A R T I C L E
INTERAGENCY TEAMS:
A VEHICLE FOR SERVICE
DELIVERY REFORM
Nicole E. Allen
University of Illinois Urbana Champaign
Pennie G. Foster-Fishman and Deborah A. Salem
Michigan State University
䡲
Human service delivery organizations often have great difficulty
implementing new service delivery technologies. This study examines the
extent to which interagency service delivery teams facilitate the
implementation of a popular reform that significantly challenges the status
quo: family-centered service delivery. Survey data from 121 providers
representing 25 agencies within one county suggest that interagency teams
may promote provider implementation of new service delivery practices.
Teams members were more likely than nonteam members to implement
practices consistent with family-centered service delivery. Consumer focus
group data support these findings, with consumers noting that services
received from providers in the team context were more individualized,
empowering, and comprehensive than the services they typically received in
the county. The implications of these findings for practitioners and
scholars interested in facilitating human service delivery reform are
discussed. © 2002 Wiley Periodicals, Inc.
Human service delivery organizations ~e.g., child welfare organizations, mental health
agencies! often have difficulty implementing new service delivery practices, specifically those that require radical change in providers’ approach to service delivery
~Williams, 1995!. Concerns about the feasibility of changing human service delivery
The order of the first two authors was alphabetically determined.
This research was supported by grants from the State of Michigan Family Independence Agency, Michigan
State University Outreach Office, the Institute for Public Policy and Social Research at Michigan State
University, the Miller Foundation, and the Binda Foundation. The authors wish to thank the following
groups and individuals for their contributions to this research: The County’s Multi-Purposive Collaborative
Body and its evaluation subcommittee, Applied Developmental Science at Michigan State University, Mark
Schauer, Stacy Curtis, Carrie Preston, David Loveland, Juliette Mackin, and Deborah Bybee.
Correspondence to: Nicole E. Allen, Department of Psychology, University of Illinois Urbana Champaign,
603 East Daniel Street, Champaign, IL 61820.
JOURNAL OF COMMUNITY PSYCHOLOGY, Vol. 30, No. 5, 475–497 (2002)
© 2002 Wiley Periodicals, Inc.
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jcop.10020
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practices are particularly salient today, given the growing recognition that traditional
service delivery approaches have failed to address the needs of many high risk children and families ~Knitzer, 1982; Weissbourd, 1990!. Numerous national, state, and
local initiatives have called for significant reform in how services are provided to
children and families, including altering the financing, structure, and guiding ideological frameworks ~e.g, Foster-Fishman, Salem, Allen, & Fahrbach, 1999; Friedman,
1994; Golembiewski, 1985; Stroul & Friedman, 1986!. One popular reform is the
current emphasis on providing family-centered service delivery ~e.g., Nelson & Allen,
1995!.
Family-centered service delivery is an individualized empowering approach that
emphasizes consumers’ strengths and encourages their active involvement in the design,
implementation, and evaluation of services ~Schorr, 1988; VanDenBerg & Grealish,
1996; Yoe, Santarcangelo, Atkins, & Burchard, 1996!. This orientation differs in important ways from the traditional service delivery model which is typically driven by a
medical model approach that is often more deficits oriented, and professionally and
programmatically driven ~Rappaport, 1977; Tyler, Pargament, & Gatz, 1983!. In contrast to this traditional approach, family-centered service delivery involves the implementation of four distinct service delivery practices. First, providers are expected to
focus on consumer strengths and capacities rather than consumer deficits ~e.g., poor
parenting skills; Dunst, Johanson, Trivette, & Hamby, 1991!. Second, there is an expectation that providers will extend their focus beyond the traditional assessment of
treatment needs ~e.g., counseling! and also focus on families’ broad-based needs ~i.e.,
a broad range of needs! including, for example, basic living needs ~e.g., food, clothing! and social support needs ~e.g., making new friends, attending a support group;
Dunst et al., 1991!. Third, providers are expected to focus on the needs and strengths
of the entire family, rather than only a target client ~Dunst et al., 1991; Garbarino,
1988; Weissbourd, 1990!. Finally, given that families are viewed as experts on themselves, providers are required to include them in goal identification ~Dunst et al.,
1991; Rounds, 1991!. Given these expectations, the family-centered service delivery
approach requires providers to deliver services in new and sometimes unfamiliar ways
~Dunst, 1985; Williams, 1995!.
The emphasis on family-centered service delivery can be found in reforms targeting a variety of service delivery domains, including child welfare ~Yoe et al., 1996!,
developmental disabilities ~Dunst & Trivette, 1987!, mental health ~Morrissey, Johnsen,
& Calloway, 1997! and special education ~Duchnowski, 1994!. Across these domains,
the positive implications for consumers served from a family-centered service delivery
model have begun to be established ~Bradley, 1983; Marcenko & Smith, 1992; Scannapieco, 1994; Trivette, Dunst, & Hamby, 1996; Weiss & Jacobs, 1988; Weissbourd &
Kagan, 1989!. For example, Trivette et al. ~1996! found that consumers who were
receiving services from a family-centered organization compared to a traditional
professional-centered organization were more likely to feel empowered by the service
delivery process, indicating greater control over accessing needed resources. In the
field of child abuse and neglect, Scannapieco ~1994! found that home-based familycentered services had a positive impact on family functioning, and reduced out-ofhome placement of children with both low- and high-risk families.
Given the promise of family-centered service delivery to result in positive outcomes for consumers, it has been adopted by policy makers, state-level administrators,
and organizational leaders in many communities and service delivery contexts ~Flint,
1993!. Although leaders have adopted this model and made it a requirement of the
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service delivery process, it is still unclear whether or not the adoption of such reform by human service system leaders actually shifts how services are delivered to
consumers by providers. In fact, there is often a significant gap between the adoption
of change by leaders and the actual implementation of change by employees ~i.e.,
front line service providers engaging in new behaviors; e.g., Cameron & Vanderwoerd,
1997; Foster-Fishman & Keys, 1997; Mahoney & O’Sullivan, 1990; McBride, Brotherson, Joanning, Whiddon, & Demmitt, 1993; Nelson & Allen, 1995!. Williams ~1995!
observes that, “articulating an interagency mission and objectives @regarding service
delivery reform# is difficult, but implementing them is fraught with obstacles and
challenges” ~p. 416!. Organizational scientists argue that while the adoption of new
technologies by key leaders is a necessary step towards successful change, it is not a
sufficient means for guaranteeing its successful implementation ~e.g., Klein & Sorra,
1996!. Many innovations fail because employees do not, or cannot, implement the
required changes ~e.g., Klein & Sorra, 1996; Mahoney & O’Sullivan, 1990!. Further,
the implementation of family-centered service delivery practices requires secondorder change ~Watzlawick, Weakland, & Fisch,1974!. That is, service delivery providers
are required to make fundamental shifts in their behavior that are inconsistent with
the governing norms of professionals as experts and clients as the passive recipients of
their expertise. To facilitate the diffusion of family-centered service practices in human
service delivery systems, we must identify interventions that foster employee implementation of this reform.
One popular mechanism for facilitating the implementation of family-centered
service delivery has been the development of interagency teams. Interagency teams
consist of service providers from diverse agencies ~e.g., mental health, substance
abuse, judicial, and educational organizations! within the community who meet regularly to plan for and provide services to targeted consumers ~e.g., Adams & Krauth,
1995; Lewis, 1995!. These teams have become a popular vehicle for reform implementation across a variety of service delivery domains. Although they have been used
extensively to help implement family-centered service delivery, we know little about
their effectiveness in facilitating the implementation of this service delivery model.
Thus, the purpose of this study is to examine whether or not involvement in interagency teams facilitates service provider implementation of the family-centered service delivery model.
INTERAGENCY TEAMS
Interagency teams may be an effective intervention for promoting employee implementation of new service delivery practices for several important reasons. First, interagency teams serve as new social settings ~Kelly, Ryan, Altman, & Stelzer, 2000! within
their communities, and as such, may be well positioned to help employees “unfreeze”
old attitudes and behaviors and adopt the significant changes these reforms require
~Bartunek & Moch, 1987; Lewin, 1951; Schein, 1985!. Unfreezing requires members to
interpret a system’s capacity to change and perceive the proposed change as desirable
and necessary ~Armenakis, Harris, & Mossholder, 1993!. Because individual attitudes
and behavior are influenced by the demands, character, values, and norms of the
contexts within which people live and work ~Bronfenbrenner, 1979; Kelly et al., 2000!,
this unfreezing is often facilitated by the creation of new social settings ~Kelly et al.,
2000!. New social settings may be particularly important considering that existing
organizational settings contain values and practices incongruent with the desired
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change ~Cameron & Vanderwoerd, 1997; Nelson & Allen, 1995!. Given that traditional
human service delivery organizations include numerous policies and practices incompatible with a family-centered approach ~i.e., they typically focus on and treat
consumer deficits, ignore consumer strengths, and have services that are providerdirected!, the creation of new social settings that support the attitudes and behaviors
required by this reform seems critical.
Second, interagency teams may provide a more tightly coupled, structured context
for introducing change than the traditional service delivery system. Human service
delivery organizations are often considered loosely coupled ~Weick, 1976! because
their technology is indeterminate and ambiguous and the administration has a limited
ability to observe and control human service providers’ interactions with consumers.
This loose-coupling makes it difficult for human service delivery organizations to
effectively inform their members of a change endeavor and to monitor its implementation ~Weick, 1976!. The interagency team context, on the other hand, may be a
more tightly coupled setting. For example, within an interagency team that has been
created to implement a particular service approach, the desired technology ~i.e.,
family-centered service delivery! is typically well-defined and service delivery guidelines and expectations are often quite explicit. Team members have the opportunity
to monitor and provide feedback on each other’s service delivery behavior because
they meet to discuss and develop consumer service delivery plans and the progress of
their implementation. While traditional human service delivery organizations could
be more tightly coupled ~e.g., via case presentation and frequent staff meetings!, teams
may be well situated to accomplish this more easily given consistent direct contact
among providers.
Third, interagency teams involve employees in a manner that may help to promote their commitment to the change initiative and their perception of the desirability of the change. Because service delivery providers have significant autonomy in
deciding how services are actually provided to clients ~Kouzes & Mico, 1979; Lipsky,
1980!, change needs to be implemented in a manner that promotes employee support
of new service delivery technologies ~Glisson, 1978!. Rogers ~1995! suggests that individuals’ perceptions of the relative advantage of an innovation influences the rate of
adoption and that interpersonal channels are an effective way to communicate this
advantage. Teams may be adept at promoting employee buy-in because they involve
active employee participation and interaction with other service providers, enabling
providers to witness and experience, first-hand, the feasibility and desirability of these
new practices, an important step towards promoting employee support for change
~Armenakis et al., 1993!.
Overall, within the current zeitgeist of service delivery reform, interagency teams
may play an important role in helping to mitigate employee resistance to mandated
change ~Argyis, 1970! by promoting a venue that fosters “unfreezing” of old attitudes
and behaviors and validates providers’ new attitudes and behaviors, increases employee
accountability, and enhances employee understanding of and commitment to the
desired reforms.
While many states are utilizing interagency teams, to date research addressing
their effectiveness has been limited. There is some evidence that the development of
interagency teams result in changes in the service delivery system. For example, Pandiani & Maynard ~1993! found that the existence of interagency teams improved
interagency collaboration. In addition, interagency teams have also been linked to the
adoption of positive attitudes towards service reform efforts ~Foster-Fishman et al.,
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1999!. While these studies highlight some of the ways teams may alter the service
delivery system and the attitudes of service providers, there is very limited research
addressing whether or not team involvement actually impacts the service delivery
practices of participating providers. For example, one study found that assessments of
family needs developed by teams provided a better match to the needs identified by
mothers when compared to the assessments developed by individual providers ~Garshelis
& McConnell, 1993!. While comparisons of providers who are team members and
those who are not are rare, such comparisons are critical to understanding whether or
not teams are a promising intervention for fostering provider implementation of new
service delivery practices. This understanding is particularly important given that
many communities are viewing interagency teams as an expensive service delivery
experiment ~i.e., requiring many provider hours!, and are beginning to question if
they are effective in promoting the implementation of new service delivery practices.
CURRENT STUDY
Within a county where all service providers were mandated to provide family-centered
services, we examined whether or not providers involved in interagency teams deliver
services in a manner that is more consistent with the family-centered service delivery
approach than providers who are not members of these teams. To do this we compared providers on the extent to which they implemented the specific components of
a family-centered service delivery approach in the development of their service delivery plans. Specifically, based on the literature describing family-centered service delivery, we would expect a provider involved in these teams to be more likely to implement
practices including: ~a! identifying client strengths ~Dunst et al., 1991!; ~b! focusing on
the broad-based needs of clients ~e.g., material needs, social support needs! ~Dunst
et al., 1991!, rather than only traditional, deficit-oriented needs ~e.g., diagnosis for
treatment, parenting skills training!; ~c! attending to the needs and strengths of the
entire family, rather than only a single family member ~e.g., Garbarino, 1988; Weissbourd, 1990!; and ~d! involving clients and0or families in the creation of goals ~Dunst
et al., 1991; Rounds, 1991!. In addition, we sought to validate our findings by conducting focus groups with consumers who were served by an interagency team.
METHOD
To insure that the questions asked and the methods employed accurately represented
the experiences of service providers within this county, this study employed a joint
insider–outside methodology ~Bartunek & Louis, 1996!. A committee of organizational
leaders, service providers, and one consumer representative worked collaboratively
with the research team on sample selection, measurement development, data collection, data analysis, and feedback. This committee was a subgroup of the county’s
interagency coordinating council ~ICC!, a governing body formed approximately 10
years prior to the onset of this study to improve the quality of life of county residents
by improving service delivery processes and outcomes. The ICC included representatives from 32 agencies including both human service and criminal justice systems and
had recently become the state’s designated collaborative body. In that role, it became
responsible for the implementation of service delivery reforms within the county and
the distribution of state funds allocated to support the interagency teams.
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This study utilized quantitative survey methods to investigate whether or not
providers who are involved in an interagency team are more likely to implement a
family-centered service delivery model than those who are not. The survey data were
collected from human service providers in the county. To validate our findings, focus
group data was also collected from consumers who received services from one of the
county’s interagency teams.
Setting
Creek County is a mid-sized community in a Midwestern state. Prior to data collection,
this county became one of a few selected in the state to pilot a new approach to
service delivery—family-centered services. While the specific components of this reform
effort emerged from a state-sponsored initiative to improve services, they reflected the
goals and previous attempts of the ICC to improve services within the county. The ICC
engaged in numerous activities to stimulate this reform including developing a shared
mission regarding the adoption of family-centered service delivery in the county,
gaining support for this approach from the leaders of member and nonmember
organizations, making training available to service providers throughout the county
on family-centered service delivery, and creating interagency service delivery teams.
The ICC was committed to implementing this reform and was working with our
evaluation team to examine the degree to which their efforts were successful.
This study was part of this larger evaluation and focuses on the role of interagency
service delivery teams as a mechanism used to facilitate the implementation of a
family-centered service delivery approach. At the time of the study, there were two
interagency teams in the county: one focused on early intervention with families with
children aged 0–3 who were at risk for child abuse and neglect or struggling with
disabilities, and one focused on children with mental health issues and their families.
Given the desire of this community to stimulate widespread reform in their service
delivery system and their use of teams to achieve their reforms goals, this county was
an excellent setting for this study.
The interagency teams in this county were purposely created to include all agencies relevant to a given population. For example, for the Early Intervention Community Team, agencies who could provide potential resources to a family with a child 0–3
were invited and most chose to participate ~approximately 20 agencies in total!. These
included agencies that provided: mental health ~e.g., individual or family counseling!,
physical health ~e.g., medical clinics!, educational ~e.g., parenting classes, special education, Head Start!, child protective, supportive ~e.g., child care!, and specialized ~e.g.,
services for children with developmental disabilities, the local domestic violence shelter! services as well as material resources ~e.g., food, clothing!.
When an organization agreed to participate they were required to ~a! send a
representative to team meetings, and ~b! make organizational resources available to
support families’ service plans. Leaders of participating agencies would typically assign
service delivery providers to attend team meetings or ask for volunteers. The team
coordinators indicated that the majority of providers were assigned by organizational
leaders and required to attend team meetings. Occasionally, more than one provider
would represent an organization or multiple providers would rotate attending team
meetings. A larger community team would meet biweekly, with child and family teams
forming for particular families and meeting as necessary.
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Families were referred to teams by their individual providers. When providers
thought that a family could benefit from receiving team-based services ~i.e., the range
and complexity of their needs were not well met by the traditional service delivery
system!, they would present the family with the option of working with a team. If the
family agreed, the provider would present the family with a list of all community team
members, provide the family with information regarding each participating organization and ask the family to decide which organizations they wanted represented at their
meeting. Families would then come to a regularly scheduled community team meeting ~with representation from only the agencies selected by the family! to begin the
process of building a service plan. The primary goals of this meeting were: ~1! to allow
families to tell their story in their own voice and to discuss a plan of action with the
family, not in their absence which is typical of traditional service delivery models, ~2!
to develop a service delivery plan that would build on a family’s strengths and meet
their diverse needs, and ~3! to form a smaller team of providers ~i.e., a child and
family team! who would work with the family to further develop and meet their service delivery goals. After an initial plan was developed and a child and family team
was formed, tasks would be delegated to different team members including family
members. Typically, the service provider who brought the family to the community
team would act as the coordinator of the child and family team, but often family
members would be encouraged to lead their child and family team meetings. The
team’s flexibility in meeting family needs was increased by access to noncategorical
funds ~i.e., funds that can be used for assistance not typically provided in the traditional service delivery system!. This provided a pool of flexible funds to meet family
needs that could not be met by existing community resources ~e.g., to repair a car
motor or to fund home health care that would not be covered by a family’s insurance!.
A subcommittee of the community team would review requests from child and family
teams for noncategorical funds.
Survey Data Collection
Organizational Sample. Considering the purpose of this study, we purposively created a
sample that included the organizations most central to the family-centered service
delivery reform effort. Given the role of the ICC in directing these reforms, the initial
sample included all 20 agencies that were members of the ICC who employed direct
service providers and who were implementing these reforms. To ensure that our
sample was representative of the core service providing agencies in the county targeted in these reforms, we included an additional 13 organizations identified by our
evaluation subcommittee as important agencies in the County and as involved in the
reform implementation. One organization deemed appropriate declined participation. Thus, while service delivery organizations were purposely rather than randomly
sampled, the organizations targeted in this study represent a wide array of agencies in
the county ~e.g., domestic violence shelters, Head Start, substance abuse programs,
Community Mental Health, Public Health! with regard to service domains ~e.g., mental health, physical health, education!, organization types ~not-for-profit and profit
organizations, government and community-based agencies!, and populations served
~e.g., families with small children, adults with mental illness!.
Provider Sample. For a larger study, surveys were distributed to a sample of 530 providers across the 32 targeted organizations. Three hundred twenty-eight surveys were
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Table 1. Demographic Characteristics
Demographic Characteristics
Age
20 to 29
30 to 39
40 to 49
50 to 59
60 and over
Gender
Female
Race0ethnicity
White
African American
Latino
Asian
Other
Highest educational level
High school
Technical school
Some college
College degree
Some graduate
Graduate degree
%
(N ⫽ 121!
17.4
25.6
40.5
14.9
1.7
81.0
82.5
14.2
1.7
.8
.8
6.6
.8
16.5
23.1
17.4
35.5
returned, yielding a response rate of 62%. Because of the nature of the larger study,
three survey versions were randomly distributed to the targeted providers—two of
these included a family-centered practices outcome measure. Of the 203 surveys returned
including the family-centered practices outcome measure, data from 121 service providers ~60%! across 25 organizations was included in subsequent analyses. Surveys
from providers were excluded when they did not provide adequate data or did not
complete the outcome measure portion of the survey ~10%! or they did not provide
direct services that involved developing service delivery plans 1 ~e.g., administrators,
administrative assistants, day care providers, nurses providing medical care to the
elderly, nurses aides who provided home visits to clean patients, and teachers; 30%!.
The majority of providers were between 30 and 49 years old ~66.1%! and had
completed at least a college degree ~76%!. Participants were predominantly female
~81%! and White ~82.5%!. Twenty-three percent of providers were interagency team
members ~N ⫽ 28!. Teams primarily included service providers who were mandated to
attend team meetings. See Table 1 for the demographic characteristics.
Data Collection Procedures. A presentation describing the purpose of the study and the
planned methodology was made in person to interagency council leaders and via
1
The 30% of participants who were not included in subsequent analyses either indicated that the measure
was irrelevant to their work or this determination was made based on examination of the data they
provided. For example, one provider completed the form based on a 15-minute telephone contact with a
client. Another completed the form for an entire class of Head Start students. Finally, service providers
serving elderly clients in a medical capacity ~mostly public health and visiting nurses services! were excluded
from these analyses.
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phone to noncouncil leaders. Interested leaders provided a list of all eligible directcare workers and managers. Given the large number of organizations involved in our
sample it was critical to adapt data collection procedures to gain entry into such a
diverse array of settings. Thus, dependent upon the leaders’ desires and the size and
structure of the organizations, surveys were distributed either to the entire population
of providers or to a random sample.2 A standardized protocol was presented to the
targeted staff in either written or oral form. Surveys were either distributed to staff
during a group presentation, left in staff mail boxes, or mailed. To encourage participation, staff were invited to enter a lottery for one of five gift certificates for a local
mall. Staff either completed and returned the survey immediately after the presentation, returned it in a sealed drop box left in their organization, or returned it by mail.3
Extensive follow-up procedures were pursued until at least a 60% return rate across
the county was achieved.
Survey Instrument
Demographic Information. Categorical data was collected on providers’ age, gender, ethnic background, education, organizational level, and years employed by their
organization.
Team Membership. Providers responded to two items assessing the extent of their involvement in each of two interagency teams. To indicate whether or not a provider was a
member of a team a dichotomously scored variable was created ~0 ⫽ not at all involved,
1 ⫽ involved!.
Indicators of Family-Centered Service Delivery
To assess the implementation of family-centered service delivery, we asked providers
to report information from their most recent service delivery plans. We selected
service delivery plans because all direct service providers were required to develop
these plans for all clients. In addition, service delivery plans reflect the types of
services to be provided and how the client was involved in the planning process
providing excellent indicators of the services actually put into place. We anticipated
that the nature of the plans would be impacted by the degree to which a provider was
implementing a family-centered service delivery model. A family-centered practice
measure was developed to assess the degree to which providers’ self-reported service
delivery plans reflected a family-centered service delivery approach. While we ideally
would have liked to examine and code providers’ actual plans, given the confidentiality issues involved in accessing client treatment plans and the resource constraints of
the study this was not possible. Instead, providers were asked to reflect on the most
recent client for whom they completed a plan for services and detail information
about the service plan that reflected key elements of family-centered service delivery
~e.g., assessment of strengths, assessment of needs vs. deficits, and involvement of
clients and families in the creation of goals!. Provider reports were then coded to
2
In some cases random sampling was stratified by organizational role ~e.g., social workers, nurses!.
While using a variety of data collection methods is not optimal, participants were always provided with
standardized information via oral or written form. Response rates did not vary considerably across organizations.
3
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Journal of Community Psychology, September 2002
create a multidimensional assessment of the extent to which they reflected a familycentered service delivery approach.
Coding and Interrater Reliability. A coding scheme developed specifically for this study
was used to code providers’ service delivery plans. This coding framework was developed based on the primary tenets of family-centered service delivery as described in
the literature on this approach and by the key informants with whom we collaborated.
In addition, to assess whether this coding framework was a valid measure of indicators
of family-centered service delivery, an expert in the implementation of this model
independently reviewed and verified the coding framework ~face validity!. A single
rater coded all of the data for this study. To determine the reliability of this coding,
a second rater coded a subset of this data ~i.e., for a random selection of 25% of all
cases interrater agreement ⫽ 93%!. Raters were not aware of which families were seen
by teams and which were not. Each component of this measure and its operation are
discussed below.
Assessing Strengths. Providers were asked to provide a written description of the client’s
strengths and were given the space to record up to six strengths.4 Strengths refer to
the characteristics, skills, or knowledge clients or families have which reflect their
capacities ~e.g., good communication skills, supportive natural-support network!. To
measure the extent to which providers considered consumer strengths, the number of
legitimate strengths ~i.e., those responses describing consumer weaknesses were excluded!
listed was summed.
Assessing Needs. Providers were also asked to describe up to six clients’ needs. To
identify needs that were consistent with a family-centered approach, the needs listed
by providers were coded into five categories that were emergent from the data and
grounded in descriptions of family-centered service delivery ~e.g., Dunst et al., 1991!.
Three of these categories reflect broad-based needs and are considered congruent
with the family-centered model: basic living needs ~e.g., housing, food!, community
resource0natural support network needs ~e.g., support from family0friends, legal services!, and promotional skill building needs ~e.g., education!. The remaining two
categories reflect deficit-oriented needs and are considered incongruent with the
targeted reform: compensatory skill building needs ~e.g., parenting skills, anger management skills!, and treatment needs ~e.g., counseling, medical assessment!. Those
needs that were consistent with the family-centered service delivery approach ~i.e.,
basic living, community resource and promotional skill building needs! were summed
to create a single score representing the total number of broad-based needs identified
by providers.
Transcending the Individual Level. Another goal of family-centered services is that the
client’s natural support system be considered in the service delivery process. To assess
4
In three cases providers listed more than six strengths and0or six needs. Given the open-ended nature of
this measure, these strengths and needs were included in the final sum for the number of strengths
identified, the number of family-centered needs identified, and the number of strengths and needs identified at the family-level. In two cases these providers were not team members ~therefore, not favoring the
hypothesized relationship in this study!. Further, the team member who exceeded the space allotment was
excluded as an outlier, further reducing the risk of biasing subsequent analyses in favor of the hypothesized
relationship.
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the extent to which providers considered the client’s context, the strengths and needs
identified were assigned one of two categories: individual client level ~e.g., motivated,
creative! or family0natural support network level ~e.g., caring aunt, supportive family!.
To provide an estimation of the degree to which a provider looked beyond the
individual client in the identification of strengths and needs, a single score was
computed by totaling the number of times a provider identified strengths or needs on
the family0natural support network level.
Involving Clients and Families in Goal Setting. To assess the degree to which providers
involved clients and families in goal identification, providers detailed the goals that
were developed for the client and indicated who was involved in developing each goal
~the provider, client, and0or family!. To estimate the degree to which providers believed
that they were including clients and0or families in the creation of goals a ratio was
created by dividing the number of goals which involved consumer input ~client and0or
family! by the total number of goals ~a score of “1” indicating that consumers were
involved 100% of the time!.
Focus Group Data Collection
Because our survey data was cross-sectional, potentially influenced by a self-selection
and self-report bias, and based upon providers’ perceptions of their own service
delivery practices, we felt it was important to validate our findings by examining
consumers’ service delivery experience. Because we did not have access to client
records, we conducted a focus group with a small number of consumers currently
involved with the largest interagency team in the community. These consumers had
previous involvement with the traditional service system and were thus well positioned
to compare service delivery experiences. The purpose of this focus group was to
gather data that could serve to validate or invalidate the providers’ self-reports of their
service delivery practices.
Sample. All families who had received services from the largest interagency team in the
county in the last year were invited to participate in a focus group ~32 families!. To
protect consumer confidentiality, each family was sent a letter by team leaders notifying them of the focus groups and the opportunity to provide feedback regarding the
services they had received. Families were provided with a self-addressed return envelope to indicate interest. After the recruitment letter was sent, providers who had
previously had contact with the families made telephone calls or home visits ~if they
could not reach the family by phone! to be sure families had received the information
and to ask if they had any questions. Providers did not recruit families or ask them to
participate, but they did respond to questions about the groups. Of the 32 families
who received services, eight families could not be contacted ~e.g., moved to another
area!. Of the remaining families ~N ⫽ 24!, 42% ~N ⫽ 10! chose to participate. Transportation and child care were provided for families to facilitate participation. Each
consumer who participated received a $25 reimbursement for their time. While a
control focus group ~i.e., a focus group including families who did not receive teambased services! would have been ideal, issues of confidentiality in this community and
limited funding did not allow for such an inquiry.
The sample consisted of primarily low-income consumers ~average income of
$1370 per month!. One family member per family participated in the focus group.
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Two participants were African American and seven were White. Two of the consumers
had a high school degree and five had some trade school or college, and one had a
college degree. The majority of the sample was unemployed ~n ⫽ 7!. Consumers
reported working with the interagency team for an average of 11.5 months. All but
one family had accessed noncategorical dollars ~flexible funds! to augment their
service delivery plan and all had prior experience with the traditional service delivery
system in the county. Thus, these families were well positioned to report on their
service delivery experiences in traditional and team settings and compare their experiences with the team to previous experiences with the human service delivery system.
Focus Group Protocol. Families were asked a series of questions during the focus group
that explored their service delivery experiences with the interagency team. These
questions addressed ~a! the degree to which families perceived the services provided
by the team to be family-centered ~i.e., consumers being actively involved in the
service delivery process; e.g., What role did you play in planning services with the
team?!, ~b! the degree to which families perceived the services provided by the traditional human service delivery system to be family-centered ~e.g., What role did you
play in planning services with the service delivery provider who you worked with?!, ~c!
how the service delivery provided by the team differed, if at all, from the services
families had received in the past ~e.g., How were the services you received working
with the team similar to services you have received in the past? How were the services
you received working with the team different from services you have received in the
past?!, ~d! how the team impacted families’ lives ~e.g., What impact did working with
the team have on your family?!, and ~e! what aspects of team involvement were most
beneficial ~e.g., What do you think was most beneficial about working with the team?!.
The focus group data was transcribed and then initially content analyzed by the
first author. Using QSR-Nudist, the data was organized into the relevant interview
question and then an iterative content analysis approach was used. For each interview
question, first-order themes that described the character of team service provision
and its comparison with nonteam services in Creek County were initially identified. A
second-order content analysis of these emergent themes was then conducted to identify the substantive or overarching themes that emerged across the interview questions
~Strauss & Corbin, 1990!. Both first- and second-order themes were independently
discussed and confirmed with the other authors.
SURVEY RESULTS
Providers’ Family-Centered Practices
Overall, our survey data suggested that providers were implementing the various
components of family-centered service delivery in a limited manner. Providers appeared
to focus somewhat on client strengths, with the average provider identifying four
client strengths. However, approximately 40% of the providers identified two or fewer
individual level strengths. Identifying clients’ basic living needs was also rare, with only
half of the providers in the sample identifying at least one basic living need ~e.g.,
housing, food, clothing!. In addition, few providers targeted the family level in their
plan development with only half of the providers identifying at least one strength or
need at the family level. However, most providers ~83%! indicated they included
clients and0or families in the creation of at least half of the goals identified in the
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Table 2. Means and Standard Deviations of Outcome Variables by Team Membership
Team Members
Dependent Variables
Family-centered practices
Identifying family-centered needs
Identifying family–level strengths and needs
Identifying individual–level strengths
Involving consumers0families in goal setting
Nonteam Members
M
SD
n
M
SD
n
Univariate
F -test
~1,114!
2.67
1.74
4.00
.79
1.90
1.99
1.52
.30
27
27
27
27
1.60
.84
3.56
.71
1.55
1.14
1.75
.38
89
89
89
89
8.87*
7.58*
1.37
1.18
*p ⬍ .01
service plan and approximately half of the providers indicated they included families
in the creation of all of the goals identified ~54%!.
Team Membership and Family-Centered
Service Delivery Practices
To examine the extent to which team members and nonteam members differed in
their implementation of family-centered service delivery practices a one-way MANOVA
was performed including the following dependent variables: ~a! the number of strengths
identified, ~b! the number of family-centered needs identified ~e.g., basic living needs,
community0natural support network needs!, ~c! the number of strengths and needs
which were identified on the family level,5 and ~d! the percent of goals families were
involved in creating.6
The overall F -test indicated that team members were more likely to implement
family-centered practices than nonteam members ~F ~4,111! ⫽ 3.50, p ⬍ .05!. Univariate F -tests ~Table 2! indicated that interagency team members were significantly more
likely than nonteam members to: ~a! identify needs consistent with strengths-based,
family-centered service delivery ~F ~1,114! ⫽ 8.87, p ⬍ .01; Team Mean ⫽ 2.67; Nonteam Mean ⫽ 1.60! and ~b! identify strengths and needs of the family rather than only
of the target client ~F ~1, 114! ⫽7.58, p ⬍ .01; Team Mean ⫽ 1.74; Nonteam Mean ⫽
.84!. Team members and nonteam members were not different regarding ~a! the
number of strengths identified ~F ~1,114! ⫽1.37, p ⬎ .05; Team Mean ⫽ 4.00; Nonteam
Mean ⫽ 3.56!, and ~b! the percent of goals in which the provider involved the client
and0or family ~F ~1,114! ⫽1.18, p ⬎ .05; Team Mean ⫽ 79%; Nonteam Mean ⫽ 71%!.
To determine whether the difference between team and nonteam members identification of family-centered needs was confounded by the possibility that team members
served more needy families, we conducted some additional analyses. We found that
team members and nonteam members did not differ with regard to the number of
treatment needs they identified ~t ⫽ ⫺.24, d.f. ⫽ 114, p ⬎ .5! or the number of
compensatory skill building needs they identified ~t ⫽ ⫺.19, d.f. ⫽ 114, p ⬎ .5!. This
5
To adjust for skewness in the number of family level strengths and needs identified, a log transformation
was preformed on this variable for subsequent analyses.
6
One outlier ~a team member! was removed from the analyses because her scores on strengths-based,
family-centered indicators were considerably higher than those of other providers. The results of the
analyses were the same whether or not she was included.
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Journal of Community Psychology, September 2002
suggests that the difference in the number of family-centered needs identified by
team versus nonteam member was not simply a result of the families served by team
members having more needs, but by team members actually being more likely to focus
on the broad-based needs of families.7
FOCUS GROUP RESULTS
Overall, families who participated in our focus group described the services provided
by the interagency team and its members as different from traditional service delivery
in a variety of ways. These included team services being more ~a! comprehensive, ~b!
individualized, and ~c! inclusive and nonjudgmental of consumers than those provided by the traditional human service delivery system. In other words, families reported
that the services they received from interagency teams included more of the service
delivery components included in the family-centered services delivery model than
those offered by the traditional service system.
Comprehensive Services
Families described the services they received from the interagency team as more
comprehensive then those provided by the traditional service delivery system. Consumers explained that the team met all of the needs of their family, including those
of family members other than the target client. Families noted that this holistic focus
was an unusual experience for them. In their interactions with traditional human
services, they noted that it was more typical for services to focus only on their child.
As two consumers stated:
It’s not just the children that they’re there for. They’re helping the whole
family whether it’s a two-parent, two-kid household or single parent with one
child or more children.
I feel the team is just that, they are a team. Even though you have these
children, my husband has @a serious illness# and they were there for all of our
needs, all of our needs, the team. Whereas @with traditional# human services
you’re just there. You’re there for the services that they offer, if you can get
them to help.
Individualized Services
Families also described the team as providing services that met their unique and
specific needs. This individualized, person-centered approach varied significantly from
the service or program-centered nature of most other services in the county. As two
consumers described:
They’re a totally different type of team. They more in tune with what our real
needs are and not as to what their service is.
7
To perform the two group comparisons in this study, we had approximately 80% statistical power to detect
a large effect size ~d ⫽ .75! and approximately 65% statistical power to detect a medium effect size ~d ⫽ .5!.
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I don’t think there’s any similarity to it @traditional services# because when you
go out . . . into the community and you stop at a lot of different places . . .
They don’t care about the details or what the needs is and @the team# wanted
to know details. I mean because they wanted to know what all the reasons were
for wanting @the service#, why did we really need this service. And we were able
to explain all the experiences that we’ve had, what it’s done to us . . . and that
this type of illness put us financially back . . . emotionally back, physically
brought us down. And they cared about those things and other places that you
go to they don’t care . . . They’re there for this type of service and that type
of service only.
One consumer noted that such individualized treatment is needed because consumer’s vary in their needs and desires:
There’s variance, though. Everybody’s had different experiences . . . you know
some people need help with rent or housing or getting food . . . other people
. . . have sick children or they have children that have been abandoned by
other family members. I myself have no family support. So they’re a basic,
they’re a basic support system for me . . . my story isn’t similar to a lot of these.
The only thing that’s in common is I have a child and I’m working with the
same team.
As part of this individualized service provision, consumers reported that the team
addressed a broad array of family needs ~i.e., material, physical health, mental health,
etc.!. Overall, this focus on the unique and multiple needs of families significantly
varied from how services were typically provided in Creek County.
Inclusive/Nonjudgmental Services
Families described the team as including them fully in the service delivery process.
Overall, they described being more involved in goal development, service planning,
and service implementation. One family described the initial planning meeting:
You know, she sat down with me before we went to the team leader. @She
asked,# what do you need? What would help you in the future? What would
keep you on your feet? . . . Sit down and write me a plan. They didn’t come
and say, okay, you need this and this and this . . . and we’ll get you this and
this . . .
Other families shared this experience, one said:
I planned, the team and I sat down and made a plan. Because see you’ve got
. . . children, you need so many things. We started out with medical. The
children needed medical help, dental help, psychological help. You know . . .
there was no beds, there was no clothing, there was nothing.
Families described the planning process they experienced in traditional human
services as very different from this process. They noted that in non-team service
delivery settings, providers typically did not take the time to inquire about their needs
or, if they did, their needs were ignored in the service delivery plan.
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Journal of Community Psychology, September 2002
It’s frustrating. You try to tell’em what you need or what the problem is and
it’s like a smack in the face. They don’t care. It’s well, I don’t care. I have my
job to do and that’s what I’m gonna do . . . They’re just like well, that’s not my
problem. It’s kind of like you go to a store and you ask where something is
and they’re like well, that’s not my department.
Families also noted that they felt more respected and valued by interagency team
members than by other, nonteam providers in the county. Families stated that in their
interactions with the traditional service delivery system they often felt judged or
looked down upon. However, this was not their experience with interagency team
members. One consumer said, “The person ~team member! that comes to your house
isn’t just somebody that’s coming to look at your house or your family. They’re more
like a friend.” Another consumer echoed this saying, “If something doesn’t go right or
I don’t do something right, they’re not there to knock me down. They’re there to
provide another avenue or give me something else.”
Overall, this experience of inclusion and of being respected helped families feel
that the team gave them the tools to make and sustain positive changes in their lives.
One participant shared her feelings about how the team had prepared her for the
future, “they’re making it able for me to get back up on my feet and when they do pull
out and they do leave, I’m not going to fall flat on my face.” Another consumer also
expressed her feelings that the team prepared her to make a better life for herself and
her children. She said,
They’re not just like in your life, then out of your life . . . They make sure that
you have the needs you know to take care of your kids . . . to find out your
support and things like that and if you need someone to talk to they’re there
for you . . . not just to give you things, but to help you focus and make a better
life for you and your children or your grand kids . . .
Of course, while the participants in our focus group described the services they
received from interagency teams and their members as more family centered than
those offered by the traditional service system, it is important not to assume that this
experience is reflective of all consumer’s interactions with these teams and their
members. It is possible that consumers that refused to participate in this focus group
were the least satisfied with the services they received, the most critical of the interagency teams, or those most in need. Nevertheless, this focus group data does provide
some validation for the survey data results, suggesting that interagency team members
are more likely to provide family-centered services than providers within the traditional service delivery context.
DISCUSSION
The findings from this study suggest that interagency teams may be a promising venue
for fostering the successful implementation of some types of human service delivery
reform. In Creek County, the service delivery providers involved in interagency teams
were more likely to engage in service delivery practices that reflect a family-centered
approach to care. Team members were more likely than nonteam members to identify
the strengths and needs of the entire family and to meet broad-based family needs.
Consumers working with interagency teams described the services they received as
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more comprehensive, inclusive, and individualized than the services they had previously received in the county.
The potential role that interagency teams can play in promoting the successful
implementation of family-centered service delivery is highlighted when we consider
the extent to which these reforms were not being implemented in other contexts
within Creek County. Despite the county’s widespread efforts at diffusing these reforms,
and the fact that their implementation was mandated by several funding sources, at
the time of this study few service delivery providers were actually implementing these
changes. For example, nearly three quarters of the providers in our sample identified
no ~47%! or only one ~27%! family level strength or need with their last client. While
most providers in the county were limited in their implementation of these new
reforms, providers involved in interagency teams were more likely to practice in ways
that were consistent with a family-centered approach.
While it does appear that providers who were involved in teams were more likely
to implement these innovations, methodological limitations of our study require us to
be cautious in our interpretation of the data. There are three issues related to selfselection that could potentially bias our findings. First, there is the possibility of a
response bias in the sample of participants who completed the survey. Examination of
differences across organizations with different response rates suggests that our sample
was representative of providers in the county. While our overall response rate was
62%, for 10 organizations we had a response rate of 100% and in another three we
had a response rate of over 80%. If our overall sample was biased, we would expect
different patterns of findings for organizations with low response rates. While the
small number of interagency team members made it impossible to test this in the
current analysis, in a previous study using the total sample, we found a consistent
pattern of relationships between providers’ perceptions of contextual support for
reform and their attitudes towards these reforms across organizations, regardless of
response rate ~Foster-Fishman et al., 1999!. There is no reason to think that providers
would be any more likely to self-select on the basis of their service delivery practices
than on their beliefs.
Second, given the cross-sectional nature of this data any causal attributions made
are limited. It is possible that providers who were more family-centered in their
practice were more likely to join teams. Our experiences observing county planning
meetings, interagency team meetings, and feedback sessions suggest that this was not
the case, however. Most providers did not volunteer to be team members, but were
assigned to the team by their organizational leaders. Many providers expressed skepticism about the team approach at their initial meetings. Over a 12-month period we
observed changes in providers’ behavior during interagency team meetings that demonstrated greater alignment with family-centered service delivery practices ~e.g., changes
in the language used to describe families, greater knowledge of available resources!. In
addition, one service provider testified during our feedback meetings that she was
initially resistant to the family-centered approach to service delivery, but had changed
her attitude and practice with all of the families she served as a result of her participation on the team.
Finally, our sample of families who took part in the focus group was small and
self-selected. It is certainly possible that those families who participated in the focus
group had more satisfying experiences with the services they received from the teams
and0or that they were coping better at the time the focus group was conducted. While
these families clearly experienced the services that they received from the team as
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different from those they had received in the past, we cannot generalize their experiences to those of all families who receive team-based services.
While we must be cautious in our causal interpretations and in how we generalize
our findings, extensive knowledge of the county’s service delivery system, authentification by members of the setting, and validation of our findings with the focus group
data give us confidence in the validity of our conclusions. Providers who were team
members demonstrated service delivery practices that were more consistent with a
family-centered approach and families who had received team-based services reported
that their experiences were consistent with this approach. Given that many previous
attempts to transform human service delivery practices have been unsuccessful ~e.g.,
Bargal & Schmid, 1992; Foster-Fishman & Keys, 1997; Glisson, 1978!, the fact that
interagency team membership was associated with provider practices that were consistent with the desired changes is particularly notable. They point to the need for
future longitudinal research that can more adequately address the questions of causality and generalizability. Our findings also raise the question of how interagency
teams might facilitate the adoption of innovation. Klein and Sorra ~1996! provide one
framework for understanding how settings can promote a climate that encourages the
implementation of innovation. The ways in which interagency teams might promote
such a climate is discussed below.
Promoting a Climate for Implementation
The fundamental challenge faced in innovation implementation is promoting employee
support for and use of new practices. Klein & Sorra ~1996! argue that employees are
far more likely to implement an innovation if they work in a setting that does the
following: ~a! promotes needed skills, ~b! provides incentives for the adoption of
innovation and disincentives for failure to adopt innovation, ~c! eliminates obstacles to
implementation, and ~d! develops employee attitudes and values that are congruent
with the innovation. While our study did not examine how teams impact the implementation of innovative service delivery practices, given what we know about an
interagency team’s structure and process ~e.g., Pandiani & Maynard, 1993; VanDenBerg & Grealish, 1996! and what we observed in Creek County, interagency teams
appear to have many of the qualities Klein and Sorra ~1996! highlight when describing
settings that have the capacity to facilitate the adoption of innovation.
One critical component of innovation implementation is the promotion of relevant employee skills. The switch to family-centered care requires providers to deliver
services in a manner that is very different from traditional approaches to care and
requires skills often not found among service delivery providers ~Dunst, 1985; VanDenBerg & Grealish, 1996!. While Creek County had sponsored several workshops on
these reforms, providers outside of the interagency team context were offered no
additional implementation support, were not provided with the time needed to practice this behavior, and often faced incompatible policy and procedures within their
home organization ~Foster-Fishman et al., 1999!. Teams provide a context where new
service approaches can be modeled ~Bandura, 1977!, less experienced service providers can learn from those more experienced in implementing the reforms ~Bailey et al.,
1991!, and members can practice new skills and behaviors.
In addition to promoting skill development, Klein and Sorra ~1996! suggest that
settings must provide incentives for implementing a desired innovation and disincentives for avoiding implementation. The loosely coupled structure of traditional human
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service delivery organizations significantly inhibits an agency’s capacity to monitor the
implementation of reforms and to reward and sanction behavior ~Weick, 1976!. In
contrast, in teams where providers practice in a group, behavior that is often invisible
to other providers becomes visible. The team may therefore be better equipped to
support, reward, and monitor providers’ implementation of reforms.
A third strategy for creating a climate for innovation involves eliminating obstacles
to successful implementation. In the traditional service delivery system, organizational
structures and norms often fail to support the implementation of service delivery
innovations ~Cameron & Vanderwoerd, 1997; Cohen & Lavach, 1995; Foster-Fishman
et al., 1999!. Implementing innovative services to consumers is difficult considering
the fragmentation of a traditional service delivery system that can limit providers’
access to and knowledge of other service delivery organizations. Interagency teams
may assist providers in circumventing barriers to addressing broad-based consumer
needs because they create opportunities to interact with providers from other organizations. This might increase their knowledge of what other organizations have to
offer and how these services can be accessed. Finally, in some communities teams may
increase providers’ access to noncategorical funds that can be employed to support a
greater implementation of family-centered service delivery.
Finally, the implementation of innovations is also more likely to succeed if providers have positive attitudes towards and value the targeted innovation. Positive attitudes towards service delivery changes has been found to be a predictor of providers’
adoption and implementation of a more integrated approach to service delivery ~Glisson & Hemmelgarn, 1998! and more family-centered practices ~Allen, 1997!. Interagency teams may help providers adopt positive attitudes towards these reforms by
providing a forum where the benefits of reforms are demonstrated and the barriers to
their implementation are minimized ~Foster-Fishman et al., 1999!.
The Limitations of Interagency Teams
It is important to note that we found that team members were not distinguishable
from nonteam members on all indices of family-centered practice. While team members were more likely than nonteam members to address the broad-based needs of
clients and to address the needs and strengths of all family members, they were not
more likely to identify the strengths of the “target client” or to include clients and0or
families in creating goals. These findings could be related to differences in the ease of
implementing these separate elements of the reforms. It is possible that the identification of consumer strengths and the inclusion of families in goal setting require less
behavior change on the part of providers than the other elements of these reforms
~e.g., attending to the specific needs of family members in addition to the target
client! and that the training offered to all staff in Creek County on the familycentered model may have been a sufficient means for facilitating these changes. These
findings may also be attributed to differences in the efficacy of the team context in
promoting different behavioral shifts. Future research should further explore the
impact of interagency team membership on the different behavioral changes required
by these reforms. Finally, the lack of differences with regard to including families in
the identification of goals may reflect a limitation of our measure. In particular,
providers were asked to indicate whether or not they included clients and0or families
in goal setting, but were not asked to detail how they included them. Thus, a provider
who simply asked a client if a particular goal was acceptable might appear equivalent
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to a provider who asked a family to develop the goal on their own. Future research
should attempt to capture providers’ service delivery practices with more sensitive
indices.
In addition, it is critical to note that while participation on interagency teams is
associated with the implementation of new service delivery practices by individual
providers, these settings did not appear to impact the overall service delivery system.
Within Creek County, significant contextual barriers to this form of service delivery
still existed ~Foster-Fishman et al., 1999!. These barriers included rigid financial reimbursement procedures that funded categorical services and restricted flexible funding
pools, strict rules regarding when and where providers could deliver services to consumers, and inconsistent leader support of family-centered service delivery. While
interagency teams may be a promising avenue for helping individual providers to
change their approach to service delivery, their influence may be limited to those who
participate in them.
IMPLICATIONS FOR PRACTICE AND RESEARCH
Overall, the findings from this study have important implications for those interested
in promoting and understanding the successful implementation of family-centered
service delivery. Given that teams appear to provide a venue for the adoption of
positive attitudes towards ~Foster-Fishman et al., 1999! and implementation of practices consistent with this reform, it seems important to maximize the number of
providers involved in these settings. However, it is common practice to include only a
selected group of providers in these teams. For example, in Creek County, only 21%
of all providers surveyed reported at least some experiences working in these interagency teams. Increasing the number of teams and0or rotating team membership
among several service providers would expose more providers to this setting. Rotating
membership may also avoid the perception that the team setting is a new service
delivery program ~Williams, 1995! as opposed to a setting employed to facilitate the
implementation of a new service delivery philosophy.
While interagency teams appear to be an effective intervention for promoting
service delivery reform, it is important to recognize that they are resource intensive,
requiring significant amounts of financial support ~e.g., noncategorical dollars! and
service provider time ~which is sometimes not reimbursable!. Still, if providers who are
team members are better at meeting consumers’ broad-based needs and facilitating
their independence, teams may actually result in a reduction in service delivery costs
in the long run. Thus, one direction for future research is an examination of the
short- and long-term costs associated with team interventions. In addition, in examining the financial costs associated with interagency teams, it is vital to build a better
understanding of those factors that contribute to effective team functioning. Given
the small number of teams in our study, we were not able to systematically examine
what internal group factors contributed to an effective team. Certainly, previous research
would suggest that group characteristics such as group cohesiveness, leadership style,
and internal communication patterns might significantly affect the interagency team’s
capacity to influence group member behaviors and accomplish its goals ~e.g., Hackman, 1990; Larson, Foster-Fishman, & Franz, 1998!.
In conclusion, interagency teams appear to be a promising intervention for encouraging providers’ implementation of family-centered service delivery practices. Given
the difficulties typically associated with implementing new service delivery technolo-
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gies, interagency teams may be a promising context for fostering the implementation
of service delivery reforms. Future research aimed at establishing the causal role of
teams in shifting providers’ service delivery practices, exploring how teams influence
their participants, and identifying what types of reforms are facilitated through a team
approach and what types of families are best served will help us to better understand
the potential role of interagency teams in human service delivery system reform.
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