According to W. Edwards Deming, American companies require nothing less than a transformation of management style and of governmental relations with industry. In Out of the Crisis, originally published in 1982, Deming offers a theory of management based on his famous 14 Points for Management. Management's failure to plan for the future, he claims, brings about loss of market, which brings about loss of jobs. Management must be judged not only by the quarterly dividend, but by innovative plans to stay in business, protect investment, ensure future dividends, and provide more jobs through improved product and service. In simple, direct language, he explains the principles of management transformation and how to apply them.

Out of the Crisis

In the past few years several major reports highlighted the gap between our knowledge of effective treatments and services currently being received by consumers. These reports agree that we know much about interventions that are effective but make little use of them to help achieve important behavioral health outcomes for children families and adults nationally. This theme is repeated in reports by the Surgeon General (United States Department of Health and Human Services 1999; 2001) the National Institute of Mental Health [NIMH] National Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment (2001) Bernfeld Farrington & Leschied (2001) Institute of Medicine (2001) and the Presidents New Freedom Commission on Mental Health (2003). The authors call for applied research to better understand service delivery processes and contextual factors to improve the efficiency and effectiveness of program implementation at local state and national levels. Our understanding of how to develop and evaluate evidence-based intervention programs has been furthered by on-going efforts to research and refine programs and practices to define "evidence bases" and to designate and catalogue "evidence-based programs or practices". However the factors involved in successful implementation of these programs are not as well understood. Current views of implementation are based on the scholarly foundations prepared by Pressman & Wildavskys (1973) study of policy implementation Havelock & Havelocks (1973) classic curriculum for training change agents and Rogers (1983; 1995) series of analyses of factors influencing decisions to choose a given innovation. These foundations were tested and further informed by the experience base generated by pioneering attempts to implement Fairweather Lodges and National Follow-Through education models among others. Petersilia (1990) concluded that "The ideas embodied in innovative social programs are not self-executing." Instead what is needed is an "implementation perspective on innovation--an approach that views postadoption events as crucial and focuses on the actions of those who convert it into practice as the key to success or failure". (excerpt)

Implementation research: a synthesis of the literature.

Mental health: A report of the surgeon general

The Seasons of a Man's Life

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

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

The mental health system has realized significant metamorphoses in the standards and practices of quality care for people with psychiatric disability during the past decade. Now change agents are wrestling with effective strategies that help real-world systems to adopt programs reflecting these metamorphoses. Two fundamental approaches to systems change are compared and contrasted here: evolution and revolution. First, the authors compare the different ways in which evolution and revolution might approach change in the mental health system. They do this by showing how they might influence the transformation of day treatment into supported employment programs. Then, the authors present the two approaches as naturally occurring change processes that work in tandem to affect real-world adaptations. Finally, they summarize practical strategies that change agents might adopt to realize evolution and revolution. Clearly, all stakeholder groups need to become strategic about system change so that real-world practices keep up with the ideals emerging in practice guidelines and evidence-based practice reviews.

What works for mental health system change: evolution or revolution?

Objective: This study examined the impact of an Individual Placement and Support (IPS) program enhanced with Motivational Interviewing (MI) on process and outcome variables. This combined program assisted individuals with psychiatric disabilities in weighing the pros and cons of work, locating employment based on personal choice, and maintaining competitive jobs through unlimited support. Methods: 125 individuals completed employment process and outcome measures at baseline and six-month follow-up. McNemar, paired samples t-test, correlation, and simultaneous regression were utilized to analyze the data set. Results: From baseline to six-month follow-up, program participants significantly increased the number of obtained jobs, hours worked per week, hourly wage, and monthly job income. Job interviews and offers were found to be positively correlated with the combination of job leads from employment specialists (ES) and clients telephoning employers. Participants' stage of change was found to be positively...

Process and Outcome Analysis of a Supported Employment Program for People with Psychiatric Disabilities

The goal of this qualitative study was to explore and present the perspectives of unemployed and employed individuals with psychiatric disabilities on the benefits and costs of work. The participants in this study were enrolled in a supported employment program that provided assistance in weighing the pros and cons of work, locating employment based on personal choice, and maintaining competitive jobs through unlimited support. At the 12 th month of participation in the job program, 89 people completed the Stages of Change Interview for Seeking Competitive Employment. For 59 unemployed participants, results suggested 47 distinct themes that were categorized into 5 conceptual frameworks: financial, emotional, cognitive, behavioral, and interpersonal. For 30 employed participants, results suggested 25 distinct themes that were categorized into the same 5 conceptual frameworks. Implications for future research will be discussed.

Perspectives on benefits and costs of work from individuals with psychiatric disabilities

Objective Individuals with psychiatric disabilities experience 90% unemployment rates; however, individuals experience 61% employment rates when engaged in high-fidelity individual placement and support programs. To build on current research of variables influencing employment outcomes, we hypothesized that an Incentive factor and a Barrier factor are related to employment status. This mixed method study developed the Employment Commitment Measure (ECM) and explored the correlation between employment commitment and employment status. Method In our 1st phase of this mixed method study, we developed the ECM consisting of an Incentive factor with 5 items and a Barrier factor with 6 items through community-based participatory research. In our 2nd phase of this mixed method study, 198 randomly picked individuals with psychiatric disabilities completed a demographic survey and the ECM. We completed independent sample t tests with Bonferroni correction, cross-tabulated chi-square analyses, confirmatory factor analysis, Cronbach's alpha tests, a logistic regression, and a slope plotting. Results The ECM consists of 11 items, with 5 items loading on an Incentive factor and 6 items loading on a Barrier factor. Results indicated that the Incentive factor scores were associated with employment status and significant differences on Incentive factor scores between employed and unemployed participants. Results indicated nonsignificant differences between employed and unemployed participants by age, education, gender, ethnicity, housing, mental health tenure, and agency tenure. Conclusions Our findings indicated incentives for employment may provide a better guide for correlations of and commitment to employment when compared to barriers. We discuss the implications for employment for individuals with psychiatric disabilities.

Analyses of employment incentives and barriers for individuals with psychiatric disabilities.

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What works for mental health system change: evolution or revolution?

Process and Outcome Analysis of a Supported Employment Program for People with Psychiatric Disabilities

Perspectives on benefits and costs of work from individuals with psychiatric disabilities

Analyses of employment incentives and barriers for individuals with psychiatric disabilities.