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The Prevention Management Team: A Model of Care Coordination and Service Delivery for Children

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The Prevention Management Team: A Model of Care Coordination and Service Delivery for Children
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The Prevention Management Team: A Model of Care Coordination and
Service Delivery for Children

Elizabeth Wack


ABSTRACT


The objective of this study was to determine the satisfaction of those involved in the Prevention Management

Team (PMT), a multi-disciplinary, multi-agency case review and services planning consortium designed to evaluate

at-risk children and coordinate social services delivery in a rural county. Data for the study was collected from

three entities involved with the PMT process: agencies, parents/guardians, and school guidance counselors.

This study investigated whether each community agency perceived that it had an active, contributing role

in evaluation and referral, whether parents perceived that their child was appropriately served, and whether

guidance counselors perceived that the PMT was a timely and valuable service. Results suggest that this model

is perceived by the entities involved to be effective, collaborative, and helpful in a rural, school-based context,

and that those involved are generally satisfied.



INTRODUCTION


It has been established that up to 20% of youth under age 20 have emotional and behavioral disorders

warranting intervention, and less than one in three children in need actually receive services (Surgeon

General's Report, 1999). The statistics for rural areas are even worse: 75% of children who need mental

health services do not receive them, and less than 30% of those that receive care actually receive

adequate treatment (U.S. Center for Mental Health Services, 1997). Clearly, there is a great deficiency in

the availability and quality of mental health services for children, and this need is especially amplified in

rural communities.



There has been considerable debate among mental health experts regarding the best model of care to

provide services to children. In the past, community mental health systems often failed to integrate services

they provided with other agencies, which could potentially enhance treatment (Oynett & Ford, 1996). The lack

of collaboration sometimes causes clients' needs to be overlooked, or allows for clients to become trapped in

an approach that is not most conducive for changing or improving their situation (Knitzer, 1982). One model

meant to combat the singularity of traditional service provision is a multi-agency, multi-disciplinary team model.

A multi-agency team is composed of a variety of organizations from the community; it is a group that draws

its resources from the cooperation of multiple entities. A multi-disciplinary team is a group comprised of






individuals from various fields, orientations, or professions that may or may not work for the same

entity. Professionals report that multi-agency service programs ease the task of coordinating information

about children and tracking their progress across time (Crowsen & Boyd, 1993). While multi-disciplinary teams

have been used often in urban areas, only recently has this model been considered in a rural setting (Kuder,

Gairola, & Hamilton, 2001). The implementation and evaluation of both a multi-agency, multi-disciplinary model

is rarely discussed in the literature, though, when it is discussed, specific advantages of this model of care

are evident, especially for use in a rural context.



While there is much descriptive research on purely multi-disciplinary teamwork, there are fewer empirical

studies documenting an investigation of the use of multi-disciplinary, multi-agency teams in mental health

settings. However, the literature reveals that multi-disciplinary, multi-agency teams have been found to be

effective in preliminary studies and that this type of service is especially useful in a rural setting as it alleviates

some cost and facilitates inter-agency coordination (Ciaran, 2003; Amundson, 2001; Oldenettel & Wordes, 2000).



The Need for Evaluation


Multi-disciplinary and multi-agency teams vary widely, depending upon context and goals, and are rarely

integrated. Evaluative multi-disciplinary mental health team research is in its early stages, yet has proven to

be effective in identifying problematic elements and possible solutions (Moss, 1994). In order to understand the

true nature of multi-disciplinary teams, they should be viewed as unique, and should be evaluated separately, on

a case-by-case basis, rather than compared to a given model. Multi-disciplinary teams are used broadly and in

many different contexts that may produce results specific to that context. Regardless, the purported benefit of

this model of care, agreed upon within the literature, is that a multi-disciplinary team of community agencies

can provide targeted and coordinated care, and improve access to a wide range of services for individuals with

a variety of problems (Chenven & Brady, 2003). However, it has been argued that such systems of care are

overused and accepted as the standard for service delivery without an appropriate critical analysis (Galvin

& McCarthy, 1994). Thus, the literature emphasizes that reaching the ideals multi-disciplinary teams are seeking

to attain is dependent upon the overall perceptions of efficacy and the satisfaction of those entities involved in

or affected by the process (Oynett & Ford, 1996).



Although the multi-disciplinary, multi-agency team has been studied in a rural context (Amundson, 2001;

Kuder, Gairola, & Hamiltion, 2001), it has yet to be studied when implemented to assess, plan, and provide

services for at-risk children and families.



The current study seeks to address two issues deficient in the literature by evaluating a rural, multi-disciplinary,

and multi-agency team and surveying all components of the model: the referrers, the service providers, and

the service users. In this way, the picture of the particular team evaluated will take into account its rural

population and the limitations and benefits therein.





The Prevention Management Team


The literature reveals little about the use of a multi-disciplinary, multi-agency team in providing services to

children and families in the school-setting, and thus it is important to evaluate this model in such a context.

The objective of the current study is to determine the satisfaction and perceptions of efficacy of those involved in

the Prevention Management Team (PMT): a multi-disciplinary, multi-agency case review and services

planning consortium designed to assess at-risk children and coordinate social services delivery in Columbia

County. The PMT is part of a large, federally funded project called Columbia Acting Together for Children

(Project CATCh), conducted by the Columbia County school system in partnership with the University of

Florida. When the project began in 2003, Columbia County had significantly high levels of unemployment,

juvenile crime, domestic violence, sexual abuse, illiteracy, and drug use.



The PMT was created in an effort to develop coordinated treatment efforts for troubled youth and their families,

and as a way to pool community resources to provide a comprehensive service-planning structure in an

area otherwise lacking in behavioral and social services. Guidance counselors or teachers refer students

with emotional or behavioral problems to have a focused evaluation. After the assessment, more complex

cases, requiring the involvement of multiple agencies, are referred to the PMT meeting where the case is

discussed among community agency members in order to develop a plan of action for the child and family. Once it

is decided that a case will go to the PMT, parents and guidance counselors are invited to attend the PMT meetings

to discuss concerns or suggestions with agency members. The PMT is made up of representatives from a wide

array of community agencies. Meetings are generally no longer than one hour and take place bi-monthly. It is

during these meetings that agency members pool all collected information about the child and family and

share suggestions about the kinds of services that would benefit the child and family and facilitate entry into services.



Hypothesis One


The first hypothesis is that agency members believe the PMT is a worthwhile model that enhances the

service-planning process and stimulates community collaboration in a respectful manner. This hypothesis will

be investigated through the use of frequency counts. In order to gauge team members' feelings of the worth of

the PMT, the question "The PMT is useful for planning appropriate services for children" will be analyzed

using descriptive statistics and frequency counts. For the qualitative component, comments made during the

agency member interviews will be coded as positive, negative, or neutral and the percentages of these comments

will be analyzed to determine the overall attitude agency members have towards the PMT.



Hypothesis Two


The second hypothesis is that parents whose children have been referred to services will believe that their

children are receiving useful and appropriate services as indicated by their satisfaction with the service-

planning process. All parents who sign a plan of action will be asked to participate. Of those parents whose

children were seen by the PMT, frequency counts will be used to gauge how well listened to parents felt,






how comfortable they felt attending the PMT meeting, how difficult or inconvenient the process is perceived to

be, and how satisfied they are with the PMT. A Pearson's correlation will be used to test for any correlations

among the questions of the survey to determine whether there are links between any aspects of the process.



Hypothesis Three


The third hypothesis is that guidance counselors will feel that they contribute to the process and that

referred students are receiving appropriate services and it will be examined with the use of frequency counts of

data taken from several survey questions. The questions selected for the analysis are meant to gauge

the convenience of attending the PMT, satisfaction with time between referrals and the PMT, usefulness of the

PMT approach, the level of respectfulness to all parties involved in meetings, whether service planning is

efficient, and whether the plan of action is satisfactory. Additionally, the use of a correlation matrix will reveal

any relationships among questions.



METHOD


The sample is based on those individuals involved in the PMT process since its inception in May 2003 through

March 2005. The catchment area is Columbia County, Florida, which is a rural area that has approximately

10,000 school-aged children. During this period, 138 cases were addressed. The participants are drawn from

the three different entities affected by the PMT: agency members, parents, and guidance counselors.

Each component is described separately in order to clarify and distinguish among the various methodologies

and procedures unique to each.



Agency Members


Participants. A total of twelve agency members were involved in the current study. Five agency members were

male and the remaining seven were female. All agency members were Caucasian, which reflects the

ethnic demographic of Columbia County.



Procedure and Measure. A sign-up sheet for an interview time was passed out to PMT agency members at

two agency meetings. Members who were not in attendance at either meeting were contacted by phone to set up

an interview time. Agency members were contacted by phone at the time they indicated on the sign up sheet

and were assured of interview confidentiality prior to beginning the interview. The interviews were guided and

semi-structured, geared toward investigating members' thoughts concerning several elements of the PMT.

The interviews contained four quantitative components shared by guidance counselor and parent surveys to be

used for comparison. Each quantitative item was scaled from one to five, a score of one signifying that the

participant strongly disagreed with the statement and a score of five signifying that the participant strongly

agreed with the statement. The investigator kept notes during the interview and later organized the data into

general themes for clarity and analysis.







Parents


Participants. A total of 21 parents (of 24 children) whose children received services from the PMT were

surveyed. The median age of the children was 10 and two-thirds of those children were male.



Procedure and Measure. Parents completed separate surveys expressly created for the purpose of

evaluating CATCh services and the PMT from the perspective of a service user. The questions were designed by

a group of researchers from the University of Florida. Each survey was scaled from one to seven, a score of

one signifying that the participant strongly disagreed with the statement and a score of seven signifying that

the participant strongly agreed with the statement. The parent survey consisted of 19 scaled, quantitative

questions and one qualitative component in which they were asked to provide any additional thoughts they had

about CATCh services and the Prevention Management Team. Parents were also asked to provide the number

of children who had been referred services by the PMT as well as their age, school, and gender. Parents

were contacted through their interaction with CATCh counselors. During the signing of the child's action plan

(which took place after the PMT meeting), parents were given the survey to complete. Demographic questions

were solicited: child's age, gender, and school name. If the child had been referred to the PMT, it was noted on

the form. Once completed, the material was returned to the University of Florida personnel.



Guidance Counselors


Participants. The total number of guidance counselors who returned surveys was 18, eight from the

elementary level, four from the middle school level, and six from the high school level. All guidance counselors

were female, which is consistent with the very high percentage of female guidance counselors in the school system.



Procedure and Measure. Guidance counselors received their surveys through the Columbia County Public

School System mail. The guidance counselor survey consisted of 15 scaled, quantitative points and 3

qualitative components in which they were encouraged to provide any opinions they had about the PMT. Each

survey was scaled from one to seven, a score of one signifying that the participant strongly disagreed with

the statement and a score of seven signifying that the participant strongly agreed with the statement. The

questions targeted potential difficulties in the PMT referral process as well as overall inquiries regarding

satisfaction and utility. Additionally, guidance counselors were asked about the number of students they had

referred over the 18-month period and the type of school, whether elementary, middle, or high school.

They completed the surveys and returned them, via the same school mail system, in an enclosed envelope to

the office of University of Florida clinicians' office located in the Columbia County School Board building in Lake

City, Florida.



RESULTS


Hypothesis One








It was hypothesized that agency members would believe that the PMT is a worthwhile model for service-planning

that stimulates community collaboration. To test this hypothesis, each of the four questions was analyzed to

measure the levels of respondents' agreement with the question and the percentages of respondents who agreed

or disagreed with the given statement (Table 1). The results of the frequency test on the survey question, "The

PMT is useful for planning appropriate services for children," indicate that the majority (75%) of agency

members strongly agree with this statement (n = 9) while the remaining participants (8.3%) agree with or

feel neutral (16.7%) about this question (n = 12). A small portion (16.7%) of agency members feel that the

PMT process is inefficient while the majority (83.3%) believe that it is efficient (n = 12).




Table 1
Frequencies of Agency Member Quantitative Survey Responses

Response Strongly Disagree Disagree Neutral Agree Strongly Agree

I understand the CATCh referral, assessment, and
8.3% 25.0% 66.7%
service planning process

PMT is convenient for me to attend ----- -- 16.7% 25.0% 58.3%

PMT is useful for planning appropriate services for
16.7% 8.3% 75.0%
children

PMT process is efficient ----- 16.7% ----- 58.3% 25.0%


Once coded, qualitative data indicated that agency members had overwhelmingly positive perceptions of the

PMT. Analysis of the data revealed that 54.5 % of comments made by those surveyed were positive in nature.

The most common comments were in regard to the PMT's facilitation of community agency collaboration and the

high level of comfort members felt when sharing information at the PMT. However, 29.5% of comments

were negative and mainly cited the lack of follow-up information about children previously serviced by the PMT

and the lack of parental involvement as the main causes of consternation. Additionally, 16.0% of comments

were coded as neutral and consisted mainly of recommendations that were outside of the scope of the PMT (e.

g., need for more after-school care, better school-safety tactics).



Hypothesis Two


It was hypothesized that those parents whose children were evaluated by the PMT would believe that their

children are receiving useful and appropriate services through the PMT as indicated by their levels of satisfaction

with the service-planning process that takes place during the PMT meetings. A majority of parents whose

children were seen by the PMT disagree with the statement, "We had to wait too long for the PMT" (n = 20, P

= 95.3), however, one parent mildly agreed with the statement (n = 1, P = 4.8). Additionally, 100.0% of

these parents felt that they were listened to and felt comfortable sharing their thoughts during the PMT meetings

(n = 23). All of these parents disagreed with the statement that participating in the PMT was inconvenient (n = 23,

P = 100.0) and all responding parents indicated that seeking services was not difficult (n = 20, P = 100.0).

Finally, 90.0% of parents with children who went to the PMT are satisfied with the PMT while 5.0% are unsure






about their satisfaction and 5.0% are very dissatisfied with the PMT (n = 20).


Table 2
Frequencies of Parent Survey Responses


Disagree Mildly Disagree Unsure


Mildly
Agree


Agree Strongly Agree


I felt comfortable
talking to U.F. during
the assessment

I was listened to

I felt comfortable
talking at the PMT

I am worried about
confidentiality

We had to wait too long
for the initial
assessment

We had to wait too long
for the PMT

Seeking services
through CATCh has
been hard

I am satisfied thus far


14.3% 76.2%


19.0% 76.2%


19.0% 81.0%


55.0%



33.3%



66.7%



65.0%


30.0%



38.1%



23.8%



35.0%


10.0%


14.3%



4.8%


----- 5.0%


4.8%


----- 15.0% 75.0%


Of those parents whose children were seen by the PMT, a Pearson's Correlation revealed a significant

inverse relationship between their perception of wait time and satisfaction with services facilitated by the PMT (r

= -.806, p < .001): parents who felt that they had to wait too long for services expressed more

dissatisfaction. Furthermore, a positive relationship exists between the level of comfort a parent feels talking at

the PMT and how listened to they feel at the PMT (r = .691, p < .001).



Hypothesis Three


It was hypothesized that guidance counselors would feel that they contributed to the PMT process and that

the students they referred received appropriate services. A test of frequency was conducted on questions created

to gauge feelings about PMT convenience, satisfaction with time between referrals and service provision,

overall usefulness of the model, level of respectfulness, efficiency of service planning, and satisfaction with the

final action plan (Table 3). The results indicated that the PMT is not perceived as inconvenient by 72.7%

of responding guidance counselors (n = 8). However, a percentage of responding guidance counselors mildly

agreed with the statement that the PMT is inconvenient (n = 3, P = 27.3). While 27.8% of guidance counselors

were dissatisfied with the time between referral and the PMT meeting, 39.0% of guidance counselors reported

that they were satisfied with the time lapse (n = 12). All but one of the responding guidance counselors agreed

that the PMT is useful (n = 11, P = 91.6). Additionally, 100.0% of responding guidance counselors agreed that


Response


Strongly
Disagree






their views are respected by the PMT (n = 12). Most responding counselors agreed that the service planning

is efficient (n = 9, P = 81.8), and that the action plans devised by the PMT were satisfactory (n = 9, P = 90.0).




Table 3
Frequencies of Guidance Counselor Responses


Disagree Mildly Disagree Unsure


Mildly
Agree


Agree Strongly Agree


I felt confident that I
can explain Project
CATCh

Project CATCh is too
involved

Participating in the
PMT is inconvenient

I am satisfied with the
time between referral
and PMT

The PMT is useful

I feel my views are
respected at the PMT

I feel the PMT is
efficient

I feel that the services
are equally available
to all


----- 6.3% 12.5% 43.8% 31.3%


6.3%


18.2%



8.3%


62.5%


54.5%


12.5%


6.3% ----- 6.3%


----- 27.3%


----- 33.3%


----- 8.3%


----- 14.3%


----- 25.0% 25.0% 8.3%


----- 8.3% 25.0% 58.3%


25.0% 75.0%


9.1%


----- 54.5% 27.3%


6.7% 6.7% 33.3% 53.3%


A Pearson's correlation revealed a significant inverse relationship between guidance counselor willingness to

refer children to the PMT in the future and their belief that the PMT is too involved (r = -.846, p < .001) and

a positive correlation was found between guidance counselors' belief that the PMT is useful and the possibility

that they would refer children again (r = .911, p < .001). An additional relationship was found between

guidance counselors' confidence in their explanations of the PMT to parents and the likelihood they would

refer children to the PMT in the future (r = .719, p < .005).




DISCUSSION



The purpose of this study was to determine whether the PMT model of service provision is perceived as a

beneficial and efficient way to provide children and families with the services they need. The overall results of the

3 hypotheses suggest that the three primary entities involved in the PMT are generally satisfied with the

model, indicating that it is perceived as useful in this rural, school setting.



The first hypothesis was supported by data and suggested that agency members involved in the PMT believe that

the PMT is a worthwhile model. A frequency test revealed that the majority of agency members strongly agreed


Response


Strongly
Disagree






that the PMT was useful for service planning. Further analysis of the qualitative data indicated that agency

members had overwhelmingly positive opinions regarding the time commitment, the potential to help children in

the community, the quality of information provided at the meetings, and the meeting as an effective way to

enhance collaboration between the various agencies represented by the PMT. These results suggest that members

of the PMT feel that their efforts are beneficial to the children that are referred to them and are encouraged by

the collaboration they witness at meetings. Perceptions of team members indicate that the multi-disciplinary,

multi-agency approach undertaken by the PMT is indeed satisfactory to those involved and that this model

is appropriate for this particular setting.



The second hypothesis revealed the most strongly positive results, as parents who had contact with the

team responded that they are generally satisfied with many elements of the PMT. Results indicated that parents

were invited to attend meetings, and when they did, they felt comfortable sharing their opinions, and felt that

the PMT listened to their concerns. Parents reported that accessing services through the PMT was neither too

hard nor too inconvenient. These sentiments help to explain the overwhelming satisfaction parents felt about the

PMT process in general. In fact, several parents surveyed had two or more children receiving services via PMT,

and reported that both experiences resulted in improvements for their children. Comments made by parents on

the surveys indicated that parents are overwhelmingly grateful for the resources the PMT provided.



The third hypothesis also was supported by the data, suggesting that guidance counselors felt that they

contributed to the PMT process and were confident that the students they referred were receiving

appropriate services. A high percentage of those guidance counselors surveyed strongly agreed that the PMT

meeting was convenient to attend, that the PMT was useful and efficient, that there was a high level of

respectfulness among all parties involved, and that the action plan agreed upon for the child was

satisfactory. However, an issue that could be improved is the time between referrals and the PMT meeting. The

data suggested that guidance counselors would be more likely to refer students as long as they felt that they

could satisfactorily explain the process to parents and did not perceive the process as too involved, complicated

or time-consuming. Additionally, an integral component of obtaining future referrals is the perception that the PMT

is useful. The data indicated that if guidance counselors fail to see the PMT as useful, there would likely be

a cessation in referrals.



This major limitation of this study is the small sample sizes of the sub-populations surveyed. The types of

analyses that could be executed were limited due to the small sample sizes. The number of parents (n = 21)

sampled was smaller than desired by the experimenter due to data collection difficulties. The

administrators responsible for distributing the parent surveys at the signing of the action plan failed to distribute

the questionnaires throughout the entire survey period. Direct collection by the experimenter would have

yielded more accurate and complete data.



As suggested by Moss (1994), it is important to draw conclusions about multi-disciplinary mental health teams on

a case-by-case basis as they are broadly, and often haphazardly, implemented. As purported by Oynett and






Ford (1996), reaching the ideal that a multi-disciplinary mental health team can attain is dependent upon the

overall perceptions of efficacy and the satisfaction of those entities involved in or affected by the process. In

this study those perceptions were effectively targeted and they suggest that the PMT is a satisfactory method

to provide services to schoolchildren and their families in the rural community that was examined.






REFERENCES



1. Amundson, B. (2001). America's rural communities as crucibles for clinical reform: Establishing collaborative

care teams in rural communities. Journal of Families, Systems & Health,19(1), 13-23.

2. Chenven, M. & Brady, B. (2003). Collaboration across disciplines and among agencies within systems of care. In

A. Pumariega & N. Winters, (Eds.), The handbook of child and adolescent systems of care: The new

community psychiatry (pp. 66-81). California: Josey-Bass.

3. Ciaran, K. (2003). The mental health needs of looked after children: An integrated multi-agency model of

care. Journal of Clinical Child Psychology and Psychiatry, 8(3), 323-335.

4. Crowsen, R.L. & Boyd, W.L. (1993). Coordinated services for children: Designing arks for storms and seas

unknown. American Journal of Education, 101, 140-179.

5. Galvin, S. & McCarthy, S. (1994). Multi-disciplinary community teams: Clinging to the wreckage. Journal of

Mental Health, 3(2), 157-167.

6. Knitzer, J. (1982). Unclaimed children. Washington, DC: Children's Defense Fund.

7. Kuder, L., Gairola, G., & Hamilton, C. (2001). Development of rural interdisciplinary geriatrics teams. Gerontology

& Geriatrics Education, 21(4), 65-79.

8. Moss, R. (1994). Community mental health teams: A developing culture. Journal of Mental Health, 3(2), 167-175.

9. Oldenettel, D. & Wordes, M. (2000). The Community Assessment Center Concept. Washington, DC: Office of

Juvenile Justice and Delinquency. (OJJDP Bulletin No. NCJ 178942)

10. Oynett, S. & Ford, R. (1996). Multidisciplinary community teams: Where is the wreckage? Journal of Mental Health,

5(1), 47-56.

11. U.S. Center for Mental Health Services, Mental Health, United States, 1998 (SMA99-3285). Washington, D.C.: 1999.

12. U.S. Public Health Service, Report of the Surgeon General's Conference on Children's Mental Health: A National

Action Agenda. Washington, DC: 2000


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Journal of Undergraduate Research Volume 7, Issue 2 November/December 2005The Prevention Management Team: A Model of Care Coordination and Service Delivery for ChildrenElizabeth Wack ABSTRACTThe objective of this study was to determine the satisfaction of those involved in the Prevention Management Team (PMT), a multi-disciplinary, multi-agency case review and services planning consortium designed to evaluate at-risk children and coordinate social services delivery in a rural county. Data for the study was collected from three entities involved with the PMT process: agencies, parents/guardians, and school guidance counselors. This study investigated whether each community agency perceived that it had an active, contributing role in evaluation and referral, whether parents perceived that their child was appropriately served, and whether guidance counselors perceived that the PMT was a timely and valuable service. Results suggest that this model is perceived by the entities involved to be effective, collaborative, and helpful in a rural, school-based context, and that those involved are generally satisfied.INTRODUCTIONIt has been established that up to 20% of youth under age 20 have emotional and behavioral disorders warranting intervention, and less than one in three children in need actually receive services (Surgeon Generals Report, 1999). The statistics for rural areas are even worse: 75% of children who need mental health services do not receive them, and less than 30% of those that receive care actually receive adequate treatment (U.S. Center for Mental Health Services, 1997). Clearly, there is a great deficiency in the availability and quality of mental health services for children, and this need is especially amplified in rural communities. There has been considerable debate among mental health experts regarding the best model of care to provide services to children. In the past, community mental health systems often failed to integrate services they provided with other agencies, which could potentially enhance treatment (Oynett & Ford, 1996). The lack of collaboration sometimes causes clients needs to be overlooked, or allows for clients to become trapped in an approach that is not most conducive for changing or improving their situation (Knitzer, 1982). One model meant to combat the singularity of traditional service provision is a multi-agency, multi-disciplinary team model. A multi-agency team is composed of a variety of organizations from the community; it is a group that draws its resources from the cooperation of multiple entities. A multi-disciplinary team is a group comprised of

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individuals from various fields, orientations, or professions that may or may not work for the same entity. Professionals report that multi-agency service programs ease the task of coordinating information about children and tracking their progress across time (Crowsen & Boyd, 1993). While multi-disciplinary teams have been used often in urban areas, only recently has this model been considered in a rural setting (Kuder, Gairola, & Hamilton, 2001). The implementation and evaluation of both a multi-agency, multi-disciplinary model is rarely discussed in the literature, though, when it is discussed, specific advantages of this model of care are evident, especially for use in a rural context. While there is much descriptive research on purely multi-disciplinary teamwork, there are fewer empirical studies documenting an investigation of the use of multi-disciplinary, multi-agency teams in mental health settings. However, the literature reveals that multi-disciplinary, multi-agency teams have been found to be effective in preliminary studies and that this type of service is especially useful in a rural setting as it alleviates some cost and facilitates inter-agency coordination (Ciaran, 2003; Amundson, 2001; Oldenettel & Wordes, 2000). The Need for Evaluation Multi-disciplinary and multi-agency teams vary widely, depending upon context and goals, and are rarely integrated. Evaluative multi-disciplinary mental health team research is in its early stages, yet has proven to be effective in identifying problematic elements and possible solutions (Moss, 1994). In order to understand the true nature of multi-disciplinary teams, they should be viewed as unique, and should be evaluated separately, on a case-by-case basis, rather than compared to a given model. Multi-disciplinary teams are used broadly and in many different contexts that may produce results specific to that context. Regardless, the purported benefit of this model of care, agreed upon within the literature, is that a multi-disciplinary team of community agencies can provide targeted and coordinated care, and improve access to a wide range of services for individuals with a variety of problems (Chenven & Brady, 2003). However, it has been argued that such systems of care are overused and accepted as the standard for service delivery without an appropriate critical analysis (Galvin & McCarthy, 1994). Thus, the literature emphasizes that reaching the ideals multi-disciplinary teams are seeking to attain is dependent upon the overall perceptions of efficacy and the satisfaction of those entities involved in or affected by the process (Oynett & Ford, 1996). Although the multi-disciplinary, multi-agency team has been studied in a rural context (Amundson, 2001; Kuder, Gairola, & Hamiltion, 2001), it has yet to be studied when implemented to assess, plan, and provide services for at-risk children and families. The current study seeks to address two issues deficient in the literature by evaluating a rural, multi-disciplinary, and multi-agency team and surveying all components of the model: the referrers, the service providers, and the service users. In this way, the picture of the particular team evaluated will take into account its rural population and the limitations and benefits therein.

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The Prevention Management Team The literature reveals little about the use of a multi-disciplinary, multi-agency team in providing services to children and families in the school-setting, and thus it is important to evaluate this model in such a context. The objective of the current study is to determine the satisfaction and perceptions of efficacy of those involved in the Prevention Management Team (PMT): a multi-disciplinary, multi-agency case review and services planning consortium designed to assess at-risk children and coordinate social services delivery in Columbia County. The PMT is part of a large, federally funded project called Columbia Acting Together for Children (Project CATCh), conducted by the Columbia County school system in partnership with the University of Florida. When the project began in 2003, Columbia County had significantly high levels of unemployment, juvenile crime, domestic violence, sexual abuse, illiteracy, and drug use. The PMT was created in an effort to develop coordinated treatment efforts for troubled youth and their families, and as a way to pool community resources to provide a comprehensive service-planning structure in an area otherwise lacking in behavioral and social services. Guidance counselors or teachers refer students with emotional or behavioral problems to have a focused evaluation. After the assessment, more complex cases, requiring the involvement of multiple agencies, are referred to the PMT meeting where the case is discussed among community agency members in order to develop a plan of action for the child and family. Once it is decided that a case will go to the PMT, parents and guidance counselors are invited to attend the PMT meetings to discuss concerns or suggestions with agency members. The PMT is made up of representatives from a wide array of community agencies. Meetings are generally no longer than one hour and take place bi-monthly. It is during these meetings that agency members pool all collected information about the child and family and share suggestions about the kinds of services that would benefit the child and family and facilitate entry into services. Hypothesis One The first hypothesis is that agency members believe the PMT is a worthwhile model that enhances the service-planning process and stimulates community collaboration in a respectful manner. This hypothesis will be investigated through the use of frequency counts. In order to gauge team members feelings of the worth of the PMT, the question The PMT is useful for planning appropriate services for children will be analyzed using descriptive statistics and frequency counts. For the qualitative component, comments made during the agency member interviews will be coded as positive, negative, or neutral and the percentages of these comments will be analyzed to determine the overall attitude agency members have towards the PMT. Hypothesis Two The second hypothesis is that parents whose children have been referred to services will believe that their children are receiving useful and appropriate services as indicated by their satisfaction with the serviceplanning process. All parents who sign a plan of action will be asked to participate. Of those parents whose children were seen by the PMT, frequency counts will be used to gauge how well listened to parents felt,

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how comfortable they felt attending the PMT meeting, how difficult or inconvenient the process is perceived to be, and how satisfied they are with the PMT. A Pearsons correlation will be used to test for any correlations among the questions of the survey to determine whether there are links between any aspects of the process. Hypothesis Three The third hypothesis is that guidance counselors will feel that they contribute to the process and that referred students are receiving appropriate services and it will be examined with the use of frequency counts of data taken from several survey questions. The questions selected for the analysis are meant to gauge the convenience of attending the PMT, satisfaction with time between referrals and the PMT, usefulness of the PMT approach, the level of respectfulness to all parties involved in meetings, whether service planning is efficient, and whether the plan of action is satisfactory. Additionally, the use of a correlation matrix will reveal any relationships among questions.METHODThe sample is based on those individuals involved in the PMT process since its inception in May 2003 through March 2005. The catchment area is Columbia County, Florida, which is a rural area that has approximately 10,000 school-aged children. During this period, 138 cases were addressed. The participants are drawn from the three different entities affected by the PMT: agency members, parents, and guidance counselors. Each component is described separately in order to clarify and distinguish among the various methodologies and procedures unique to each. Agency Members Participants. A total of twelve agency members were involved in the current study. Five agency members were male and the remaining seven were female. All agency members were Caucasian, which reflects the ethnic demographic of Columbia County. Procedure and Measure. A sign-up sheet for an interview time was passed out to PMT agency members at two agency meetings. Members who were not in attendance at either meeting were contacted by phone to set up an interview time. Agency members were contacted by phone at the time they indicated on the sign up sheet and were assured of interview confidentiality prior to beginning the interview. The interviews were guided and semi-structured, geared toward investigating members thoughts concerning several elements of the PMT. The interviews contained four quantitative components shared by guidance counselor and parent surveys to be used for comparison. Each quantitative item was scaled from one to five, a score of one signifying that the participant strongly disagreed with the statement and a score of five signifying that the participant strongly agreed with the statement. The investigator kept notes during the interview and later organized the data into general themes for clarity and analysis.

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Parents Participants. A total of 21 parents (of 24 children) whose children received services from the PMT were surveyed. The median age of the children was 10 and two-thirds of those children were male. Procedure and Measure. Parents completed separate surveys expressly created for the purpose of evaluating CATCh services and the PMT from the perspective of a service user. The questions were designed by a group of researchers from the University of Florida. Each survey was scaled from one to seven, a score of one signifying that the participant strongly disagreed with the statement and a score of seven signifying that the participant strongly agreed with the statement. The parent survey consisted of 19 scaled, quantitative questions and one qualitative component in which they were asked to provide any additional thoughts they had about CATCh services and the Prevention Management Team. Parents were also asked to provide the number of children who had been referred services by the PMT as well as their age, school, and gender. Parents were contacted through their interaction with CATCh counselors. During the signing of the childs action plan (which took place after the PMT meeting), parents were given the survey to complete. Demographic questions were solicited: childs age, gender, and school name. If the child had been referred to the PMT, it was noted on the form. Once completed, the material was returned to the University of Florida personnel. Guidance Counselors Participants. The total number of guidance counselors who returned surveys was 18, eight from the elementary level, four from the middle school level, and six from the high school level. All guidance counselors were female, which is consistent with the very high percentage of female guidance counselors in the school system. Procedure and Measure. Guidance counselors received their surveys through the Columbia County Public School System mail. The guidance counselor survey consisted of 15 scaled, quantitative points and 3 qualitative components in which they were encouraged to provide any opinions they had about the PMT. Each survey was scaled from one to seven, a score of one signifying that the participant strongly disagreed with the statement and a score of seven signifying that the participant strongly agreed with the statement. The questions targeted potential difficulties in the PMT referral process as well as overall inquiries regarding satisfaction and utility. Additionally, guidance counselors were asked about the number of students they had referred over the 18-month period and the type of school, whether elementary, middle, or high school. They completed the surveys and returned them, via the same school mail system, in an enclosed envelope to the office of University of Florida clinicians office located in the Columbia County School Board building in Lake City, Florida.RESULTSHypothesis One

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It was hypothesized that agency members would believe that the PMT is a worthwhile model for service-planning that stimulates community collaboration. To test this hypothesis, each of the four questions was analyzed to measure the levels of respondents agreement with the question and the percentages of respondents who agreed or disagreed with the given statement (Table 1). The results of the frequency test on the survey question, The PMT is useful for planning appropriate services for children, indicate that the majority (75%) of agency members strongly agree with this statement (n = 9) while the remaining participants (8.3%) agree with or feel neutral (16.7%) about this question (n = 12). A small portion (16.7%) of agency members feel that the PMT process is inefficient while the majority (83.3%) believe that it is efficient (n = 12). Table 1 Frequencies of Agency Member Quantitative Survey Responses Response Strongly Disagree Disagree Neutral Agree Strongly Agree I understand the CATCh referral, assessment, and service planning process --------8.3% 25.0% 66.7% PMT is convenient for me to attend --------16.7% 25.0% 58.3% PMT is useful for planning approproate services for children --------16.7% 8.3% 75.0% PMT process is efficient ----16.7% ----58.3% 25.0% Once coded, qualitative data indicated that agency members had overwhelmingly positive perceptions of the PMT. Analysis of the data revealed that 54.5 % of comments made by those surveyed were positive in nature. The most common comments were in regard to the PMTs facilitation of community agency collaboration and the high level of comfort members felt when sharing information at the PMT. However, 29.5% of comments were negative and mainly cited the lack of follow-up information about children previously serviced by the PMT and the lack of parental involvement as the main causes of consternation. Additionally, 16.0% of comments were coded as neutral and consisted mainly of recommendations that were outside of the scope of the PMT (e. g., need for more after-school care, better school-safety tactics). Hypothesis Two It was hypothesized that those parents whose children were evaluated by the PMT would believe that their children are receiving useful and appropriate services through the PMT as indicated by their levels of satisfaction with the service-planning process that takes place during the PMT meetings. A majority of parents whose children were seen by the PMT disagree with the statement, We had to wait too long for the PMT (n = 20, P = 95.3), however, one parent mildly agreed with the statement (n = 1, P = 4.8). Additionally, 100.0% of these parents felt that they were listened to and felt comfortable sharing their thoughts during the PMT meetings (n = 23). All of these parents disagreed with the statement that participating in the PMT was inconvenient (n = 23, P = 100.0) and all responding parents indicated that seeking services was not difficult (n = 20, P = 100.0). Finally, 90.0% of parents with children who went to the PMT are satisfied with the PMT while 5.0% are unsure

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about their satisfaction and 5.0% are very dissatisfied with the PMT (n = 20). Table 2 Frequencies of Parent Survey Responses Response Strongly Disagree Disagree Mildly Disagree Unsure Mildly Agree Agree Strongly Agree I felt comfortable talking to U.F. during the assessment 4.8% 4.8% ------------14.3% 76.2% I was listened to 4.8% ----------------19.0% 76.2% I felt comfortable talking at the PMT --------------------19.0% 81.0% I am worried about confidentiality 55.0% 30.0% 5.0% 10.0% -------------We had to wait too long for the initial assessment 33.3% 38.1% 9.5% ----14.3% ----4.8% We had to wait too long for the PMT 66.7% 23.8% 4.8% ----4.8% --------Seeking services through CATCh has been hard 65.0% 35.0% --------------------I am satisfied thus far 5.0% --------5.0% ----15.0% 75.0% Of those parents whose children were seen by the PMT, a Pearsons Correlation revealed a significant inverse relationship between their perception of wait time and satisfaction with services facilitated by the PMT (r = -.806, p < .001): parents who felt that they had to wait too long for services expressed more dissatisfaction. Furthermore, a positive relationship exists between the level of comfort a parent feels talking at the PMT and how listened to they feel at the PMT (r = .691, p < .001). Hypothesis Three It was hypothesized that guidance counselors would feel that they contributed to the PMT process and that the students they referred received appropriate services. A test of frequency was conducted on questions created to gauge feelings about PMT convenience, satisfaction with time between referrals and service provision, overall usefulness of the model, level of respectfulness, efficiency of service planning, and satisfaction with the final action plan (Table 3). The results indicated that the PMT is not perceived as inconvenient by 72.7% of responding guidance counselors (n = 8). However, a percentage of responding guidance counselors mildly agreed with the statement that the PMT is inconvenient (n = 3, P = 27.3). While 27.8% of guidance counselors were dissatisfied with the time between referral and the PMT meeting, 39.0% of guidance counselors reported that they were satisfied with the time lapse (n = 12). All but one of the responding guidance counselors agreed that the PMT is useful (n = 11, P = 91.6). Additionally, 100.0% of responding guidance counselors agreed that

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their views are respected by the PMT (n = 12). Most responding counselors agreed that the service planning is efficient (n = 9, P = 81.8), and that the action plans devised by the PMT were satisfactory (n = 9, P = 90.0). Table 3 Frequencies of Guidance Counselor Responses Response Strongly Disagree Disagree Mildly Disagree Unsure Mildly Agree Agree Strongly Agree I felt confident that I can explain Project CATCh 5.6% --------6.3% 12.5% 43.8% 31.3% Project CATCh is too involved 6.3% 62.5% 12.5% 6.3% ----6.3% 6.3% Participating in the PMT is inconvenient 18.2% 54.5% --------27.3% ----14.3% I am satisfied with the time between referral and PMT 8.3% ----33.3% ----25.0% 25.0% 8.3% The PMT is useful --------8.3% ----8.3% 25.0% 58.3% I feel my views are respected at the PMT --------------------25.0% 75.0% I feel the PMT is efficient 9.1% --------9.1% ----54.5% 27.3% I feel that the services are equally available to all ------------6.7% 6.7% 33.3% 53.3% A Pearsons correlation revealed a significant inverse relationship between guidance counselor willingness to refer children to the PMT in the future and their belief that the PMT is too involved (r = -.846, p < .001) and a positive correlation was found between guidance counselors belief that the PMT is useful and the possibility that they would refer children again (r = .911, p < .001). An additional relationship was found between guidance counselors confidence in their explanations of the PMT to parents and the likelihood they would refer children to the PMT in the future (r = .719, p < .005).DISCUSSIONThe purpose of this study was to determine whether the PMT model of service provision is perceived as a beneficial and efficient way to provide children and families with the services they need. The overall results of the 3 hypotheses suggest that the three primary entities involved in the PMT are generally satisfied with the model, indicating that it is perceived as useful in this rural, school setting. The first hypothesis was supported by data and suggested that agency members involved in the PMT believe that the PMT is a worthwhile model. A frequency test revealed that the majority of agency members strongly agreed

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that the PMT was useful for service planning. Further analysis of the qualitative data indicated that agency members had overwhelmingly positive opinions regarding the time commitment, the potential to help children in the community, the quality of information provided at the meetings, and the meeting as an effective way to enhance collaboration between the various agencies represented by the PMT. These results suggest that members of the PMT feel that their efforts are beneficial to the children that are referred to them and are encouraged by the collaboration they witness at meetings. Perceptions of team members indicate that the multi-disciplinary, multi-agency approach undertaken by the PMT is indeed satisfactory to those involved and that this model is appropriate for this particular setting. The second hypothesis revealed the most strongly positive results, as parents who had contact with the team responded that they are generally satisfied with many elements of the PMT. Results indicated that parents were invited to attend meetings, and when they did, they felt comfortable sharing their opinions, and felt that the PMT listened to their concerns. Parents reported that accessing services through the PMT was neither too hard nor too inconvenient. These sentiments help to explain the overwhelming satisfaction parents felt about the PMT process in general. In fact, several parents surveyed had two or more children receiving services via PMT, and reported that both experiences resulted in improvements for their children. Comments made by parents on the surveys indicated that parents are overwhelmingly grateful for the resources the PMT provided. The third hypothesis also was supported by the data, suggesting that guidance counselors felt that they contributed to the PMT process and were confident that the students they referred were receiving appropriate services. A high percentage of those guidance counselors surveyed strongly agreed that the PMT meeting was convenient to attend, that the PMT was useful and efficient, that there was a high level of respectfulness among all parties involved, and that the action plan agreed upon for the child was satisfactory. However, an issue that could be improved is the time between referrals and the PMT meeting. The data suggested that guidance counselors would be more likely to refer students as long as they felt that they could satisfactorily explain the process to parents and did not perceive the process as too involved, complicated or time-consuming. Additionally, an integral component of obtaining future referrals is the perception that the PMT is useful. The data indicated that if guidance counselors fail to see the PMT as useful, there would likely be a cessation in referrals. This major limitation of this study is the small sample sizes of the sub-populations surveyed. The types of analyses that could be executed were limited due to the small sample sizes. The number of parents (n = 21) sampled was smaller than desired by the experimenter due to data collection difficulties. The administrators responsible for distributing the parent surveys at the signing of the action plan failed to distribute the questionnaires throughout the entire survey period. Direct collection by the experimenter would have yielded more accurate and complete data. As suggested by Moss (1994), it is important to draw conclusions about multi-disciplinary mental health teams on a case-by-case basis as they are broadly, and often haphazardly, implemented. As purported by Oynett and

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Ford (1996), reaching the ideal that a multi-disciplinary mental health team can attain is dependent upon the overall perceptions of efficacy and the satisfaction of those entities involved in or affected by the process. In this study those perceptions were effectively targeted and they suggest that the PMT is a satisfactory method to provide services to schoolchildren and their families in the rural community that was examined. REFERENCES1. Amundson, B. (2001). Americas rural communities as crucibles for clinical reform: Establishing collaborative care teams in rural communities. Journal of Families, Systems & Health,19(1), 13-23. 2. Chenven, M. & Brady, B. (2003). Collaboration across disciplines and among agencies within systems of care. In A. Pumariega & N. Winters, (Eds.), The handbook of child and adolescent systems of care: The new community psychiatry (pp. 66-81). California: Josey-Bass. 3. Ciaran, K. (2003). The mental health needs of looked after children: An integrated multi-agency model of care. Journal of Clinical Child Psychology and Psychiatry, 8(3), 323-335. 4. Crowsen, R.L. & Boyd, W.L. (1993). Coordinated services for children: Designing arks for storms and seas unknown. American Journal of Education, 101, 140-179. 5. Galvin, S. & McCarthy, S. (1994). Multi-disciplinary community teams: Clinging to the wreckage. Journal of Mental Health, 3(2), 157-167. 6. Knitzer, J. (1982). Unclaimed children. Washington, DC: Childrens Defense Fund. 7. Kuder, L., Gairola, G., & Hamilton, C. (2001). Development of rural interdisciplinary geriatrics teams. Gerontology & Geriatrics Education, 21(4), 65-79. 8. Moss, R. (1994). Community mental health teams: A developing culture. Journal of Mental Health, 3(2), 167-175. 9. Oldenettel, D. & Wordes, M. (2000). The Community Assessment Center Concept. Washington, DC: Office of Juvenile Justice and Delinquency. (OJJDP Bulletin No. NCJ 178942) 10. Oynett, S. & Ford, R. (1996). Multidisciplinary community teams: Where is the wreckage? Journal of Mental Health, 5(1), 47-56. 11. U.S. Center for Mental Health Services, Mental Health, United States, 1998 (SMA99-3285). Washington, D.C.: 1999. 12. U.S. Public Health Service, Report of the Surgeon Generals Conference on Childrens Mental Health: A National Action Agenda. Washington, DC: 2000 --top--

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