Developing Systems of Care and Using Theories of Change

Excerpted from Chapter 3 of Developing Outcome Strategies in Children's Mental Health, edited by Mario Hernandez, Ph.D., & Sharon Hodges, Ph.D.

Copyright © 2001 Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.


Background

Developing systems of care requires more than strong collaboration. At a minimum it requires the following:

• Establishing clear links between the ideas for how a system should be built and the chosen strategies for creating positive change
  
  
• Grounding planning in information about the local populations to be served and their strengths and needs
  
  
• Avoiding pressure to begin offering services immediately just to meet expectations of outside funders
  
  
• Being accountable to family members, funding agents, and other stakeholders (Koch, Lewis, & McCall, 1998; Rouse, Toprac, & MacCabe, 1998)
  
  
• Engaging a broad base of stakeholders in the development process
  
  
• Engaging families as full partners (Hodges et al., 1999)

Integrating multiple perspectives and complex and deeply held values, beliefs, and expectations into the planning and implementation of service systems is a formidable challenge for the would-be consensus builder. Theory-based approaches to planning can help build consensus among diverse stakeholder groups by clarifying the links between ideas and action.

Using Theories of Change

A theory of change is an articulation of the underlying beliefs and assumptions that guide a service delivery strategy and that are believed to be critical for producing change and improvement in children and families (Hernandez, Hodges, & Worthington, 2000). A theory of change can also be defined as the beliefs that funding agencies, planners, and implementers have about what children and their families need and what strategies enable them to meet those needs.

In contrast to results-based accountability strategies, a theory-based approach anchors selected measures in a theoretical context (Chen & Rossi, 1983), a requirement for, among other things, a quality evaluation (Bickman, 1990; Chen & Rossi, 1983; Shern, Trochim, & LaComb, 1995). Weiss (1995) suggested that the concept of grounding evaluations in theories of change assumes that most complex social programs are based on a theory or belief about how and why the program will work, regardless of whether the theory has been made explicit. Weiss recommended evaluation as a means for helping program implementers articulate their theory and define the assumptions built into their approach. According to Friedman (1997), unless this is accomplished, evaluations cannot accurately specify the reasons for the results that are observed.

Using a theory-based approach, stakeholders are compelled to examine the underlying beliefs and assumptions through which they link intended outcomes with strategies for achieving those outcomes. That is, they are drawn to focus on why they assume that certain services or policies will lead to positive changes in the population of children and families served. Moreover, a theory-based approach requires stakeholders to link the intended results of service delivery to their organizational mission so that the integrity of the relationship between the mission and the intended results is assured.

A clearly articulated theory of change provides the foundation for stakeholders to come to an agreement on activities that contribute substantially to meeting those expectations. Articulating a theory of change often presents challenges because program planners and other stakeholders have not examined the underlying assumptions of the services they provide (Connell, Kubisch, Schorr, & Weiss, 1995). Establishing a theory of change for a system or program requires planners and implementers at all levels to examine their own assumptions about appropriate and effective strategies and practices and to discuss these assumptions with others engaged in the theory-development process. True consensus regarding the theory of change cannot be reached in the absence of such discussions. The potential benefit of this process is that individuals at all levels of a system or program become more consistent in the delivery of services and supports.

During the development of a theory of change, disagreement among stakeholders frequently surfaces. The process of articulating a unified theory of change serves the useful purpose of highlighting points that require agreement. It is essential that stakeholders become aware of these differences as the first step in building consensus for both short- and long-range planning.