title: A business model for managing system change through strategic financing and performance indicators: a case study.
abstract: This article describes how a system of care operated by a county government agency used a fiscal crisis as the opportunity to reform its children's system. A cross-system response to the crisis is outlined that includes a system of care framework coupled with a business model, inter-departmental collaboration and leadership, the use of strategic reinvestment strategies, and a quality improvement system that focuses on key indicators. Implementation of the system change is described with a specific focus on cross-system entry points, financing strategies that re-allocate funds from deep-end programs to community-based services, and management oversight through the use of performance indicators to monitor and support effectiveness. This article examines the results of the system change, including the diversion of youth from system penetration, the reduction in residential treatment bed days, the re-allocation of these savings to community-based services, and the outcomes of children who were diverted from residential care and served in the community. The article offers a number of recommendations for other communities contemplating system change.
authors.affiliation: Department of Child and Family Studies, University of South Florida, Tampa, FL 33612, USA. miarmstr@usf.edu
authors.forename: Mary I
authors.initials: MI
authors.lastname: Armstrong
authors.forename: Heidi
authors.initials: H
authors.lastname: Milch
authors.forename: Peter
authors.initials: P
authors.lastname: Curtis
authors.forename: Phillip
authors.initials: P
authors.lastname: Endress
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003155:Community Mental Health Centers / Q000191:economics / Q000458:organization & administration; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000458:organization & administration*; D057172:Economic Recession; D005376:Financial Management / Q000458:organization & administration*; D006801:Humans; D017146:Models, Organizational; D009518:New York; D019982:Organizational Case Studies; D019984:Quality Indicators, Health Care