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Concept Mapping. A Next Generation Strategy For Planning and Evaluating Systems Change. Presenters. Lenore B. Behar, Director Child & Family Program Strategies William M. Hydaker, Director Hydaker Community Consulting. Andrea Aderton, Project Director Circle of Hope Project

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concept mapping

Concept Mapping

A Next Generation Strategy

For Planning and Evaluating

Systems Change

presenters
Presenters

Lenore B. Behar, Director

Child & Family Program Strategies

William M. Hydaker, Director

Hydaker Community Consulting

slide3
Andrea Aderton, Project Director

Circle of Hope Project

St. Joseph, MO

Mona Gauthier, Principal Investigator

Cathy Baxter, Evaluator

commUNITY cares

Hattisburg, MS

slide4
John Reiss, Consultant

Florida Institute for Family Involvement

Associate Professor of PediatricsInstitute for Child Health PolicyUniversity of  Florida Gainesville, FL

slide5
Purpose: Enhance, facilitate, and support family and consumer involvement in the development of responsive, family-centered, and community based systems of care for children, youth and young adults and their families.
slide6
Integrating Families, Communities, and Providers (IFCAP)

Funding:

Federal Maternal and Child Health Bureau’s Division of Services for CSHCN

Funding Initiative:

Implementation of HP 2010 goal of statewide access to family-centered care through medical homes

Eligible applicants:

State Title V CSHCN Programs or Program’s designee

slide7
IFCAP Partnerships

FIFI:

Invited by Children’s Medical Services (Florida Title V) to apply, as the lead organization, for 3-year grant

Lead Partners:

Children’s Medical Services

Florida Pediatric Society (Florida AAP Chapter)

Eligible applicants:

State Title V CSHCN Programs or Program’s designee

slide8
IFCAP

Vision and Approach

Vision:

Build and sustain a family-centered, community-based, culturally competent system of care for all children and youth with special health care needs (CYSHCN) and their families in Florida through community partnerships.

Approach:

Family – Enhance capacity to be full partners

Providers – Enhance capacity to implement medical home approach and partner with families

System – Enhance capacity to facilitate, fund and sustain quality care and partnerships for CYSHCN

Community – Support existing partnerships to build local systems

slide9
Supporting Communities

Build capacity of communities to respond to the needs of CYSHCN

Assist communities in understanding needs of CYSHCN and their families

Prepare communities to serve as the primary site of service delivery for their CYSHCN

Help communities build a network or services and supports for CYSHCN and their families

Ensure communities have the necessary resources to maintain medical home efforts

slide10
Use Existing Partnerships to

Build Local Systems

Request for proposals:

Identify and describe the community

Describe composition of the community’s health care professionals, health and related programs, community agencies, schools and other formal and informal organizations and the current capacity of these entities to partner with families and work in a collaborative fashion to provide all CSHCN with a medical home.

Describe barriers that will be addressed.

slide11
Use Existing Partnerships to

Build Local Systems

Request for proposals:

Applicants are expected to have already established a formal or informal community-based coalition (i.e. working group, committee, task force) that includes a range of CSHCN stakeholders.

Initial activity can involve expanding membership of core group.

Describe membership of applicant and community’s a) demonstrated potential to develop partnership and b) current and potential capacity to serve CSHCN and their families.

ifcap communities
IFCAP Communities

Jacksonville

Sarasota

Broward Co.

slide13
Circle

of

Home, Opportunities, Parents and Professionals, Empowerment

policy team members
Policy Team Members

● Family Guidance Center ● The Center

● Northwest Health Services ● St. Joseph Youth Alliance

● Heartland Health ● Children’s Division

● St. Joseph School District ● Key Family Contact

● Preferred Family Healthcare ● Youth Coordinator

● Albany Regional Center ● State to Local Liaison

● Buchanan County Juvenile ● Parents

Court ● Youth

slide15
Goal
  • The goal of Circle of HOPE, a collaborative community effort, is to design and create a system of care that will enhance service delivery system for children at risk or with severe emotional disturbance and their families through integration of physical, behavioral health and educational services.
population of focus
Population of Focus
  • Diagnosis of SED or
  • Displays inability to function in family, school or community that is expected to last more than one year.
  • Age 8-13
operating principles
Operating Principles
  • Services will be coordinated across agencies and service agencies.
  • Information will be shared between agencies to eliminate the need for parents, family members or youth to provide the same information to multiple agencies.
  • Data will drive decision-making
  • No Wrong Door
  • An infrastructure will be created to develop and sustain the system of care over time.
  • Family involved in all phases of planning, implementation, evaluation of services.
circle of hope service model
Circle of Hope Service Model

Referral Sources

  • Parents
  • Schools
  • Primary Healthcare

Screening

  • Family Support Assistant- system navigator

Enrollment

  • Functioning Evaluation
  • Care Coordinator- facilitator/case management

Service Planning

  • Wraparound Process

Transition Planning

slide19
Administrative Staff

Service Delivery Staff

Project Director

Andrea Aderton

SOC Service Providers

Clinical Coordinator Elizabeth Keane

Psychiatrists

Service Contracts

Clinical Supervisor

(Interim)

Vicky Myers

Physicians

TA/Cultural Competency

Nicki Samson

Evaluation

MIMH/LAN Resources

Behavioral Health Providers

Care Coordinator

Mike Bolten

Care Coordinator Vacant

Marketing & Communications

Key Family Contact

Joseph Turner

Non Mental Health Services

Resource Planning & Development

Family Support Assistant

Donna Barber

FSA Vacant

Children’s Division

Youth Coordinator

Jayme Neal

Juvenile Justice

Administrative Assistant

Wendy Tyrrell

Schools

Staff & Services Pattern Chart

key initiative partners
Key Initiative Partners
  • MS Department of Mental Health
  • Pine Belt Mental Healthcare Resources
  • Mississippi Families as Allies
other initiative participants
Other Initiative Participants
  • Forrest, Lamar & Marion County and City School Districts
  • Juvenile Justice/ Youth Court
  • Youth Development Initiative
  • Health Department
  • Department of Human Services
  • Boys & Girls’ Club
initiative partners continued
Initiative Partners, continued…
  • Aldersgate
  • Big Brothers/Big Sisters
  • Forrest County Youth Court
  • Hattiesburg Police Department
  • Mississippi Children’s Home Services/CARES
  • MCHS (Adolescent Shelter)
  • Oseola McCarty Youth Center
  • Catholic Social & Community Services
and still more
…..and still more….
  • School Attendance Officers – Forrest & Lamar
  • Center for the Prevention of Child Abuse
  • Lamar County – Parents As Teachers
  • Lamar County Sheriff’s Department
  • University of Southern Mississippi – Resource Center
and growing
And growing….
  • Junior Auxiliary
  • Harden House
  • Memorial Behavioral Health
  • Parham Group
  • Salvation Army Boys & Girls Club
who is the target population when do services start
Who is the target population?When do services start?
  • The target population for this grant is youth ages 10-18 with a serious emotional disorder AND substance misuse in Forrest, Lamar, and Marion Counties.
  • Service Implementation Schedule:
    • Forrest County: October 1, 2007
      • Currently accepting referrals
    • Lamar County: October 2008
    • Marion County: October 2009
intensive workshop overview
Intensive Workshop Overview
  • Introduction to Concept Mapping.
  • Process – how it works.
  • Products.
  • Break (10 minutes).
  • How to use Concept Mapping.
  • Comparison to other planning/ evaluation methods.
introduction to concept mapping
Introduction to Concept Mapping
  • Group discussion of planning and evaluation experiences.
  • Concept Mapping defined.
  • Concept Mapping as a planning and evaluation tool.
  • Examples.
planning and evaluation experiences
Planning and Evaluation Experiences
  • Strengths
  • Challenges
  • Evaluation, quality improvement, continuous quality improvement?
definition
Definition
  • A structured conceptualization process which can be used to organize the thoughts and ideas of a group of participants or stakeholders who wish to develop conceptual framework for planning and evaluation.
  • The process is used to develop a concept map which is a pictorial representation of all of the ideas generated by the entire group and the relationships of each of the ideas to each other.
  • The participants express both their individual ideas and interact with the entire group and develop additional ideas that are expressions of the group.
advantages
Advantages
  • Time efficient
  • Easy to understand process
  • Facilitates broader community involvement
  • Effective engagement strategy
  • Moves away from the “jargon” of professionals and evaluators
  • Gives participants an equal voice
  • Supports ownership
  • Multiple uses e.g. planning, logic model development, and evaluation
examples from the field
Examples from the Field
  • National Traumatic Stress Initiative
  • Comprehensive Community Mental Health Services Program for Children and Their Families
  • State of Mississippi
  • Maternal Child Health Bureau
process how does it work
Process – how does it work?
  • Convening a group.
  • Brainstorming.
  • Sorting the responses.
  • Rating the responses.
  • Feedback session & products.
convening a group
Convening a Group

The organizers determine who the participants will be. They may include administrators, staff, board members, family members, youth and/or community leaders.

develop the focus prompt
Develop the Focus Prompt

The Focus Prompt is the trigger for Brainstorming. It sets the framework for how the group thinks about the task.

examples of a focus prompt
Examples of a Focus Prompt
  • “To develop a system of care in our community, we must have the following characteristics and functions …..”

Or

  • “To have a system of care in our community, we must…..”
slide41
Brainstorming
  • Generate ideas in response to a prompt.

Sorting

  • Sort each idea into groups you believe are related to each other.
  • Label each group.

Rating

  • Rate each idea as to importance using a 1-5 point scale.
  • Rate each idea as to feasibility using a 1-5 point scale.
brainstorming
Brainstorming
  • Participants are encouraged to generate statements representing the entire conceptual domain of the topic of interest.
  • Theoretically no limit on the number of statements, though excessive numbers may become cumbersome.
slide43
The Brainstorming Process
  • As someone makes a statement, it is typed into the computer and projected onto the screen.
  • Each successive statement is put on the screen.
  • Brainstorming is complete when the group cannot generate any more statements.
  • We will do up to 100 statements.
  • The prompt statement gives you your task.
brainstorming guidelines
Brainstorming Guidelines
  • Keep the focus on the task.
  • Any input addressing the task is OK.
  • No criticism of others’ input.
  • No editing, except for clarity.
  • Listen to others.
  • Watch for duplication.
  • Participate.
roles of the facilitators
Roles of the Facilitators
  • Make sure topic is thoroughly considered.
  • Get everyone involved.
  • Keep everyone on task.
focus prompt
Focus Prompt

“To have a system of care in our community, we must…..”

sorting
Sorting

After appropriate editing, each statement is printed on an index card and a complete set of cards is provided to each participant.

slide48
Sorting Statements
  • Your task is to organize the statements into
  • groups that make sense to you.
  • Each of you has two things:
    • 1. Cards to sort into piles.
  • 2. A label to go with each pile.
  • Sort the cards into piles and place one
  • label on each pile.
  • Don’t create piles with miscellaneous items
  • You must have more than 1 pile!
  • You cannot have a pile that has only 1 card in it.
rating
Rating
  • Utilizes a Likert scale
  • Each respondent is asked to rate each item on two separate dimensions
  • Each item is rated on a 1 to 5 response scale with 1 equaling strongly disagree and 5 equaling strongly agree
slide50
Ratings

Use the rating sheets to determine the importance and feasibility of each statement.

Remember, Importance then Feasibility.

feedback and products
Feedback and Products
  • Concept Map derived from sorting and labeling.
  • Ladder graph derived from ratings of importance and feasibility.
  • Go-zone map derived from ratings of importance and feasibility.
multidimensional scaling
Multidimensional Scaling
  • Concept Systems software program calculates spatial relationships of paired data from the total square similarity matrix much as one would position cities on a blank map if the distance between the cities was known.
  • Further mathematical scaling is done using a multivariate analysis to represent the location of all of the statements on a two dimensional point map.
multidimensional scaling cont d
Multidimensional Scaling, cont’d
  • Points on the map represent individual statements and their positions, relative to each other, indicate are important.
  • Points close to each other are conceptually similar, while points that are far apart are conceptually different.
  • The point map forms the basis for the construction of the cluster map, the point rating map, and the cluster rating map.
hierarchical cluster analysis
Hierarchical Cluster Analysis
  • Individual statements on the map are grouped into clusters of statements that theoretically reflect similar concepts.
  • The resultant “cluster map, depicts how the multidimensional scaling points were grouped.
  • There can be as many clusters as statements, and the number decided upon is determined by the discretion of the analyst.
hierarchical cluster analysis cont d
Hierarchical Cluster Analysis, cont’d
  • In the instance of approximately 100 statements, 20 down to 3 clusters are examined.
  • As the analysis moves from one cluster level to the next lowest,

(e.g., from 10 to 9 clusters for instance) the grouping is examined to determine if it makes sense terms of the overall concept.

slide59
Community Development

Quality Services

Communication/Collaboration

Five Cluster Solution

Youth & Family

Focus

Training/Evaluation

slide60
Quality Services

Six Cluster Solution

Community Development

Youth & Family Focus

Cultural Issues

Training/Evaluation

Communication/Collaboration

slide61
Community Development

Seven Cluster Solution

Family Focus

Youth Focus

Cultural Issues

Quality Services

Training/Evaluation

Communication/Collaboration

the ladder graph
The Ladder Graph
  • Shows the results of comparisons between participant responses on importance and feasibility, by cluster
  • Depicts the correlation between these two dimensions
  • A correlation ranges from -1.00 to +1.00
  • The correlation coefficient (r value) for the level of agreement between the two dimensions is significant at 0.93
cluster ratings on importance and feasibility
Importance

Feasibility

4.1

4.1

Youth Focused Initiatives

Community Education

Family Issues

Family Issues

Evaluation

Youth Focused Initiatives

Advocacy

Service Delivery

Community Education

Communication/Collaboration

Funding

Communication/Collaboration

Evaluation

Advocacy

Service Delivery

Funding

r = 0.93

2.9

2.9

Cluster Ratings on Importance and Feasibility
go zone plot
Go-Zone Plot
  • Facilitates strategic planning. By focusing on those statements that are perceived to be the most important and most feasible (upper right quadrant) action plans can be created.
  • Facilitates development of a logic model for systems change, by defining areas of importance.
go zones
4.71

30

20

36

1

53

26

34

8

22

14

51

7

2

72

38

44

24

85

6

79

54

25

12

45

17

50

23

33

71

13

56

57

21

64

27

11

83

70

86

16

28

61

84

62

3.91

76

63

75

4

3

77

47

37

18

55

49

19

69

80

Feasibility

46

29

68

74

40

66

59

42

32

31

52

5

43

81

67

10

60

41

9

65

58

78

82

73

15

48

39

35

3

3.38

4.22

4.96

Importance

Go-Zones
twelve highest statements
Twelve Highest Statements
  • Listen to youth.
  • Ask youth what they want
  • Deal with confidentiality.
  • Develop a plan for communications.
  • Train direct service staff to serve children and families.
  • Focus on strengths.
twelve highest statements cont d
Twelve Highest Statements cont’d
  • Make sure that services are research/ evidenced based and staff are appropriately trained.
  • Get the right people hired to do the job.
  • Get the right people to the table.
  • Be family-centered.
  • Define the goals of the system of care to the agencies and to families being served.
  • Conduct ongoing evaluation.
slide69
The concept mapping framework provides an organized means of keeping participants on task for a planning or an evaluation study.
  • The methodology allows the participants to describe their ideas and thoughts in a language familiar to them rather than the language of the evaluator or planner, and free of the jargon often used in social science literature.
slide70
The results are presented in a graphic format illustrating all of the ideas and their inter-relationships at a glance to both the participant group as well as to other interested groups.
  • Finally, and possibly most importantly, the process increases group cohesiveness and morale as it imparts a sense of ownership in the decisions emanating from the results.
slide72
Purpose: Enhance, facilitate, and support family and consumer involvement in the development of responsive, family-centered, and community based systems of care for children, youth and young adults and their families.
why concept mapping
Why Concept Mapping ?

Services and Supports

CYSNCH & Families

Needs and Priorities

Coordinators

Physicians

Medical Homes

slide75
Circle

of

Home, Opportunities, Parents and Professionals, Empowerment

1 st year planning process
1st Year Planning Process
  • Policy Team Development
  • Strategic Planning
          • Vision, Mission, Goal Development
          • Population of Focus
  • Concept Mapping
          • Broader Based Stakeholder Input
          • Incorporation into the Logic Model
slide77
Clusters and Statements Sorted

Principles

Objectives

Strategies

Next Steps

eight cluster solution
Community Education

Communication/ Collaboration

Youth Focused Initiatives

Family Issues

Evaluation

  • Service Delivery

Funding for Services

Advocacy

Eight Cluster Solution
from concept mapping to logic model identifying issues
From Concept Mapping to Logic Model: Identifying Issues
  • Project Staff and Executive Committee began by examining Concept Mapping (CM) Statements.
  • Participants were asked to classify statements into three issue categories: Community, System or Practice Level
  • Involved a bit of “backwards engineering.” We had to take the “action” back to the “issue for needing the action.”
from concept mapping to logic model identifying values
From Concept Mapping to Logic Model: Identifying Values
  • Some “action statements” actually reflected a core value.
  • We decided to extract these from the “Issues” to make form the overall “values” important to our system transformation efforts.
  • Added these to existing System of Care values.
from concept mapping to logic model identifying values1
Values

Concept Mapping Statements: Framed as Actions

Issues: Community, System and Practice Level

From Concept Mapping to Logic Model: Identifying Values
from concept mapping to logic model identifying strategies
From Concept Mapping to Logic Model: Identifying Strategies
  • Concept Mapping allowed the generation of a list of “actions” needed to implement a successful System of Care
  • These “actions” were classified by category; associated strategies were easily obtained by using a worksheet format and soliciting group participation
  • We referred to these as “homework assignments.”
from concept mapping to logic model identifying strategies1
Values
  • Concept Mapping Statements:
  • Framed as Actions
  • Categorized into Groups
  • Reframed into Strategies

Issues: Community, System and Practice Level

From Concept Mapping to Logic Model: Identifying Strategies
from concept mapping to logic model outcomes
From Concept Mapping to Logic Model: Outcomes
  • Outcomes based on the “why” we wanted to accomplish our tasks.
  • Were extrapolated by examining our issues, strategies, and associated action steps.
  • Brought us full-circle back to our “action statements” from Concept Mapping.
from concept mapping to logic model outcomes1
Values
  • Concept Mapping Statements:
  • Framed as Actions
  • Categorized into Groups
  • Reframed into Strategies

Issues: Community, System and Practice Level

Outcomes:

Child and Family, Community, System and PracticeLevel

From Concept Mapping to Logic Model: Outcomes
example identifying issues
Example: Identifying Issues
  • One of our Concept Mapping Statements read:
    • Develop a Mississippi Families as Allies chapter in the Pine Belt area.
  • Issue can be “reverse engineered” to read:
    • There is a need for a Mississippi Families as Allies chapter in the Pine Belt area.
  • Statement and Issue were classified on the Community Level.
example making it a value
Example: Making It a Value
  • Our previous statement was:
    • Develop a Mississippi Families as Allies chapter in the Pine Belt area.
  • Not only does it embody a needed action, it also contributes to a System of Care principle, which is:
    • Family Driven
example identifying strategies
Example: Identifying Strategies
  • The action statement indicates a need to do something.
  • That “need” to do something was embodied as a Community Level Strategy entitled:
    • Family Advocacy and Support
  • That means to say, we want to improve the issue by using the above mentioned strategy, which takes us back to the “action” itself, which was:
    • Develop a Mississippi Families as Allies chapter in the Pine Belt area
example outcomes
Example: Outcomes
  • The last step, the Outcome, was the easiest.
  • We formulated a “why” for each issue and strategy, then transformed it to an Outcome.

So that families and youth have a channel for advocacy and support!

Why do we want a MS Families as Allies chapter in the Pine Belt Area?

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