We know that community-based mental health programs for youth and families vary in service quality and that much more needs to be known about how to create effective programs. The National Advisory Council of the National Institute of Mental Health (NIMH) concludes that too little is known about how to implement and sustain effective mental health services in the community and recommends that more work be done with community-based mental health agencies to develop strategies for positive service system change (NIMH, 2006). The Institute of Medicine (IOM) finds that the deficiencies in community-based mental health service systems prevent those suffering from mental illness from receiving the most effective care (IOM, 2006). The 2003 President’s New Freedom Commission on Mental Health report calls for the transformation of community mental health systems to improve the quality of services they provide. These reports repeat conclusions reached in previous examinations of the nation’s mental health care by the Surgeon General and National Institutes of Health that there is a critical need for strategies that can be used by community-based mental health systems to improve their services (DHHS, 1999, 2000; NIH, 1999).
The proposed study will experimentally test the effects of a planned organizational intervention strategy, labeled ARC for Availability, Responsiveness and Continuity, on the mental health services provided by a randomly assigned group mental health agencies in St. Louis, MO. ARC is an organizational development strategy that the University of Tennessee Children’s Mental Health Services Research Center (UT CMHSRC) designed to help mental health agencies deliver more effective services. ARC has been successfully tested in two preliminary NIH funded controlled studies. The proposed study will be conducted in 12 community mental health agencies in St. Louis, MO, through a partnership between the UT CMHSRC and the Washington University Center for Mental Health Services Research (WU CMHSR).
The study addresses the need for organizational intervention strategies that can improve mental health agencies in ways that contribute to service quality and outcomes. Organizational culture (the norms and expectations that guide the work of the program staff) and organizational climate (the psychological impact of the work on program staff) are associated with the priorities that guide service providers in their work, how they interact with each other, and how they interact with the individuals and families they serve. The ARC intervention model has been shown in previous research to foster the types of work environment cultures (e.g., an emphasis on proficiency, flexibility, openness to change) and climates (e.g., high in engagement and functionality and low in stress) that contribute to improved service quality and outcomes. The proposed study will examine the effects of ARC on these and other organizational and service domains to gain a better understanding of the mechanisms that link ARC to service outcomes.
The hypotheses of the study are as follows:
Hypothesis 1: Front-line staff in agencies assigned to the ARC condition will describe more positive organizational cultures (e.g., higher proficiency, lower resistance to change and less rigidity), more positive organizational climates (e.g., higher engagement and functionality in their work, lower stress), and more positive work attitudes (e.g., higher job satisfaction, and higher commitment) than front-line staff in agencies assigned to the comparison condition.
Hypothesis 2: Youth and caregivers (parents or guardians) served by agencies assigned to the ARC condition will experience higher service availability, higher service responsiveness, and higher service continuity than those served by agencies assigned to the comparison condition.
Hypothesis 3: Front-line staff in agencies assigned to the ARC condition will use evidence-based treatments (EBTs), valid assessment tools, and outcome monitoring more frequently (e.g., higher rate of adoption) and for a longer period of time (e.g., greater sustainability) than front-line staff in agencies in the comparison condition.
Hypothesis 4: The effects of ARC on service satisfaction, retention and compliance will be mediated by three organizational domains (social context, service structure and core technology) such that those served by agencies with improved service structures, social contexts, and core technologies will report higher satisfaction with services and have higher compliance and treatment retention rates.
Hypothesis 5: The effects of ARC on service outcomes will be mediated by three organizational domains such that those served by agencies with improved service structures, social contexts, and core technologies will experience greater symptom reduction and improved functioning.