Form System of Care Exp System of Care Exp System of Care Expansion and Sustainability Survey

Attachment 3

OMB No. xxxx-xxxx

Expiration Date: xx/xx/201x

CHILDREN’S MENTAL HEALTH INITIATIVE

NATIONAL EVALUATION

SYSTEM OF CARE eXPANSION AND SUSTAINABILITY SURVEY (SOCESS)

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is XXX-XX. Public reporting burden for this collection of information is estimated to average 10 minutes per respondent, per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 5600 Fishers Lane, Room 15E57-B, Rockville, Maryland, 20857.

National SOC Expansion Evaluation: System of Care Expansion and Sustainability Survey (SOCESS)

Purpose

The System of Care Expansion and Sustainability Survey (SOCESS) is an online, self-administered tool, and its purpose is to assess system of care expansion and sustainability. To provide efficient longitudinal assessment of expansion implementation, we propose utilizing online self-report options that grantees will complete annually. Similar tools have been developed to assess system of care implementation for the CMHI community grantees (Kutash, Greenbaum, Wang, Boothroyd, and Friedman, 2011). This self-report approach can provide a global assessment of strategies employed, degree of implementation of those strategies, and expansion implementation over time. The SOCESS, includes: strategies and mechanisms planned; factors that impeded and facilitated expansion efforts; and self-appraisals of degree of implementation.

Development of SOCESS Questions Content

The SOCESS is designed to capture self-report implementation data using a strategic framework (adapted from Stroul and Friedman 2011 and Stroul, Dodge, Goldman, Rider and Friedman, 2015) that consists of five analytic dimensions: 1) policies, 2) services/supports, 3) financing, 4) training/workforce, and 5) strategic communications). The evaluation will identify and assess the mechanisms and strategies employed to implement and expand systems of care, and explore the impact on system performance and child and family outcomes. Evaluation activities are framed by the five strategic areas to examine whether specific mechanisms and strategies lead to proximal and distal outcomes. System of care principles are woven throughout the framework at both the State and Local levels. The evaluation tools are designed to allow analysis across levels. The revised SOCESS organizes self-report data collection into these five areas and will allow within and across site evaluation of the implementation and impact of activities in these areas.

This self-report survey will be administered via the online CMHI portal. Respondents will rate items on a Likert-type scale. Respondents will include representatives from approximately 54 grantee organizations and representatives from family and youth organizations, child-serving sectors, advocacy organizations for diverse populations, provider organizations, and financial officers, among others. Evaluation staff will identify potential respondents through previous evaluation efforts (e.g., document review, Key Partner Interviews) and invite those stakeholders to participate in this component.

SOCESS Respondents

Respondents for the SOCESS will be top administrators involved in the expansion grant. The SOCESS will be completed by:

• The CMHI Project Director

• The Family Representative

• The Youth Representative

• The Mental Health Agency Representative

• The Child Welfare Agency Representative

• The Juvenile Justice Agency Representative

• The Education Agency Representative

• Other Agency Representatives Identified by the Grantee as Relevant to the SOC effort

• The Individual Responsible for CMHI Quality Monitoring

• Practitioners (Services and Support Section)

Method of Data Collection

The self-administered survey will be completed online. Respondents will be sent a link to the survey and will complete and submit their responses online once annually.

INFORMED CONSENT

As the SOCESS is an online, self-administered survey, an informed consent statement will be displayed on the screen when the respondent first accesses the survey online. After the informed consent statements are displayed, the respondent will be asked if they agree to participate in the survey. The respondent will be able to proceed only after checking “Yes” for agreement to participate.

CHILDREN’S MENTAL HEALTH INITIATIVE

NATIONAL SYSTEM OF CARE EXPANSION EVALUATION

SYSTEM OF CARE eXPANSION AND SUSTAINABILITY SURVEY (SOCESS)

INTRODUCTION

Thank you for your willingness to complete the System of Care Expansion and Sustainability Survey (SOCESS). The purpose of the SOCESS is to assess system of care is to assess system of care expansion and sustainability.

CONFIDENTIALITY/INFORMED CONSENT

This survey was developed by the National Evaluation Team.

For this survey, you will be asked to answer a series of questions about the expansion and sustainability of your system of care.  

Your participation is completely voluntary.  You have the right to stop at any time or to refuse to answer any question.

Your responses to these questions will be kept confidential and will not be shared outside of the evaluation team. In any of our reports, your responses will be combined with other people’s responses, so your answers will never be attributed to your name.

By submitting this form you are indicating that you have read the description of the tool above and that you agree to participate.

[] Agree to Participate

If you have any questions, please contact the National Evaluation Team at [email protected]

INSTRUCTIONS

This survey takes approximately 10 minutes to complete. Please try to answer each question on the basis of your impressions of expansion and sustainability activities in your system of care. If you feel that you do not have enough information to answer any particular question, please select the "don't know" option, rather than leaving the item blank.

For this survey, you will be asked to answer a series of questions about specific strategies to expand and sustain your system of care. The terms “children and youth” refer to the population of focus for your system of care and can include young people of any age between birth through young adulthood.

System of Care (SOC) Expansion and Sustainability Survey (SOCESS)

1. SOC Sites use several overall approaches to expand systems of care. Please select the responses that best describe how each is being used in [your System of Care].

	Not implemented	Somewhat implemented	Moderately implemented	Substantially implemented	Extensively implemented	Don’t know
Expanding to Additional Geographic Areas	1	2	3	4	5	99
Expanding to Serve Additional Populations (e.g., Early Childhood, Transition-Age Youth and Young Adults)	1	2	3	4	5	99
Expanding to Serve Children and Youth in Particular Child-Serving Systems (e.g., Child Welfare, Juvenile Justices, Education)	1	2	3	4	5	99
Expanding to Fill Gaps in the Array of Home and Community Based Services	1	2	3	4	5	99
Other (Specify)____________	1	2	3	4	5	99
Other (Specify)____________	1	2	3	4	5	99
Other (Specify)____________	1	2	3	4	5	99

2. SOC Sites focus on several different populations to expand systems of care. Please select the responses that best describe how each is being addressed in [your System of Care].

	Not Implemented	Somewhat implemented	Moderately implemented	Substantially implemented	Extensively implemented	Don’t know
Age Range
Total Population (Birth to 21)	1	2	3	4	5	99
Early Childhood	1	2	3	4	5	99
School Age	1	2	3	4	5	99
Youth and Young Adults of Transition Age	1	2	3	4	5	99
Characteristics
Most Serious and Complex Mental Health Conditions	1	2	3	4	5	99
At Risk for Out-of-Home Placement	1	2	3	4	5	99
First Episode Psychosis	1	2	3	4	5	99
Other (Specify) __________	1	2	3	4	5	99
Other(Specify)__________	1	2	3	4	5	99
Other (Specify)________	1	2	3	4	5	99

Policy/Partnerships

Structures

3. What types of structures are used to provide leadership, policy development, and oversight of System of Care expansion activities?

	Not Implemented	Somewhat implemented	Moderately implemented	Substantially implemented	Extensively implemented	Don’t know
Interagency Policy Making Entity with Agency Executives	1	2	3	4	5	99
Interagency Policy Making Entity with Deputy to Mid-Level Representatives	1	2	3	4	5	99
Interagency System Management/Operational Entity	1	2	3	4	5	99
Centralized Lead Agency for System Management	1	2	3	4	5	99
General Advisory Structures	1	2	3	4	5	99
Family and or Youth Advisory Structures	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99

4. Overall, how effective have these structures been for policy development and management of System of Care expansion activities?

Not Effective	Somewhat Effective	Moderately Effective	Very Effective	Extremely Effective	Don’t know
1	2	3	4	5	99

Partnerships

5. To what extent are the following Governmental Agencies involved in the planning and implementation of System of Care expansion activities?

	Not Involved	Somewhat Involved	Moderately Involved	Substantially Involved	Extensively Involved	Don’t Know
Mental Health	1	2	3	4	5	99
Education	1	2	3	4	5	99
Child Welfare/Social Services	1	2	3	4	5	99
Juvenile Justice
Public Health	1	2	3	4	5	99
Substance Abuse	1	2	3	4	5	99
Developmental Disabilities	1	2	3	4	5	99
Early Childhood, Early Care and Education,	1	2	3	4	5	99
Other (Specify) ___________________	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99

6. To what extent are representatives from Governmental Agencies involved in the following planning and implementation activities for System of Care expansion?

	Not Involved	Somewhat Involved	Moderately Involved	Substantially Involved	Extensively Involved	Don’t Know
Participation on Governing Bodies	1	2	3	4	5	99
Financing	1	2	3	4	5	99
State Level Policy Making	1	2	3	4	5	99
Local Level Decision Making	1	2	3	4	5	99
State Legislation	1	2	3	4	5	99
Leadership Development and Supports	1	2	3	4	5	99
Provision of Services and Supports	1	2	3	4	5	99
Strategic Communications and Social Marketing	1	2	3	4	5	99
Family Partnerships	1	2	3	4	5	99
Youth Partnerships	1	2	3	4	5	99
Interagency Partnerships	1	2	3	4	5	99
Training and Technical Assistance	1	2	3	4	5	99
Workforce Development and Supports	1	2	3	4	5	99
Accountability and Quality Assurance	1	2	3	4	5	99
Increasing Access	1	2	3	4	5	99
Managing Care and Costs for Youth with High Levels of Need	1	2	3	4	5	99
Cultural Relevance and Competency	1	2	3	4	5	99
Strategic Planning and Resolving Barriers	1	2	3	4	5	99
Other (Specify) ___________________	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99

7. Overall, how effective have these governmental partnerships been in supporting System of Care expansion?

Not Effective	Somewhat Effective	Moderately Effective	Very Effective	Extremely Effective	Don’t know
1	2	3	4	5	99

8. To what extent are the following Private Agencies, Providers, and Organizations involved in the planning and implementation of your System of Care expansion activities?

	Not Involved	Somewhat Involved	Moderately Involved	Substantially Involved	Extensively Involved	Don’t Know
Individual Private Providers	1	2	3	4	5	99
Private Provider Agencies	1	2	3	4	5	99
Family Organizations	1	2	3	4	5	99
Youth Organizations	1	2	3	4	5
Provider Organizations	1	2	3	4	5	99
Policy Organizations	1	2	3	4	5	99
Academic Institutions	1	2	3	4	5	99
Research Organizations	1	2	3	4	5	99
Other (specify) ___________________	1	2	3	4	5	99
Other (specify) ____________________	1	2	3	4	5	99
Other (specify) ____________________	1	2	3	4	5	99

9. To what extent are representatives from Private Agencies and Providers involved in the following planning and implementation activities for System of Care expansion?

	Not Involved	Somewhat Involved	Moderately Involved	Substantially Involved	Extensively Involved	Don’t Know
Participation on Governing Bodies	1	2	3	4	5	99
Financing	1	2	3	4	5	99
State Level Policy Making	1	2	3	4	5	99
Local Level Decision Making	1	2	3	4	5	99
State Legislation	1	2	3	4	5	99
Leadership Development and Supports	1	2	3	4	5	99
Provision of Services and Supports	1	2	3	4	5	99
Strategic Communications and Social Marketing	1	2	3	4	5	99
Family Partnerships	1	2	3	4	5	99
Youth Partnerships	1	2	3	4	5	99
Interagency Partnerships	1	2	3	4	5	99
Training and Technical Assistance	1	2	3	4	5	99
Workforce Development and Supports	1	2	3	4	5	99
Accountability and Quality Assurance	1	2	3	4	5	99
Increasing Access	1	2	3	4	5	99
Managing care and Costs for Youth with High Levels of Need	1	2	3	4	5	99
Cultural Relevance and Competency	1	2	3	4	5	99
Strategic Planning and Resolving Barriers	1	2	3	4	5	99
Other (specify) ___________________	1	2	3	4	5	99
Other (specify) ____________________	1	2	3	4	5	99
Other (specify) ____________________	1	2	3	4	5	99

10. Overall, how effective have these private agency partnerships been to support System of Care expansion?

Not Effective	Somewhat Effective	Moderately Effective	Very Effective	Extremely Effective	Don’t Know
1	2	3	4	5	99

Policies

11. Sites use several policy-related strategies to expand systems of care. Please select the responses that best describe how each is being used in your System of Care.

	Not Implemented	Somewhat Implemented	Moderately Implemented	Substantially Implemented	Extensively Implemented	Don’t Know
Develop Rules and Regulations	1	2	3	4	5	99
Develop Standards, Guidelines and Practice Protocols	1	2	3	4	5	99
Incorporate Requirements into Contracts with Providers, Managed Care Organizations, etc.	1	2	3	4	5	99
Incorporate Requirements into Compliance Monitoring Protocols	1	2	3	4	5	99
Enact System Of Care Related Legislation	1	2	3	4	5	99
Link With Other System Reform Initiatives (e.g., in Medicaid, Child Welfare, Juvenile Justice, Education) (specify) ­­­­­­­­­­________________	1	2	3	4	5	99
Data and Management Information System Supports for Systems of Care	1	2	3	4	5	99
Other (specify) ____________________	1	2	3	4	5	99
Other (specify) ____________________	1	2	3	4	5	99
Other (specify) ____________________	1	2	3	4	5	99

12. To what extent do the following state or local policies and activities support your System of Care expansion goals and activities?

	Does Not Support	Somewhat Supports	Moderately Supports	Substantially Supports	Extensively Supports	Don’t Know
Financing	1	2	3	4	5	99
State Level Policies	1	2	3	4	5	99
Local Level Policies	1	2	3	4	5	99
State Legislation	1	2	3	4	5	99
Leadership Development	1	2	3	4	5	99
Strategic Communications and Social Marketing	1	2	3	4	5	99
Family Involvement and Partnerships	1	2	3	4	5	99
Youth Involvement and Partnerships	1	2	3	4	5	99
Interagency Partnerships	1	2	3	4	5	99
Policies and Activities to Enhance Cultural and Linguistic Competence	1	2	3	4	5	99
Training and Technical Assistance	1	2	3	4	5	99
Workforce Development and Supports	1	2	3	4	5	99
Accountability and Quality Assurance	1	2	3	4	5	99
Managing Care and Costs for Youth with High Levels of Need	1	2	3	4	5	99
Co-locating or Out-Stationing	1	2	3	4	5	99
Other (Specify) ___________________	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99

13. Overall, how effective have these policies been in supporting System of Care expansion?

Not Effective	Somewhat Effective	Moderately Effective	Very Effective	Extremely Effective	Don’t Know
1	2	3	4	5	99

Values - Family and Youth Involvement and Cultural and Linguistic Competence (CLC)

14. To what extent are family members/family organizations involved in the following planning and implementation activities for System of Care expansion?

	Not Involved	Somewhat Involved	Moderately Involved	Substantially Involved	Extensively Involved	Don’t Know
Participation on Governing Bodies	1	2	3	4	5	99
Financing	1	2	3	4	5	99
State Level Policy Making	1	2	3	4	5	99
Local Level Decision Making	1	2	3	4	5	99
State Legislation	1	2	3	4	5	99
Leadership Development and Supports	1	2	3	4	5	99
Provision of Services and Supports, e.g., Peer Support	1	2	3	4	5	99
Strategic Communications and Social Marketing	1	2	3	4	5	99
Family Partnerships	1	2	3	4	5	99
Youth Partnerships	1	2	3	4	5	99
Interagency Partnerships	1	2	3	4	5	99
Training and Technical Assistance	1	2	3	4	5	99
Workforce Development and Supports	1	2	3	4	5	99
Accountability and Quality Assurance	1	2	3	4	5	99
Increasing Access	1	2	3	4	5	99
Managing Care and Costs	1	2	3	4	5	99
Cultural Relevance and Competency	1	2	3	4	5	99
Strategic Planning and Resolving Barriers	1	2	3	4	5	99
Other (Specify) ___________________	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99

15. Overall, how effective have these strategies been in involving family leaders and organizations in System of Care expansion?

Not Effective	Somewhat Effective	Moderately Effective	Very Effective	Extremely Effective	Don’t Know
1	2	3	4	5	99

16. To what extent are youth/youth organizations involved in the following planning and implementation activities for System of Care expansion?

	Not Involved	Somewhat Involved	Moderately Involved	Substantially Involved	Extensively Involved	Don’t Know
Participation on Governing Bodies	1	2	3	4	5	99
Financing	1	2	3	4	5	99
State Level Policy Making	1	2	3	4	5	99
Local Level Decision Making	1	2	3	4	5	99
State Legislation	1	2	3	4	5	99
Leadership Development and Supports	1	2	3	4	5	99
Provision of Services and Supports	1	2	3	4	5	99
Strategic Communications and Social Marketing	1	2	3	4	5	99
Family Partnerships	1	2	3	4	5	99
Youth Partnerships	1	2	3	4	5	99
Interagency Partnerships	1	2	3	4	5	99
Training and Technical Assistance	1	2	3	4	5	99
Workforce Development and Supports	1	2	3	4	5	99
Accountability and Quality Assurance	1	2	3	4	5	99
Increasing Access	1	2	3	4	5	99
Managing Care and Costs	1	2	3	4	5	99
Cultural Relevance and Competency	1	2	3	4	5	99
Strategic Planning and Resolving Barriers	1	2	3	4	5	99
Other (Specify) ___________________	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99

17. Overall, how effective have these strategies been to involve youth leaders and organizations in System of Care expansion?

Not Effective	Somewhat Effective	Moderately Effective	Very Effective	Extremely Effective	Don’t Know
1	2	3	4	5	99

18. To what extent do the following activities support the cultural and linguistic competence of your System of Care?

	Does Not Support	Somewhat Supports	Moderately Supports	Substantially Supports	Extensively Supports	Don’t Know
Financial Supports	1	2	3	4	5	99
State Level Policies	1	2	3	4	5	99
Local Level Policies	1	2	3	4	5	99
State Legislation	1	2	3	4	5	99
Leadership Development	1	2	3	4	5	99
Strategic Communications and Social Marketing	1	2	3	4	5	99
Development and Provision of Culture-Specific Services and Supports	1	2	3	4	5	99
Provision of Translation and Interpretation Services	1	2	3	4	5	99
Access and Effectiveness for Culturally Diverse Populations	1	2	3	4	5	99
Cultural Diversity of Workforce	1	2	3	4	5	99
Linguistic Diversity of Workforce	1	2	3	4	5	99
Training and Technical Assistance	1	2	3	4	5	99
Workforce Development and Supports	1	2	3	4	5	99
Accountability and Quality Assurance	1	2	3	4	5	99
Other (specify) ___________________	1	2	3	4	5	99
Other (specify) ____________________	1	2	3	4	5	99
Other (specify) ____________________	1	2	3	4	5	99

19. Overall, how effective have these strategies been in increasing cultural and linguistic competence in the System of Care?

Not Effective	Somewhat Effective	Moderately Effective	Very Effective	Extremely Effective	Don’t Know
1	2	3	4	5	99

Services and Supports

20. Your System of Care may provide a variety of home and community based services and supports to children, youth, and families. To what extent are the following services available in your System of Care?

	Not at all Available	Somewhat Available	Moderately Available	Substantially Available	Extensively Available	Don’t Know
Screening for Behavioral Health Needs (e.g. in Early Care, Education, Primary Care, Child Welfare, and Juvenile Justice Settings).	1	2	3	4	5	99
Assessment and Evaluation	1	2	3	4	5	99
Individualized Service Planning (Including Wraparound Process, Person-Centered Service Planning)	1	2	3	4	5	99
Service Planning and Delivery Based on Individualized Assessment	1	2	3	4	5	99
Intensive Care Management	1	2	3	4	5	99
Care Coordination	1	2	3	4	5	99
Outpatient Individual Therapy	1	2	3	4	5	99
Outpatient Group Therapy	1	2	3	4	5	99
Outpatient Family Therapy	1	2	3	4	5	99
Medication Treatment/Management	1	2	3	4	5	99
Crisis Response Services (Non-Mobile) 24 Hours, 7 Days a Week	1	2	3	4	5	99
Mobile Crisis Response Services, 24-Hours, 7-Days a Week	1	2	3	4	5	99
Intensive Home Based Services	1	2	3	4	5	99
School Based Behavioral Health Services	1	2	3	4	5	99
Day Treatment	1	2	3	4	5	99
Transition-to-Adult Services	1	2	3	4	5	99
Substance Use Treatment	1	2	3	4	5	99
Therapeutic Behavioral Aid Services	1	2	3	4	5	99
Behavior Management Skills Training	1	2	3	4	5	99
Tele-Behavioral Health Services	1	2	3	4	5	99
Youth Peer Support	1	2	3	4	5	99
Family peer Support	1	2	3	4	5	99
Supported Education and Employment	1	2	3	4	5	99
Supportive Independent Living	1	2	3	4	5	99
Transportation	1	2	3	4	5	99
Mental Health Consultation	1	2	3	4	5	99
Therapeutic Mentoring	1	2	3	4	5	99
Youth and Family Education	1	2	3	4	5	99
Customized Goods and Services Through Flexible Funds	1	2	3	4	5	99
Other (Specify)__________________________	1	2	3	4	5	99

21. Your System of Care may provide a variety of out-of-home treatment services, to what extent are the following services available in your System of Care?

	Not at all Available	Somewhat Available	Moderately Available	Substantially Available	Extensively Available	Don’t Know
Therapeutic Foster Care	1	2	3	4	5	99
Therapeutic Group Home Care	1	2	3	4	5	99
Crisis Stabilization Beds	1	2	3	4	5	99
Medical Detoxification	1	2	3	4	5	99
Substance Use Residential Treatment	1	2	3	4	5	99
Residential Treatment	1	2	3	4	5	99
Inpatient Hospitalization	1	2	3	4	5	99

22. How linked are the following out-of-home treatment services to community based services?

	Not at all Linked	Somewhat Linked	Moderately Linked	Substantially Linked	Extensively Linked	Don’t Know
Therapeutic Foster Care	1	2	3	4	5	99
Therapeutic Group Home Care	1	2	3	4	5	99
Crisis Stabilization Beds	1	2	3	4	5	99
Medical Detoxification	1	2	3	4	5	99
Substance Use Residential Treatment	1	2	3	4	5	99
Residential Treatment	1	2	3	4	5	99
Inpatient Hospitalization	1	2	3	4	5	99

23. Your System of Care may provide a variety of evidence based or supported practices as a part of your grant expansion activities. To what extent are the following services available in your System of Care? Please add any other evidence based and informed services.

	Not at all Available	Somewhat Available	Moderately Available	Substantially Available	Extensively Available	Don’t Know
Cognitive Behavior Therapy	1	2	3	4	5	99
Cognitive Therapy	1	2	3	4	5	99
Interpersonal Psychotherapy	1	2	3	4	5	99
Multi-Systemic Therapy	1	2	3	4	5	99
Family Therapy (Brief Strategic, Multi-Dimensional, Functional)	1	2	3	4	5	99
Other (Specify)___________________	1	2	3	4	5	99
Other (Specify)___________________	1	2	3	4	5	99
Other (Specify)___________________	1	2	3	4	5	99
Evidence-Based Practice Components	1	2	3	4	5	99
Evidence-Based Services Specific to or Adapted for Culturally Diverse Populations	1	2	3	4	5	99

24. To what extent do you use the following methods to encourage and support the use of evidence based or informed practices in your System of Care?

	Not Used	Somewhat Used	Moderately Used	Substantially Used	Extensively Used	Don’t Know
Requirements or Mandates (Legislation, Policy, Guidelines)	1	2	3	4	5	99
Training and Education on Specific Evidence-Based Practices	1	2	3	4	5	99
Training and Education of Evidence-Based Practice Components	1	2	3	4	5	99
Fidelity Monitoring	1	2	3	4	5	99
Distribution of Practice Guidelines and Manuals	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99

25. Overall, how effective have these methods been for encouraging and supporting the use of evidence based or supported practices in your System of Care?

Not Effective	Somewhat Effective	Moderately Effective	Very Effective	Extremely Effective	Don’t Know
1	2	3	4	5	99

26. To what extent do you use the following care coordination methods and supports in your System of Care?

	Not Used	Somewhat Used	Moderately Used	Substantially Used	Extensively Used	Don’t Know
Maximum Caseloads	1	2	3	4	5	99
Establish Tiered and Weighted Caseloads (e.g., Case Coordinators Serving Youth with More Serious and Complex Conditions Have Smaller Caseload)	1	2	3	4	5	99
Establish Process for Care Managers/Coordinators to Coordinate Services Across Child-Serving Agencies	1	2	3	4	5	99
Establish Contracts with Care Management Entities to Provide Care Management and Care Coordination Services	1	2	3	4	5	99
Training in Effective Service Planning and Coordination	1	2	3	4	5	99
Implement Shared Client-Level Information/Data Systems	1	2	3	4	5	99
Interagency Linkages and Teams	1	2	3	4	5	99
Financial supports (e.g. Medicaid codes, flex funds)	1	2	3	4	5	99
Co-location and out-stationing	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99

27. Overall, how effective have these approaches been for increasing care coordination in your System of Care?

Not Effective	Somewhat Effective	Moderately Effective	Very Effective	Extremely Effective	Don’t Know
1	2	3	4	5	99

28. To what extent are the following grant expansion activities supporting increased youth and family access to services?

	Not Used	Somewhat Used	Moderately Used	Substantially Used	Extensively Used	Don’t Know
Social marketing of System of Care Specify: ______________	1	2	3	4	5	99
Training on Eligibility Criteria	1	2	3	4	5	99
Training on Referral procedures	1	2	3	4	5	99
Expansion of the Provider Network (e.g., Contracting with New Providers)	1	2	3	4	5	99
Policies to Promote Use of Satellite Offices	1	2	3	4	5	99
Policies to Promote Use of Tele-Health Services	1	2	3	4	5	99
Efforts to Increase Service Capacity	1	2	3	4	5	99
Reduction in Financial Barriers Specify: ______________	1	2	3	4	5	99
Polices to Expand Hours of Service	1	2	3	4	5	99
Policies that Promote Service Provision in Homes and Schools	1	2	3	4	5	99
Culturally and Linguistically Appropriate Outreach	1	2	3	4	5	99
Compliance with All Americans with Disabilities Act (ADA) Regulations	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99

29. Overall, how effective have these activities been for increasing youth and family access to your System of Care?

Not Effective	Somewhat Effective	Moderately Effective	Very Effective	Extremely Effective	Don’t Know
1	2	3	4	5	99

30. To what extent are the following methods used in your System of Care to encourage and support the provision of services in the home community?

	Not Used	Somewhat Used	Moderately Used	Substantially Used	Extensively Used	Don’t Know
Expanding the Service Array Across Jurisdiction	1	2	3	4	5	99
Training on Home and Community-Based Care	1	2	3	4	5	99
Providing Peer Support	1	2	3	4	5	99
Providing Respite Services and Other Supports	1	2	3	4	5	99
Providing Mobile Crisis and Stabilization Services	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99

31. Overall, how effective have these methods been for encouraging the support and provision of services in the home community?

Not Effective	Somewhat Effective	Moderately Effective	Very Effective	Extremely Effective	Don’t Know
1	2	3	4	5	99

32. To what extent are the following grant related services, supports and policies utilized to encourage reductions in the use of unnecessary residential services?

	Not Used	Somewhat Used	Moderately Used	Substantially Used	Extensively Used	Don’t Know
Expansion of Intensive Non-Residential Clinical Services Options	1	2	3	4	5	99
Training in Least Restrictive Care	1	2	3	4	5	99
Expansion of Family Support Services such as Respite Services	1	2	3	4	5	99
Formal Assessment of Needs	1	2	3	4	5	99
Utilization Review	1	2	3	4	5
Case Review	1	2	3	4	5
Policies Requiring Discharge Planning and Coordination with Home and Community-Based Services at the Time of Admission and During Stay	1	2	3	4	5	99
Other (Specify) ________	1	2	3	4	5	99

33. Overall, how effective have these supports and policies been for encouraging reductions in the use of unnecessary residential services?

Not Effective	Somewhat Effective	Moderately Effective	Very Effective	Extremely Effective	Don’t Know
1	2	3	4	5	99

34. Please select the responses that best describe the quality improvement activities in your System of Care.

	Not planned	Data Collected but not analyzed	Data Analyzed but not used for Quality Management	Used in Quality Management Process	Don’t know
Child/youth clinical and functional outcomes	1	2	3	4	99
Family well-being outcomes	1	2	3	4	99
Child, youth and family appraisals of service experience (for example, satisfaction with services)	1	2	3	4	99
Youth involvement in governance, management, and/or operations	1	2	3	4	99
Family involvement in governance, management, and/or operations	1	2	3	4	99
Monitoring of fidelity of evidence-supported services	1	2	3	4	99
Cultural and linguistic competence in SOC governance, management, and operations	1	2	3	4	99
Culturally competent service delivery	1	2	3	4	99
Interagency collaboration	1	2	3	4	99
Coordination of services	1	2	3	4	99
Accessibility of services	1	2	3	4	99
Community-based service delivery	1	2	3	4	99
Service delivery in least restrictive settings	1	2	3	4	99
Other (specify)	1	2	3	4	99

Financing

35. To what extent are the following funding sources or mechanisms used to expand and sustain your System of Care?

	Not Used	Somewhat Used	Moderately Used	Substantially Used	Extensively Used	Don’t Know
Medicaid	1	2	3	4	5	99
Affordable Care Act	1	2	3	4	5	99
Mental Health Block Grants	1	2	3	4	5	99
Substance Use Block Grants	1	2	3	4	5	99
Federal Grants	1	2	3	4	5	99
State General Funds	1	2	3	4	5	99
Waivers Specify___________	1	2	3	4	5	99
Braided or Blended Funds Specify_________	1	2	3	4	5	99
Other (Specify)	1	2	3	4	5	99

36. Overall, how effective have these funding sources or mechanisms been for expanding and sustaining your System of Care?

Not Effective	Somewhat Effective	Moderately Effective	Very Effective	Extremely Effective	Don’t Know
1	2	3	4	5	99

Training and Workforce

37. To what extent are the following activities used in your System of Care to support the development of an effective workforce?

	Not Used	Somewhat Used	Moderately Used	Substantially Used	Extensively Used	Don’t know
Training on the SOC Approach	1	2	3	4	5	99
Training on Evidence Based and Informed Practices	1	2	3	4	5	99
Continuing Education	1	2	3	4	5	99
Addition of New Types of Providers to the Workforce	1	2	3	4	5	99
Recruitment of a Culturally and Linguistically Diverse Staff	1	2	3	4	5	99
Improved Salaries and Benefits	1	2	3	4	5	99
Quality Management	1	2	3	4	5	99
Professional Development	1	2	3	4	5	99
Recruitment and Support of Peer-To Peer Family and Youth Providers	1	2	3	4	5	99
Fidelity Training and Monitoring to the SOC Approach	1	2	3	4	5	99
Other (specify)	1	2	3	4	5	99

38. Overall, how effective have these activities been for maximizing the expansion and sustainability of your System of Care?

Not Effective	Somewhat Effective	Moderately Effective	Very Effective	Extremely Effective	Don’t Know
1	2	3	4	5	99

Strategic Communications

39. To what extent are the following communications strategies used to support the expansion and sustainability of your SOC?

	Not Used	Somewhat Used	Moderately Used	Substantially Used	Extensively Used	Don’t Know
Social Marketing Efforts Specify: ______________	1	2	3	4	5	99
Conferences and Meetings	1	2	3	4	5	99
Webinars	1	2	3	4	5	99
Newsletters	1	2	3	4	5	99
Reports	1	2	3	4	5	99
Issue Briefs	1	2	3	4	5	99
Sharing Meeting Notes	1	2	3	4	5	99
Collecting and Using Data on Child and Family Outcomes	1	2	3	4	5	99
Collecting and Using Data on Return on Investment in the SOC Approach	1	2	3	4	5	99
Personal Stories on the Experience of Youth and Family Members	1	2	3	4	5	99
Engagement of Youth Organizations	1	2	3	4	5	99
Engagement of Family Organizations	1	2	3	4	5	99
Outreach to Underserved Populations	1	2	3	4	5	99
Engagement of State Policy Makers	1	2	3	4	5	99
Engagement of Local Policy Makers	1	2	3	4	5	99
Engagement of Private and Public Partners	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99
Other (Specify) ____________________	1	2	3	4	5	99

40. Overall, how effective have these strategies been for maximizing the expansion and sustainability of your System of Care?

Not Effective	Somewhat Effective	Moderately Effective	Very Effective	Extremely Effective	Don’t Know
1	2	3	4	5	99

41. Which of the following strategies have been used to generate support and commitment for System of Care expansion among high-level decision makers?

	Not planned	Planned but Not Started	Little Implementation	Somewhat Implemented	Moderately Implemented	Extensively Implemented	Don’t Know
Data on the Effectiveness of the System of Care Approach	1	2	3	4	5	6	99
Data Showing Cost Savings	1	2	3	4	5	6	99
Personal Stories on Experience of Youth and Family Members	1	2	3	4	5	6	99
Reports	1	2	3	4	5	6	99
Other (specify) ____________________	1	2	3	4	5	6	99
Other (specify) ____________________	1	2	3	4	5	6	99

42. Overall, how effective have these strategies been for generating support and commitment for system or care expansion among high-level decision makers?

Not Effective	Somewhat Effective	Moderately Effective	Very Effective	Extremely Effective	Don’t Know
1	2	3	4	5	99

End of Instrument:

Thank you for completing this tool. We appreciate your time and participation.

2

Attachment #3 – SOCESS