Concept Mapping

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Concept Mapping

• A Next Generation Strategy
• For Planning and Evaluating
• Systems Change

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Presenters

• Lenore B. Behar, Director
• Child Family Program Strategies
• William M. Hydaker, Director
• Hydaker Community Consulting

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• Andrea Aderton, Project Director
• Circle of Hope Project
• St. Joseph, MO
• Mona Gauthier, Principal Investigator
• Cathy Baxter, Evaluator
• commUNITY cares
• Hattisburg, MS

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• John Reiss, Consultant
• Florida Institute for Family Involvement
• Associate Professor of PediatricsInstitute for
  Child Health PolicyUniversity of  Florida
  Gainesville, FL

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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.
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Integrating Families, Communities, and Providers
(IFCAP)
Funding Federal Maternal and Child Health
Bureaus 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 Programs designee
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IFCAP Partnerships
FIFI Invited by Childrens Medical Services
(Florida Title V) to apply, as the lead
organization, for 3-year grant
Lead Partners Childrens Medical
Services Florida Pediatric Society (Florida AAP
Chapter)
Eligible applicants State Title V CSHCN Programs
or Programs designee
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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
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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
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Use Existing Partnerships to Build Local Systems
Request for proposals Identify and describe the
community Describe composition of the
communitys 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.
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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
communitys a) demonstrated potential to develop
partnership and b) current and potential capacity
to serve CSHCN and their families.
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IFCAP Communities
Jacksonville
Sarasota
Broward Co.
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Circle of
Home, Opportunities, Parents and Professionals,
Empowerment
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Policy Team Members
? Family Guidance Center ? The Center ?
Northwest Health Services ? St. Joseph Youth
Alliance ? Heartland Health ? Childrens
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
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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.

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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

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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.

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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

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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
Childrens Division
Youth Coordinator Jayme Neal
Juvenile Justice
Administrative Assistant Wendy Tyrrell
Schools
Staff Services Pattern Chart
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Key Initiative Partners

• MS Department of Mental Health
• Pine Belt Mental Healthcare Resources
• Mississippi Families as Allies

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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

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Initiative Partners, continued

• Aldersgate
• Big Brothers/Big Sisters
• Forrest County Youth Court
• Hattiesburg Police Department
• Mississippi Childrens Home Services/CARES
• MCHS (Adolescent Shelter)
• Oseola McCarty Youth Center
• Catholic Social Community Services

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..and still more.

• School Attendance Officers Forrest Lamar
• Center for the Prevention of Child Abuse
• Lamar County Parents As Teachers
• Lamar County Sheriffs Department
• University of Southern Mississippi Resource
  Center

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And growing.

• Junior Auxiliary
• Harden House
• Memorial Behavioral Health
• Parham Group
• Salvation Army Boys Girls Club

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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

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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.

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Introduction to Concept Mapping

• Group discussion of planning and evaluation
  experiences.
• Concept Mapping defined.
• Concept Mapping as a planning and evaluation
  tool.
• Examples.

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Planning and Evaluation Experiences

• Strengths
• Challenges
• Evaluation, quality improvement, continuous
  quality improvement?

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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.

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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

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In Order to Avoid This
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And Get Organized Input fromCommunity
Stakeholders
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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

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Concept Systems, Inc.Example of Clients
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Process how does it work?

• Convening a group.
• Brainstorming.
• Sorting the responses.
• Rating the responses.
• Feedback session products.

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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.

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Develop the Focus Prompt

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

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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..

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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.

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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.

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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.

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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.

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Roles of the Facilitators

• Make sure topic is thoroughly considered.
• Get everyone involved.
• Keep everyone on task.

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Focus Prompt

• To have a system of care in our community, we
  must..

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Sorting

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

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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.
• Dont create piles with miscellaneous items
• You must have more than 1 pile!
• You cannot have a pile that has only 1 card in
  it.

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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

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Ratings
Use the rating sheets to determine the
importance and feasibility of each
statement. Remember, Importance then
Feasibility.
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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.

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How the data are analyzed
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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.

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Multidimensional Scaling, contd

• 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.

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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.

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Hierarchical Cluster Analysis, contd

• 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.

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The Products
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Point Map
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Five Cluster Solution
Youth Family Focus
Training/Evaluation
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Six Cluster Solution
Community Development
Youth Family Focus
Cultural Issues
Training/Evaluation
Communication/Collaboration
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Seven Cluster Solution
Family Focus
Youth Focus
Cultural Issues
Quality Services
Training/Evaluation
Communication/Collaboration
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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

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Cluster Ratings on Importance and Feasibility
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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.

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Go-Zones
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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.

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Twelve Highest Statements contd

• 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.

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What has this exercise accomplished?
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• 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.

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• 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.

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• How Others Have Used Concept Mapping

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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.
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Why Concept Mapping ?
Services and Supports
CYSNCH Families
Needs and Priorities
Coordinators
Physicians
Medical Homes
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Circle of
Home, Opportunities, Parents and Professionals,
Empowerment
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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

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• Clusters and Statements Sorted
• Principles
• Objectives
• Strategies
• Next Steps

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Eight Cluster Solution
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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.

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From Concept Mapping to Logic Model Identifying
Issues
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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.

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From Concept Mapping to Logic Model Identifying
Values
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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.

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From Concept Mapping to Logic Model Identifying
Strategies
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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.

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From Concept Mapping to Logic Model Outcomes
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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.

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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

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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

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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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