better health outcomes.
Here are a few of the resources on Spark’s Igniting Change website related to the medical home model:
- The National Center of Medical Home Initiatives for Children with Special Needs is a comprehensive resource for health professionals, families and those interested in creating medical homes for children and youth.
- Best Beginning: Partnerships Between Primary Health Care and Mental Health and Substance Abuse Services for Young Children and Their Families. This SAMHSA funded, web-based resource features eight innovative medical home practices that integrate behavioral health screening for the whole family, facilitate referrals to community services, and offer follow-up care. This resource describes how the practices use very different approaches to do it, fund it, and the lessons they learned. This is a must read for practitioners who want to replicate an integrated primary care and behavioral health model.
System of Care
Similar to the medical home model, Systems of Care is a specific approach to systems transformation. As we mentioned earlier, although systems of care is originally from the mental health system, it can be applied to any system serving children, youth, and families.
[blockquote]“A system of care incorporates a broad array of services and supports that is organized into a coordinated network, integrates care planning and management across multiple levels, is culturally and linguistically competent, and builds meaningful partnerships with families and youth at service delivery and policy levels.” Building Systems of Care: A Primer[/blockquote]
There are many resources on Spark’s Igniting Change website relevant to building systems of care. These tools provide background information, examples, and concrete toolkits on this approach to systems transformation. For example:
- Building Systems of Care: A Primer by Sheila Pires is a technical assistance tool for state and local stakeholders engaged in developing systems of care for children with behavioral health disorders and their families (but relevant to many other populations as well!). This Primer will provide you guidance on developing over 30 critical systems of care functions that require structure, such as governance, care management, financing and quality improvement, and examines the pros and cons of different structural approaches.
- The National Child Welfare Resource Center for Organizational Improvement’s Primer Hands on Child Welfare, a web-based training resource for system builders working for children, youth and families involved, or at risk for involvement with the child welfare system. This includes all key stakeholders from families, youth, providers, natural helpers, frontline staff, supervisors, county managers and State administrators, judges, court appointed special advocates, guardians ad litem, law enforcement personnel, policy makers, researchers and evaluators, technical assistance providers, advocates and others.
Five Tips for Systems Transformation
- Don’t start from scratch. There are great models and resources to guide your work.
- Make sure the values match. When you pick the model that can guide your systems transformation, make sure you and your community of stakeholders can agree with the values.
- Start from where you are at. Sounds obvious, doesn’t it? But sometimes we want to start with significant change, when small changes are all that our system is ready to undertake.
- Celebrate along the way. Systems transformation is not a one year effort, three year effort, or even a five year effort. It can take a decade or more. That doesn’t mean significant, meaningful change won’t happen every year you work on it. Celebrate those changes!
- Ask for help. Systems transformation communities throughout the country are excited to provide their insights and guidance, along with national technical assistance centers.