The state of methods and tools for social systems change

The last decade or so has seen an increase in the rate of attention to systems change and the application of multiple theories to study and influence change in systems. This article considers how these theories, described in other articles in this issues, plus theories about complex adaptive systems open opportunities for us to continue to expand our repertoire of tools and methods to address systems change. These conceptual frameworks, tools, and methods are expected to help us increase our capacity to study and influence both planned and self-organizing systems change. New tools and methods have emerged and others are needed to help us continue to explore and influence the complex social systems within which we operate.     

Systems of Care: New Partnerships for Community Psychology

For almost two decades, the federal government has supported the development of integrated models of mental health service delivery for children and families, known as systems of care (SOCs), that strive to be child-centered, family-focused, community-based, and culturally competent. These efforts align well with the values and principles (e.g., empowerment, collaboration, strengths emphasis, focus on macro-level social/system change) central to community psychology (CP; Kloos et al. in Community psychology, Cengage Learning, Belmont, 2012). Despite the convergence of many core values, CPs have historically been underrepresented in key roles in SOC initiatives. However, this has changed in recent years, with increasing examples of community psychology skills and principles applied to the development, implementation, and evaluation of SOCs. Because successful and sustainable implementation of SOCs requires community and system-level change, and SOCs are increasingly being urged to adopt a stronger "public health" orientation (Miles et al. in A public health approach to children's mental health: a conceptual framework, Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children's Mental Health, Washington, DC, 2010), there is great potential for CPs to play important roles in SOCs. This paper discusses opportunities and roles for CPs in SOCs in applied research and evaluation, community practice, and training.     

Understanding Systems Change in Early Implementation of Housing First in Canadian Communities: An Examination of Facilitators/Barriers,Training/Technical Assistance,and Points of Leverage

We present interim findings of a cross‐site case study of an initiative to expand Housing First (HF) in Canada through training and technical assistance (TTA). HF is an evidence‐based practice designed to end chronic homelessness for consumers of mental health services. We draw upon concepts from implementation science and systems change theory to examine how early implementation occurs within a system. Case studies examining HF early implementation were conducted in six Canadian communities receiving HF TTA. The primary data are field notes gathered over 1.5 years and evaluations from site‐specific training events (k = 5, n = 302) and regional network training events (k = 4, n = 276). We report findings related to: (a) the facilitators of and barriers to early implementation, (b) the influence of TTA on early implementation, and (c) the “levers” used to facilitate broader systems change. Systems change theory enabled us to understand how various “levers” created opportunities for change within the communities, including establishing system boundaries, understanding how systems components can function as causes of or solutions to a problem, and assessing and changing systems interactions. We conclude by arguing that systems theory adds value to existing implementation science frameworks and can be helpful in future research on the implementation of evidence‐based practices such as HF which is a complex community intervention. Implications for community psychology are discussed.     

Exploring the implications of social change for human development: Perspectives,issues and future directions

Researchers have investigated the implications of social change for human development from different perspectives. The studies published in this special section were conducted within Greenfield's theoretical framework (2009). The findings concerning links between specific sociodemographic features (e.g., commercial activities, schooling) and individual cognition and social behaviour are particularly interesting because they tap the underlying forces that drive human development. To further understand the issues in these studies and in the field, a pluralist‐constructive perspective is discussed, which emphasises the integration of diverse values and practices in both Western and non‐Western societies and its effects on the development of sophisticated competencies in individual adaptation to the changing global community. In addition, several issues are highlighted and some suggestions are provided for future explorations in this field.     

Moving Forward with Systems of Care: Needs and New Directions

The articles in this Special Issue on system change within systems of care (SOCs) provide guidance regarding strategies for modifying SOCs to address the needs of different populations, and ways for changing systems to support more positive child and family outcomes. This paper frames central needs, unanswered questions, and issues that remain for those working to implement SOCs. Specific needs and new directions considered include: (1) rigorous implementation-focused research to identify the necessary and sufficient elements of SOCs and the primary practice approach currently used in SOCs, wraparound; (2) applied research to assess SOCs and document their effectiveness in non-standard or non-traditional settings (i.e., non-mental health settings, including child welfare, juvenile justice, local housing authorities); (3) controlled outcome studies for school-based wraparound initiatives; (4) research to document the effectiveness of the family support efforts that are part of most SOCs; and (5) attention to context, for families, service providers, and collaborative implementation efforts, by researchers and providers alike. Progress in these areas can inform well-targeted system change efforts in the context of SOCs, a critical need given changes in federal funding for these initiatives.     

Getting the social organism thinking: strategy for systems change

The ability of community researchers/practitioners to facilitate systems change is constrained by social power--particularly the capacity to shape ideology [S. Lukes (1974). Power: A radical view. Hampshire: MacMillan] and frequently power molds ideologies which undermine systems thinking. Following what Mills [C. W. Mills, (1959). The sociological imagination. New York: Oxford University Press] (termed the "sociological imagination", this article makes the case for a strategy of systems change that promotes an integrated focus on systems and their constituent individuals. Both of these components are understood to continuously shape each other. The social imagination is introduced as a way to conceptualize the intersection between individuals' conceptions of systems and the ways that systems work to form individual identities and perceptions of social reality. Examples of attempts at systems change from community organizing and public health are used to illustrate both common fallacies and potential future directions for systems change efforts.     

Profiling Capacity for Coordination and Systems Change: The Relative Contribution of Stakeholder Relationships in Interorganizational Collaboratives

In response to increasing demands for greater coordination and collaboration among community institutions, interorganizational collaboratives (i.e., coalitions, partnerships, coordinating councils) have emerged as a popular mechanism for strengthening the capacity of a community system to respond to public and social issues. This study adopts a network approach to explore the relative importance of dense networks of cooperative relationships among members of interorganizational collaboratives for two outcomes of effectiveness: improving interorganizational coordination and fostering systems change. Based on survey and social network data collected from 48 different collaboratives, findings indicate that, relative to other key characteristics of collaboratives identified in previous literature, cooperative stakeholder relationships were the strongest predictor of systems change outcomes. However, for coordination outcomes, stakeholder relationships were overshadowed in importance by the leadership and decision making capacity of the collaborative. Collectively, findings suggest key differences in the requisite capacity profiles for coordination and systems change outcomes.     

Systems change as an outcome and a process in the work of community collaboratives for health

The widespread development of comprehensive community initiatives that aim to improve community health is driven by the need to change the systems charged with delivering the services and creating the policies related to a variety of health outcomes. Georgia's Family Connection initiative is the nation's largest statewide network of community collaboratives for health, with collaboratives operating in 159 counties. Data on community context, collaborative processes, engagement in systems change, and changes in programs and activities implemented, gathered consistently at the collaborative level over 3 years, will be used to answer the following questions. How do community contexts and the structure and processes of collaboratives affect implementation of systems change? How do systems changes affect intermediate outcomes such as the type of programs offered in a community? Longitudinal change in systems change and program implementation is described and significant predictors of between‐collaborative variation in longitudinal change for each outcome are identified.     

Lessons learned in systems change initiatives: benchmarks and indicators

Measuring progress toward systems change, sustainable efforts that address root causes of an issue by changing policies and practices, is a difficult task for communities, evaluators, and foundations. Tracking and documenting changes in resources, power, policy, sustainable funding, structured relationships and roles, and underlying values require multi-level analyses. Systems change analysts must consider at least four “strata” at once: (1) events and trends, (2) patterns of interaction, (3) context and cultural or social models, and (4) the systems themselves. In this paper we provide a brief overview of systems change; a discussion of collaboratives as one “engine” of social change; a discussion of benchmarks and indicators of collaboratives focused on systems change; and suggestions for further research. The analysis draws upon several analytic frameworks described in the literature. We illustrate these concepts with examples from six systems change initiatives funded by The California Endowment. The need for further research is outlined.     

Food Systems Change and the Environment: Local and Global Connections

Making changes to the way food is produced, distributed, and processed is one strategy for addressing global climate change. In this case study, we examine the "forming" stage of an emergent and locally-based coalition that is both participatory and focused on promoting food security by creating food systems change. Social network analysis is used to compare network density, centrality, and centralization among coalition partners before the formation of the coalition and at its one-year anniversary. Findings reveal that the coalition facilitated information seeking, assistance seeking, and collaborative efforts related to food security among a group of organizational stakeholders that were relatively disconnected pre-coalition. Results also illuminate tensions related to increased centralization of the network, coalition efficiency, and the goals of democratic decision-making. This study highlights the utility of social network analysis as a tool for evaluating the aims and trajectory of locally-based coalitions focused on global concerns.     

The stigma of mental illness: Explanatory models and methods for change

For people with mental illness, diminished quality of life and loss of personal goals does not result solely from the symptoms, distress, and disabilities caused by their psychiatric disorder. Quality of life and personal goals are also hindered by people who embrace the stigma that accompanies mental illness and mental health care. This paper reviews evidence of the impact of mental illness stigma and strategies for seeking to ease its impact. To achieve these goals, we (a) describe the ways in which stigma harm people with mental illness, (b) summarize models that explain the development and maintenance of these stigmatizing effects, and (c) review strategies that have been shown to decrease the impact of stigma. Concerns about stigma are on the political agendas of many mental health advocacy groups. It has recently also become the focus of extensive research. Our goal in this paper is to balance the practical concerns raised by mental health advocates against data that support or contradicts specific assertions.     

Developing new treatments: on the interplay between theories, experimental science and clinical innovation

It is often argued that behaviour therapy and cognitive-behaviour therapy have a sound theoretical and experimental basis. In the early days of behaviour therapy, the learning theory accounts that were the basis of treatment made clear suggestions about the procedures that were likely to be effective in treatment. In contrast, more recent cognitive-behavioural models tend to specify targets for therapy, but not the procedures that might be optimal for changing the targets. As a consequence, a considerable amount of work has to be done in order to create an effective cognitive-behavioural treatment from a promising cognitive-behavioural model. The process by which cognitive-behavioural treatments are developed is rarely discussed in the literature. For this reason, the way in which one group has used a mixture of phenomenological, experimental and treatment development studies to create effective cognitive therapy programmes for anxiety disorders is described.     

Reframing Coalitions as Systems Interventions: A Network Study Exploring the Contribution of a Youth Violence Prevention Coalition to Broader System Capacity

This longitudinal research conceptualizes community coalitions as events in local intervention systems (Hawe et al. in Am J Commun Psychol 43(3–4):267–276, 2009 ). It explores the potential contribution coalitions make, through the collaborative activities of their members, to the broader intervention systems in which they are embedded. Using social network analysis, it examines patterns of structural change in a network of 99 organizations focused on youth violence prevention (YVP) over a 5‐year period in which 30 of the 99 organizations were involved in a local YVP Coalition. Both longitudinal modeling and cross sectional analyses are used to examine change in system capacity—strong interorganizational networks—related to patterns of network density, centralization, and hierarchy. Somewhat surprisingly, the study found that capacity in the broader YVP Intervention System actually diminished during the 5‐year period of the coalition’s operation, though part of the system—the sub‐network that made up the YVP Coalition—was marginally strengthened. In this case, therefore, the evidence suggests that power and relational resources in the broader YVP Intervention System were redistributed. The article explores how the definition of capacity related to density and hierarchy may be contextually dependent. Implications for the role of coalitions in building system capacity are discussed.     

Putting the system back into systems change: a framework for understanding and changing organizational and community systems

Systems change has emerged as a dominant frame through which local, state, and national funders and practitioners across a wide array of fields approach their work. In most of these efforts, change agents and scholars strive to shift human services and community systems to create better and more just outcomes and improve the status quo. Despite this, there is a dearth of frameworks that scholars, practitioners, and funders can draw upon to aid them in understanding, designing, and assessing this process from a systemic perspective. This paper provides one framework--grounded in systems thinking and change literatures--for understanding and identifying the fundamental system parts and interdependencies that can help to explain system functioning and leverage systems change. The proposed framework highlights the importance of attending to both the deep and apparent structures within a system as well as the interactions and interdependencies among these system parts. This includes attending to the dominant normative, resource, regulative, and operational characteristics that dictate the behavior and lived experiences of system members. The value of engaging critical stakeholders in problem definition, boundary construction, and systems analysis are also discussed. The implications of this framework for systems change researchers and practitioners are discussed.     

Readiness to adaptively change under three conditions: Clinical,careers, and natural change situations

The Adaptive Change Model (ACM) was developed as an alternative form of the Transtheoretical Model of Change to address some of the criticisms of early operationalisation. Both models provide a framework for measuring the potentialities of change and to facilitate targeted behaviour change in general and clinical settings. In this research, the eight factors of the Adaptive Change Questionnaire (ACQ) operationalising the ACM were validated using confirmatory factor analysis, involving 238 respondents. The findings indicated a good fit between the model and data. A comparison of the mean scores of the factors of the ACM showed respondents seeking clinical therapy (n = 85) were lower on self‐rating of factors related to adaptive change than a group receiving career counselling (n = 88) and a non‐therapy group (n = 65). The ACQ factors correctly predicted the allocation of 79.3% of the clinical and non‐therapy respondents which confirmed previous research. The relevance of the findings for therapeutic interventions and future research are discussed.     

Sustaining and Expanding Systems of Care to Provide Mental Health Services for Children, Youth and Families Across America

The Substance Abuse and Mental Health Services Administration has been instrumental in supporting the development and implementation of systems of care to provide services to children and youth with serious mental health conditions and their families. Since 1993, 173 grants have been awarded to communities in all 50 states, Puerto Rico, Guam, the District of Columbia, and 21 American Indian/Alaska Native communities. The system of care principles of creating comprehensive, individualized services, family-driven and youth-guided care and cultural and linguistic competence, supported by a well-trained and competent workforce, have been successful in transforming the field of children's mental health and facilitating the integration of child-serving systems. This approach has achieved positive outcomes at the child and family, practice and system levels, and numerous articles have been published using data collected from system of care communities, demonstrating the effectiveness of this framework. This article will describe lessons learned from implementing the system of care approach, and will discuss the importance of expanding and sustaining systems of care across the country.     

Improving Experience in Personal Social Systems through Family Constellation Seminars: Results of a Randomized Controlled Trial

This study examined the efficacy of family constellation seminars (FCSs) on individuals' experience in their personal social systems, especially the experience of belonging, autonomy, accord, and confidence. We conducted a single‐blind, stratified and balanced, randomized controlled trial. Participants were 208 adults (M = 48 years, SD = 10, 79% women) who were randomly allocated either to the intervention group (3‐day FCSs; 64 active participants, 40 observing participants) or to the wait‐list group (64 active participants, 40 observing participants). Change was measured short‐term (2‐week and 4‐month follow‐up) using the Experience In Social Systems Questionnaire, personal domain (EXIS.pers). EXIS.pers is a new outcome measure being applied for the first time in evaluation research. In addition, we used interpersonal scales derived from established measures (Outcome Questionnaire, OQ‐45; Tool for the Evaluation of the Psychotherapeutic Progress, FEP). The average person in the intervention group showed improved experience in personal social systems, as compared with approximately 73% of the wait‐list group after 2 weeks (total score: Cohen's d = .61, p = .000) and 69% of the wait‐list group after 4 months (total score: d = .53, p = .000). The results were confirmed in per‐protocol analyses (n = 191) by the results of the EXIS.pers dimensions (Belonging, Autonomy, Accord, and Confidence) and the interpersonal scales derived from the OQ‐45 and FEP. No adverse events were reported. This RCT provides first evidence that FCSs tend to positively influence participants' experience in their social systems.     

Adolescents' family obligation and activities in rural and urban Vietnam: Implications for social change

This study examined how urbanisation may modify adolescents' values and activities concerning family obligation by surveying 572 adolescents (M_age = 15.75, SD = .73) in rural and urban Vietnam. Compared with their rural peers, urban adolescents reported a stronger sense of family obligation but spent less time actually engaging in family assistance, findings that were partly explained by urban households' less financial hardship and higher parental education levels. As expected, stronger family obligation values were associated with greater family assistance activities across rural and urban Vietnam. However, stronger family obligation values were associated with more study hours only in urban Vietnam, indicating that urbanisation may broaden the meaning of family obligation to encompass the academic domain. Additionally, weaker family obligation values were associated with more employment hours only in rural Vietnam, suggesting that rural adolescents with little attachment to the traditional value of family obligation may pursue autonomy through employment outside the home. In traditionally familistic societies undergoing urbanisation, family obligation may take on different meaning depending on adolescents' ecological settings that construct cultural values and behavioural norms.     

When the final whistle blows: Social identity pathways support mental health and life satisfaction after retirement from competitive sport

For many athletes, retirement from higher levels of competitive sport poses significant challenges. Research has shown that athletic identity is a key predictor of adjustment trajectories, but the mechanisms through which this affects outcomes are less clear. Added to this, there has been limited research on the role that wider social identities, and the resources they enable, play in adjustment. Addressing both these issues, we examined theoretically derived social identity pathways to retirement adjustment in athletes who had played sport at higher competitive levels and two potential mechanisms, or psychological resources, through which adjustment might be enabled. This was examined in two samples: retired athletes from countries in Western (n = 215) and Eastern (n = 183) regions. Loss of athletic identity, social group memberships (multiple, maintained and new), psychological resources (perceived meaning in life and control), and adjustment (life satisfaction, depression, and perceived physical health) were assessed. In both samples, the loss of athletic identity undermined adjustment by reducing meaning in life and perceived control. Path analysis showed that both maintained and gained social group memberships counteracted the negative effects of athletic identity loss on adjustment. Evidence that these pathways enabled access to psychological resources was found primarily in Chinese athletes, with maintained groups influencing personal control and new groups influencing meaning in life. These findings highlight the importance of social identity processes to retirement from higher levels of competitive sport and the mechanisms through which they can either support or undermine adjustment.