Intersection of Mental Health and Social Service Professionals

Also called, "Assessing the Cultural Divide Between Mental Health Service Sectors of Care"

          Principal Investigator: Curtis McMillen, PhD, Co-PI

          Funder: CMHSR funded pilot (through NIMH - P30 MH068579)

          Timeframe: 09/04-07/06

          Affiliation: Center for Mental Health Services Research (CMHSR)

          Project Staff: Jill Rowe-Adjibogoun, PhD, Co-PI

                                 Enola K. Proctor, PhD, Investigator                 

                                 Nicole Fedoravicius, MPH, Specialist                                       

          Participating Organizations: Missouri Department of Social Services, Children's Division

                                                           Missouri Division of Senior Services and Regulation (DSSR)

                                                           Missouri Department of Mental Health (DMH)          

          Project Contact: Nicole Fedoravicius, MPH, Specialist, (314) 935-7220 
                                      E-mail: nfedoravicius@wustl.edu

Project Update as of 07/22/2009:
Stage: Completed.

Reports: Link to Executive Summary.
Practice of Policy Implications: This study allowed the Missouri Children’s Division and DSSR to answer system questions that they found essential to how they do business. In addition, we shared the findings with leadership of the Missouri Children’s Division, DSSR and DMH.

 

Description: The overall purpose of this study was to understand how social service and mental health professionals intersect and interact with each other.  Working in partnership with Missouri Children’s Division, DSSR and DMH staff, we sought to better understand how state employees work with the providers of services in the mental health sector (i.e., psychiatrists, psychologists, etc.).  We wanted to better understand what allowed for their relationship to flourish; what attributes defined their work cultures; and what perceptions they hold of each other. This study is important because of the high number of senior citizens and children who were involved with both the mental health and social service sectors. 

 

To accomplish this we spent time with DSSR and Children’s Division employees in a variety of settings.  This entails talking both individually and in a group setting (i.e., focus group) with some of the employees.  In addition, spent time in the field shadowing a small number of state employees as they make their visits. 

 

With Missouri Children’s Division, DSSR and DMH guidance, we hoped to find mutual areas of interest to explore. We relied on the state leadership in these state department/divisions to direct us to how, with whom and where we spent our time.  This was not a study about individual cases or employees; it is about understanding how systems of care work together. We were interested in understanding mental health and social service cultures, rather than if someone is doing their job correctly.

 

This study allowed the Missouri Children’s Division and DSSR to answer system questions that they find essential to how they do business. In addition, we proposed to share the findings with leadership of the Missouri Children’s Division, DSSR and DMH.

 

Progress in ACISR Year 1:  Individual and focus group interviews were conducted from December 2004 until April 2005 with 125 child welfare, mental health and judicial professionals.  Initial interview guides for each sector were created in consultation with experts in qualitative methods, mental health and child welfare to help explore cultural differences between mental health and child welfare professionals. Interview guides were changed iteratively over the course of the study to explore ideas raised in earlier interviews, confirm findings from earlier interviews and to explore new questions raised by analyzing data from earlier interviews.  Over time, the interview guides were changed to explore issues related to the role of the court in delivering mental health services to child welfare clients, psychological and psychiatric evaluations, psychotropic medications, how child welfare workers choose mental health professionals and other issues. Four individuals were interviewed with a guide especially designed for what we called “linking professionals,” professionals nominated by other participants for being knowledgeable about both the child welfare and mental health systems.  Interviews were conducted by three of the authors, a medical anthropologist, a qualitative research specialist, and a social worker with experience in the child welfare and mental health systems.

Plans in ACISR Year 2:  After year one, our future plans included conducting the ethnographic portion of the study and performing qualitative data analysis.  The medical anthropologist on the research team spent time with the local child welfare agencies that participated in the interview component.  She attended employee orientation, training workshops and immersed herself in the daily workings of the agency.  We also presented our findings to participants in the study.