Using an annual “system of care assessment” to amplify the voices of agencies and practitioners in New Hampshire’s children’s mental health system

Abstract Information: New Hampshire’s System of Care (SOC) Assessment evaluates the characteristics of five different evidence-based behavioral health practices as delivered to the state’s most vulnerable children and their families. The primary aim of the SOC Assessment is to serve as a children’s behavioral health needs assessment by identifying strengths, needs, and gaps in the service array. A secondary aim is to identify systems barriers to high-quality practice by amplifying and empowering the voices of mental health agencies and practitioners. Two doctoral-level evaluators with behavioral health expertise leverage the scholarly literature; individual interviews with state program officers and practice trainers; and documentation and group interviews with supervisors and practitioners to score each practice using the System of Care Assessment Tool (SOCAT). Inspired by Glasgow’s RE-AIM model, the SOCAT includes 21 items organized into five domains. These domains assess the degree to which each practice 1) was delivered in a way that was sensitive to youth and family’s preferences, cultures, and trauma histories (Values); 2) was provided to the right children, at the right time, in the right amount (Reach); 3) was implemented in a way that was faithful to the practice model (Implementation); 4) is supported by high-quality research evidence (Potency); and 5) occupied a feasible, sustainable, and coordinated niche within the overall service array (Synergy). As such, the SOCAT places the functioning of highly disparate behavioral health practices across many sites on a common metric. This fosters comparability, transparency, and common language/understanding. The first two SOC Assessments examined the status of ten highly diverse behavioral health practices delivered throughout NH’s children’s behavioral health system of care. As intended, these assessments have certainly helped state leaders “see” the service array in a more systemic, data-informed, and comprehensive manner. Perhaps more importantly, they have also lifted the voices of mental health agencies and staff by highlighting their belief in evidence-based practice, commitment to the highest possible quality of care for their children and families, and painful awareness of the resource constraints that cause them to fall short of that ideal. In so doing, the assessments have reframed the problem – from convincing mental health agencies and their staff that evidence-based practice is virtuous, to fully equipping them to meet that challenge.