Master's Thesis - Kimberly D. Williams, MPH
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Master's Thesis - Kimberly D. Williams, MPH

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Participated in project to retool website content for the Thomas Scattergood Behavioral Health Foundation. Assisted in the creation of a design challenge for website. Ultimate goal was for dialogue ...

Participated in project to retool website content for the Thomas Scattergood Behavioral Health Foundation. Assisted in the creation of a design challenge for website. Ultimate goal was for dialogue and opportunities generated from design challenge to foster innovative and sustainable advancements by consumers, practitioners, and policymakers in behavioral health system. Utilized components of the design thinking methodology – human-centered design – for development of design challenge question. Components included collection and analysis of qualitative data derived from local community stakeholders who completed key informant interviews. Utilized interview data as inspiration for design challenge question. In addition, conducted literature review exploring historical evolution of United States behavioral health care system as well as the creation and implementation of modern social innovations through design thinking tools including human-centered design.

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Master's Thesis - Kimberly D. Williams, MPH Master's Thesis - Kimberly D. Williams, MPH Document Transcript

  • No Health Without Mental Health:Innovative Solutions to Creating Change in Behavioral Health Care A Thesis Submitted to the Faculty of Drexel University by Kimberly D. Williams in partial fulfillment of the requirements for the degree of Master of Public Health May 2012
  •   © Copyright 2012 Kimberly D. Williams. All Rights Reserved.
  • iii ACKNOWLEDGMENTS I would like to thank my advisor, Dennis Gallagher, MA, MPA. Theopportunity for me to participate in this project would not have been possible withouthis recommendation. I am truly indebted and thankful for his generous guidance,motivating questions, thoughtful feedback, and unwavering support to both the overallproject as well as the completion of this thesis. I would like to express my appreciation and thanks to Joe Pyle, MA of theThomas Scattergood Behavioral Health Foundation for spearheading this project andinitiating the collaboration with Drexel University. His commitment to theadvancement of behavioral health care through collaborative and innovative effortshas been truly inspiring. Additionally, I would like to thank Jason D. Alexander, MA of Capacity forChange, Larry Geiger of Geiger Design, and John A. Rich, MD, MPH of DrexelUniversity School of Public Health for their invaluable contributions throughout theentire course of this project. I would like to extend my gratitude to the preeminent community stakeholderswho generously offered their time to participate in our key informant interviews.Their invaluable feedback regarding the current status behavioral health care elevatedour project as well as my personal knowledge to a level of appreciation and awarenessfor which I am very grateful. Special thanks to Arthur C. Evans, Jr., PhD of the Philadelphia Department ofBehavioral Health and Intellectual disAbility Services for his additional support andendorsement of the Scattergood Foundation design challenge. Last but certainly not least, I would like to thank Katherine Carroll and AlysonFerguson for graciously allowing me to contribute to their Community-Based Mater’sProject as a part of my Block VIII Independent Study. Without their steadfastdedication to the project, this opportunity would not have been possible for me. I amsincerely thankful for their support, patience, and insight. I have no doubt that theywill each make an immeasurable contribution to the field of public health in the yearsto come.
  • iv TABLE OF CONTENTSLIST OF TABLES ....................................................................................................... vLIST OF FIGURES ....................................................................................................vi1. INTRODUCTION ................................................................................................... 12. BACKGROUND ...................................................................................................... 4 2.1 No Health Without Mental Health ....................................................................... 4 2.2 National and Regional Mental Health Care Policy .............................................. 5 2.3 National and Regional Mental Health Status ..................................................... 10 2.4 Social Innovation for Wicked Problems ............................................................ 12 2.5 Design Thinking................................................................................................. 13 2.6 Human-Centered Design .................................................................................... 15 2.6.1 Desirability, Feasibility, Viability ............................................................... 15 2.6.2 Hear, Create, Deliver ................................................................................... 17 2.7 “Web 2.0” and Social Media.............................................................................. 18 2.8 Philanthropy as a Change Agent ........................................................................ 19 2.8.1 Dorothy Rider Pool Health Care Trust ........................................................ 20 2.8.2 Advancing Colorado’s Mental Health Care ................................................ 21 2.8.3 “Philanthropy 2.0” ....................................................................................... 233. THE SCATTERGOOD PROJECT ..................................................................... 24 3.1 The Scattergood Foundation .............................................................................. 24 3.2 The Scattergood Project ..................................................................................... 26 3.2.1 Project Development ................................................................................... 26 3.2.2 Website Development ................................................................................. 28 3.2.3 IRB Submission........................................................................................... 29 3.2.4 Interview Recruitment ................................................................................. 29 3.2.5 Phase 1: Hear .............................................................................................. 30 3.2.6 Phase 2: Create ........................................................................................... 31 3.2.7 Phase 3: Deliver.......................................................................................... 33 3.2.8 Report Writing............................................................................................. 36 3.3 Future of the Scattergood Project ....................................................................... 374. LESSONS LEARNED........................................................................................... 38 4.1 Personal Narrative .............................................................................................. 38 4.2 Future Executive MPH Student Opportunities................................................... 41LIST OF REFERENCES.......................................................................................... 43APPENDIX A: INTERVIEW GUIDE.................................................................... 50APPENDIX B: DESIGN BRIEF DRAFT .............................................................. 52APPENDIX C: LINKS FOR ADDITIONAL INFORMATION.......................... 54
  • v LIST OF TABLES1. Scattergood Project Timeline (2011 – 2012)........................................................ 262. Key Informant Interview Themes ........................................................................ 323. Design Challenge Model ........................................................................................ 33      
  • vi LIST OF FIGURES1. Human-Centered Design: Desirability, Feasibility, Viability ........................... 162. Human-Centered Design: Hear, Create, Deliver ............................................... 18
  •  
  • 1   1. INTRODUCTION As the former U.S. Surgeon General, Dr. David Satcher, aptly declared,“There is no health without mental health.” In addition to calls for the integration ofmental and physical health systems, the field of public health should improve theextent to which mental health factors are incorporated into its objectives andstrategies. Over the past 50 years, there have been numerous legislative advancements toimprove that quality of and access to health care for undeserved Americans includingMedicaid, Medicare, and most recently the Patient Protection and Affordable CareAct (PPACA) (Barr, 2011). In addition to these measures, specific improvementshave been implemented to improve behavioral health care including the MentalHealth Parity Act (MHPA) as well as the expanded Paul Wellstone and PeteDomenici Mental Health Parity and Addiction Equity Act (MHPAEA) (Frank &Giled, 2006). However, the national prevalence and incidence of mental disordersremains disturbingly high at 46.4% and 26.2% respectively (Kessler & Wang, 2008).As such, the quality and accessibility of behavioral health care continue to be apressing concern. In addition to financial concerns that reduce access to healthinsurance coverage and health care services, another major barrier is the persistenceof personal and societal stigma surrounding mental illness (Corrigan, 2004; Corrigan,Markowitz, & Watson, 2004). The multi-faceted issues that contribute to the barriers and deficiencies in thebehavioral health care systems may be classified as “wicked problems.” Rittel andWebber (1973) cited that due to their complex nature, wicked problems cannot beaddressed by utilizing traditional scientific methods. Instead, sources of wickedproblems could be mitigated by the creation and administration of disruptive social
  • 2  innovations (Brown & Wyatt, 2010; Kolke, 2012). Employing the use of designtechniques may be an effective way to inspire and generate social innovations. Brown(2009) asserted that the application of design thinking methodologies, such as human-centered design, may in fact be a systematic and integral way to achieve sociallyinnovative solutions. As design practice has evolved into the application of design thinking methodsfor social causes and concerns, the world of technology has also progressed. Twoprimary examples include the evolution of the World Wide Web into what has beencoined “Web 2.0” as well as the subsequent creation of social media applications.The advent of Web 2.0 and its social media tools have enabled users to capitalize onthe inherently interactive nature and social networking potential of this technology(Treese, 2006). As a result, users provide as much information as they receive andthus, have shifted from a passive consumer role to a role of active participation(Brown, 2009). While the introduction of design thinking and Web 2.0 have made significantcontributions to society, philanthropic foundations have also served as a unique agentof change. Specifically, philanthropies have played an integral part in improving thehealth of the local communities they serve. Examples of two local foundations whichexemplify innovative ways to improve the health of their communities include theDorothy Rider Pool Health Care Trust and Advancing Colorado’s Health Care Trust(Meehan, Kaufman, Carlin, & Palmer, 2001; TriWest Group, 2011a). The era of “philanthropy 2.0” is seen as another evolution in the developmentof philanthropic foundation operations. This has been precipitated by their utilizationof Web 2.0 and social media applications to increase the level of communication
  • 3  between the foundations, their grantees, and other strategic partners (Brest, 2012;Morozov, 2009). The Thomas Scattergood Behavioral Health Foundation in Philadelphia,Pennsylvania is a key example of a foundation that has embraced philanthropy 2.0strategies. Its mission is to carry forth the goals of the foundation’s namesake,Thomas Scattergood, into the 21st century and continue to advance the field ofbehavioral health (Thomas Scattergood Behavioral Health Foundation [ScattergoodFoundation], 2012). In addition, the Scattergood Foundation has taken inspirationfrom design thinking methodologies in order to promote social innovations forbehavioral health care. In anticipation of the 200th anniversary of the affiliated Friends Hospital, theScattergood Foundation set out to retool its website. In doing so, it collaborated withthe Drexel University School of Public Health, Geiger Design, as well as a publicinterest consulting group, Capacity for Change, to implement this project. Theprimary goal of the project was to utilize design thinking practices and Web 2.0applications in order to develop a design challenge for the local community. Stepsfrom the human-centered design process were conducted in an effort to achieve thisgoal. The revised website went live on May 6, 2012. However, the implementationof the initial Scattergood design challenge was postponed until after additionalfeedback and engagement from website users in the community could be obtained. The delayed implementation of the Scattergood design challenge presents anideal opportunity for future Drexel Master of Public Health students to activelyparticipate in this project. Ultimately, it is anticipated that the design challengespresented on the Scattergood website will foster innovative and sustainableadvancements for the regional and national arenas of behavioral health.
  • 4   2. BACKGROUND 2.1 No Health Without Mental Health The fields of mental health and public health are not mutually exclusive. TheWorld Health Organization (WHO) asserted as such in their Constitution when theydefined health as “a state of complete physical, mental and social well-being and notmerely the absence of disease or infirmity” (1946, p. 1). Just as calls to integratemental and physical health care increase, public health should continue this trend byimproving the extent in which mental health is incorporated into its policies,educational programs, communication strategies, prevention research, surveillancepractices, and epidemiological reviews (Centers for Disease Control and Prevention[CDC], 2011b; WHO, 2002). Coinciding with the release of the seminal Surgeon General report on mentalhealth (U.S. Department of Health and Human Services [DHHS], 1999), Dr. DavidSatcher echoed the sentiments of the WHO Constitution and declared, “there is nohealth without mental health.” However, what if we took this one step further andconcluded that there is no public health without mental health? In essence, truewellness cannot be achieved without holistically addressing the physical, mental, andsocial factors that play a role in our health and well-being. In doing so, it may bepossible to expand the framework of public health promotion and preventionstrategies to better include mental health components in their objectives (CDC, 2011b;WHO, 2002). With this in place, we may be one step closer to a truly integratedhealth care system where mental health will be accepted as an undeniable andinvaluable factor in health and wellness.
  • 5   2.2 National and Regional Mental Health Care Policy In an effort to offset the rising burden of costs as well as improve the qualityof and access to services, several reforms to our health care system have beenimplemented during the past 50 years. As a result, our mental health care policieshave undergone some critical revisions, which have led to dramatic improvements inthe accessibility and quality of mental health care as well as how society addressesand views mental illness. Unfortunately, issues with cost, access to care, systemfragmentation, and stigma remain a real concern (Giled & Frank, 2009; Frank &Giled, 2006; Frank & Giled, 2007). In 1965, Medicare and Medicaid were enacted by Congress as amendments tothe existing Social Security Act and thus, referred to as Title XVIII and XIXrespectively. The passage of both federal programs marked one of the mostsignificant chapters in our country’s history by increasing access to health care formillions of Americans. In addition, both reform measures would contribute tochanging the landscape in which health care services are evaluated and administered(Barr, 2011). Medicare provides health insurance coverage primarily for individuals whoare eligible for Social Security benefits and 65 years of age or older. However, it wasrevised a few years later to also include two additional categories of individuals underthis age limit: those deemed permanently disabled and those in end-stage renaldisease or what is referred to as kidney failure (Barr, 2011). Medicaid currently provides coverage for specified groups of low-incomeindividuals and their families or disabled individuals who meet the mandatedqualifications. Unlike Medicare, which is universally available for all elderlyindividuals, Medicaid was not initially intended to provide coverage for all people
  • 6  who fall below the federal poverty line (FPL) and was only made available to certainsubgroups that met the eligibility requirements (Barr, 2011). Another notabledifference between the two programs is that Medicaid is managed by the state andlocal governments with a percentage of program costs being funded by federalreimbursements, whereas the federal government solely administers Medicare (Barr,2011). While Medicaid was not specifically created to increase coverage forindividuals with mental health concerns, it did considerably reduce the state’s cost ofmental health care. As a result, the number of individuals with diagnosable mentaldisorders who received coverage through Medicaid dramatically increased over theyears (Frank & Giled, 2006; Henry J. Kaiser Family Foundation [KFF], 2011). As of2011, approximately 24% of adult Americans enrolled in Medicaid reportedly had adiagnosable mental disorder (Garfield, Zuvekas, Lave, & Donohue, 2011). One of the mandates included in the initial implementation of Medicaid wasthat services at state and county mental health hospitals or private psychiatric facilitieswould not be covered. This was known as the Institution of Mental Disease (IMD)exclusion. The IMD exclusion was included to prevent state costs from shifting to thefederal budget. Another goal was to encourage state health systems to transition fromprimarily long-term, in-patient mental health care to programs that focused oncommunity-based treatments (Frank & Giled, 2006; KFF, 2011). It is now clear thatthe Medicaid IMD exclusion only partially succeeded in this effort. Indeed, Medicaidis considered to have played a significant role in the deinstitutionalization of mentalhealth services by the dramatic decrease of patients at state and county mentalhospitals. After a peak of over 550,000 in-patient residents in 1955, there was asteady decrease of 1.5% per year during the next ten years. Starting in 1965, the rate
  • 7  jumped to a patient decrease of 8% per year. This was especially evident in the rapidreduction of elderly in-patients from these facilities, which totaled about 70.6%between 1955 and 1973 (Frank & Giled, 2006). However, many patients were in factonly transferred to other types of in-patient care, specifically psychiatric wards ingeneral hospitals and nursing homes. In particular, there was a 74% increase ofelderly patient residents in nursing homes between 1960 and 1970 (Frank & Giled,2006). Despite some improvements, the marginalization of behavioral health carecontinued and the fragmentation between behavioral and physical health care wasonly perpetuated by these new legislations (Frank & Giled, 2006). In fact behavioralhealth services were literally “carved out” of the general health system and thusmanaged under a separate funding structure (Frank & Giled, 2006; Zuvekas, 2005). A prime example of the fragmentation of mental health care can be seen inPennsylvania’s public welfare system. Under the state’s Department of PublicWelfare (DPW), the HealthChoices program consists of two divisions that administermanaged care programs for residents who receive medical assistance (DPW, 2010a).The Office of Mental Health and Substance Abuse Services (OMHSAS) division runsthe behavioral health managed care organizations (DPW, 2012). The Office ofMedical Assistance Programs (OMAP) runs the physical health managed careorganizations and administers the Medicaid program for the state (DPW, 2010b). Assuch, state residents in need of medical assistance are forced to navigate between twocomplex health systems in order to receive comprehensive care for behavioral andphysical conditions. While many new Americans obtained health care coverage through thecreation of Medicaid and Medicare, the costs for health care rapidly increased since
  • 8  their inception (Barr, 2011). One response to these rising costs was the increasedutilization of managed health maintenance organizations (HMOs) and managedbehavioral health care organizations (MBHOs) during the 1980s and 1990s (Barr,2011; KFF, 2011). However, the increase usage of managed care organizationscontributed to furthering the marginalization and fragmentation of behavioral healthcare services from the rest of the health care system (Brousseau, Langill, & Pechure,2003; KFF, 2011; Zuvekas, 2005). In response to these issues, the Mental Health Parity Act (MHPA) was enactedin 1996. The MHPA set a historic precedent by mandating that insurance carriersprovide mental health care benefits and limits that are equal to medical and surgicalhealth care benefits and limits (KFF, 2011; Smaldone & Cullen-Drill, 2010). In 2008,the benefits provided by the MHPA were further increased with the Paul Wellstoneand Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA). Theparity requirements under the MHPAEA were expanded to include substance usedisorders as a mental health condition and eliminated arbitrary limits on the frequencyof outpatient treatment services or inpatient days of coverage (Smaldone & Cullen-Drill, 2010). The additional mandates in the 2008 MHPAEA went into effect onJanuary 1, 2010 (Smaldone & Cullen-Drill, 2010). That same year would mark a historic evolution for general as well asbehavioral health care with the passage of the Patient Protection and Affordable CareAct (PPACA), which was signed into law on March 23, 2010 (Garfield, Lave, &Donohue, 2010). While the MHPAEA sought to equalize the mental and physicalhealth care coverage, the PPACA attempted to take health care to the next level byincreasing accessibility, improving quality, as well as integrating mental and physicalhealth services (Barry & Huskamp, 2011; Garfield et al., 2010). The principle behind
  • 9  the PPACA was that all Americans should be provided access to affordable healthcare insurance in order to have access adequate health care services and thus, improveto overall health status of the nation (Barry & Huskamp, 2011; Garfield et al., 2010). Of the 59 million people currently enrolled in Medicaid, approximately only5% are eligible directly due to a mental disorder. The majority of people currentlyqualify for Medicaid based on their family or low-income status (KFF, 2011). As adirect result of the PPACA, approximately 2 million additional Americans who meetthe criteria for a mental disorder will be eligible for Medicaid after the full PPACAprovisions are enforced by 2014 (KFF, 2011). This increased rate of coverage willprimarily be possible due to updated eligibility requirements (Garfield et al., 2011).Specifically, Medicaid will be expanded to include all persons with householdincomes up to 133% of the FPL (Barr, 2011; KFF, 2011). In addition, persons withhousehold incomes up to 400% of the FPL will be eligible for subsidies to supplementthe purchase of health care coverage through health insurance exchanges (Barr, 2011;KFF, 2011). Another crucial and historic component of the PPACA for the mental healthcommunity is the inclusion of behavioral health care services as an essential healthbenefit (Garfield et al., 2010). This will prohibit affected health insurance plans fromexcluding individuals with pre-existing behavioral health conditions. As a result,many more individuals with diagnosed mental illnesses or substance use disorderswho were previously unable to obtain private insurance or Medicaid benefits, willnow be eligible for some form of health insurance that will cover their physical andbehavioral health care needs (Garfield et al., 2010). It is expected that approximately3.7 million Americans with mental disorders will be able to obtain some form ofhealth care coverage by 2019 (Garfield et al., 2011; KFF, 2011). The PPACA has the
  • 10  potential to reshape the way behavioral health services are delivered in this countryand could measurably reduce the system fragmentation between behavioral andphysical health care (Barry & Huskamp, 2011; Garfield et al., 2011). As of May 2012, the U.S. Supreme Court was currently debating theconstitutionality of the PPACA. It remains to be seen whether the court will upholdthe full PPACA, only certain provisions such as the individual mandate to purchasehealth insurance, or strike down the Act in its entirety (New York Times, 2012).Regardless of future outcomes, it is clear that more policy and system changes areneeded to ensure that Americans receive truly adequate behavioral health caretreatment and services. In addition, more needs to be done to change society’soutlook on mental illness as well as the importance of overall mental wellness. 2.3 National and Regional Mental Health Status Kessler and Wang (2008) confirmed that the national prevalence of mentaldisorders remains exceedingly prohibitive. In their epidemiological review of mentaldisorders – as categorized in the Diagnostic and Statistical Manual of MentalDisorders 4th Edition (DSM-IV) – they reported that approximately half (46.4%) ofthe U.S. population would meet the diagnosable criteria for one or more disorderduring their lifetime. In addition, more than a quarter (26.2%) of the U.S. populationwould meet the criteria for such a disorder during any given 12-month period (Kessler& Wang, 2008). The state of Pennsylvania was slightly below this national averagewith approximately 17.74% of adults over the age of 18 meeting the criteria for adiagnosable mental illness between 2008 and 2009 (Substance Abuse and MentalHealth Services Administration [SAMHSA], 2011). However, 26.24% of youngadults between the ages of 18 and 25 did meet the criteria for a diagnosable mental
  • 11  illness, which is an alarming rate for this age category and more in line with nationalprevalence rates of adults (SAMHSA, 2011). The percentage of individuals who exhibit co-occurring mental healthdisorders as well as comorbid physical health conditions has been identified asanother public health concern. Kessler and Wang (2008) cited that well over a quarter(27.7%) of Americans will experience two or more mental disorders during theirlifetime and that approximately 17% are at risk for experiencing three or more mentaldisorders. In addition, several studies have confirmed that adults with mentaldisorders are more likely to be afflicted with comorbid physical health conditionssuch as high blood pressure, heart disease, stroke, diabetes, and asthma (Chapman,Perry, & Strine, 2005; Goodell, Druss, & Walker, 2011; Institute of Medicine, 2006;Parks, Svendsen, Singer, & Foti, 2006; SAMHSA, 2012a). Adult Americans with mental disorders are also more likely to utilizeemergency department (ER) services (38.8%) or be hospitalized (15.1.%) than thosewho do not have a diagnosed mental disorder (27.1% and 10.1% respectively)(SAMHSA, 2012a). The origin of such differences between the health status ofindividuals with and without mental disorders has yet to be empirically identified.However, it is clear that individuals with mental disorders disproportionately sufferfrom chronic health conditions and thus demonstrate a greater need for physical healthcare treatment in addition to mental health services (SAMHSA, 2012a; Goodell et al.,2011). Despite the known prevalence of mental health disorders as well as theirassociation with an increased risk of comorbid physical health conditions, manyindividuals fail to seek out treatment for behavioral health related concerns nor followthrough with recommended services (Corrigan, 2004; Corrigan et al., 2004; KFF,
  • 12  2011). In fact, as many as 60% of adults with a diagnosable mental disorder werereported to not have received necessary mental health care services (KFF, 2011). Oneconfirmed reason is due to the continuing high rates of individuals who do not havehealth insurance coverage and could not afford the cost of such services (Garfield etal., 2011; KFF, 2011, SAMHSA, 2012b). In 2010, about 43.7% of adults reportedthat the primary reason they did not receive necessary mental health services wasdirectly due to issues with the cost of such care (SAMHSA, 2012b). In addition to theknown financial barriers to care, many individuals do not obtain necessary behavioralhealth treatment due the social stigma associated with mental illness (Corrigan, 2004;Corrigan et al., 2004). 2.4 Social Innovation for Wicked Problems Rittel and Webber (1973) identified “wicked problems” as issues that plagueour society and, due to the complex social systems in which they are entrenched,cannot be tackled with traditional scientific applications. Instead, the exploration andcreation of disruptive innovations have been identified as a possible means to mitigatethe factors that contribute to the wicked problems of our society (Brown & Wyatt,2010; Kolke, 2012). Thus a movement has been initiated to develop socialinnovations through alternative means in order to effectively address such wickedproblems (Brown & Wyatt, 2010; Phills, Jr., Deiglmeier, & Miller, 2008). Inresponse to this movement, the utilization of modified design techniques have beentouted as an effective way to produce potentially innovative solutions (Brown &Wyatt, 2010; Kolke, 2012). In order to reduce the many barriers to care and improve the quality ofbehavioral health services, disruptive social innovations may be the best solution to
  • 13  their wicked problems. The application of design thinking practices, includinghuman-centered design, may thus be an opportune way to foster socially innovativethinking and create tangible solutions to some of the critical systemic and culturalbehavioral health concerns that affect our society. 2.5 Design Thinking In his book, Change By Design, Tim Brown asserted that “design thinking” isa systematic and integral approach for achieving innovated solutions (2009). Someidentified best practices for the design thinking process include the use of dedicatedspaces, finite or well-defined timeframes, and multi-disciplinary teams (IDEO, 2009).In addition, Brown asserted that the design process includes three fundamental levelsor spaces of thinking when trying to develop an innovative solution: inspiration,ideation, and implementation (Brown, 2009; Brown & Wyatt, 2010). These spaces ofthoughts are not classified as distinct steps in a process because design thinking isiterative (Brown, 2009; Liedtka & Ogilvie, 2011). In fact, such levels of thinking arenot necessarily completed sequentially and may be repeated throughout the process ofdeveloping a product or solution (Brown, 2009; Brown & Wyatt, 2010; Liedtka &Ogilvie, 2011). The initial level of inspiration may involve creating a brief, which documentsthe facts and background concerning the issue at hand and defines the problem. Italso includes the process of exploring the issues, needs and barriers of the targetpopulation affected by the problem. This can best be achieved by immersing oneselfinto the daily lives and routines of individuals and observing them in naturalenvironment (Brown & Wyatt, 2010).
  • 14   The second concept, ideation, involves analyzing and synthesizing theinformation that was collected in order to eventually formulate potential solutions.Ideation largely involves active divergent thinking in which many thoughts and ideasare generated in order to facilitate the creation of potential options or solutions.Ideally, this involves brainstorming sessions with multi-disciplinary teams thatprovide varied backgrounds and alternative perspectives, which advance the divergentthinking process (Brown, 2009; Brown & Wyatt, 2010). In addition, designchallenges have also proven to further develop divergent thinking by successfullyfostering multiple ideas and potential solutions for the problem in question. Thedesign challenge process is initiated when a challenge question is posted in somecentral location for individuals or teams to review, offer comments, and designpotential solutions (Brown & Wyatt, 2010). Aside from generating multiple thoughtsand idea, participating can elevate people from a passive position to an active onewhere they are engaged and committed to the issue as well as its eventual solution(Brown, 2009). During the ideation process, the team will eventually transition froma level of divergent thinking to a level of convergent thinking where the abstractinformation collected is focused down into a few concrete ideas and solutions(Brown, 2009; Brown & Wyatt, 2010). Finally, implementation is self-explanatory to the extent that it involves settingup a plan for implementation to final solution. This also may involve the creation of acommunication strategy and prototypes to ensure that the solution is effectively andefficiently implemented (Brown, 2009; Brown & Wyatt, 2010).
  • 15   2.6 Human-Centered Design One of the core principles in design thinking is to maintain processes andgoals that are fundamentally human-centered (Brown, 2009; Brown & Wyatt, 2010).As a result, the human-centered design methodology was created in an effort tosystematically incorporate the needs of the people for whom the design product isintended. Originally created to enable for-profit corporations a way to designproducts and create innovative solutions or concepts for their businesses, the tools inhuman-centered design have been discovered to be an innovative way to createsolutions and promote change for social causes and community related concerns(Brown, 2009; Brown & Wyatt, 2010). By its very name, a human-centered process or project begins with the peopleit is tasked with supporting through its innovations. Constantly keeping theframework focused on the human component of the project and involving theconsumers throughout the design process ensures that the final product is trulydesirable, feasible, viable, and ultimately sustainable (Brown, 2009; Brown & Wyatt,2010). 2.6.1. Desirability, Feasibility, Viability The human-centered design process begins with three lenses by which theteam views and evaluates the problem at hand: Desirability, Feasibility, and Viability(see Figure 1) (Brown, 2009; IDEO, 2009). The first lens, Desirability, is the basis ofall human-centered thinking and processes. The consideration of what the targetpopulation desires and not what the evaluator believes that they need is the frameworkfrom which future solutions or concepts are derived (Brown, 2009; IDEO, 2009). Thesecond lens, Feasibility, reminds the team to ensure that all solutions are anchored in
  • 16  proposals that are considered organizationally and technically feasible (Brown, 2009;IDEO, 2009). Finally, even the most organizationally and technically feasiblesolution cannot be sustainably implemented without being financially viable.Therefore, the third lens of Viability maintains that the solutions achieved retain arealistic and practical approach in their implementation (Brown, 2009; IDEO, 2009).If the final solutions created from a human-centered design process encompass allthree of these lenses in their product or concept then it increases the likelihood thatthey will be successfully implemented and received by the community for which theywere conceived (Brown, 2009).Figure 1. Human-Centered Design Lenses: Desirability, Feasibility, Viability.Adapted from Human-Centered Design Toolkit, 2nd Edition by IDEO, 2009, p. 6.Copyright 2012 by IDEO.
  • 17   2.6.2. Hear, Create, Deliver The actual steps of a human-centered design process are implemented byutilizing techniques and specific activities in three distinct phases: Hear, Create, andDeliver (see Figure 2) (IDEO, 2009). These phases mirror the concepts of inspiration,ideation, and implementation that Brown asserted are instrumental in the designthinking process (Brown, 2009; Brown & Wyatt, 2010). The Hear phase begins withcompiling concrete information and facts about the problem at hand as well as thepeople affected by this problem. This information is obtained by conducting fieldresearch where people are observed in their environment and encouraged to providestories about their daily lives and routines (IDEO, 2009). During the Create phase,the concrete information collected is analyzed and expanded into abstract themes orconcepts. These multiple ideas are then synthesized into opportunities or options andeventually into concrete solutions for the problem (IDEO, 2009). The Deliver phaseprepares for the release of the agreed upon solution. This may involve thedevelopment of prototypes or models to serve as a guide for the solution concept. Inaddition, an implementation plan is created and eventually initiated in order toeffectively release the final solution into the community (IDEO, 2009).
  • 18  Figure 2. Human-Centered Design Phases: Hear, Create, Deliver. Adapted fromHuman-Centered Design Toolkit, 2nd Edition by IDEO, 2009, p. 7. Copyright 2012by IDEO. 2.7 “Web 2.0” and Social Media Technology is a continuously evolving factor within the development of oursociety. The evolution of the World Wide Web into what has been coined “Web 2.0”is yet another milestone in that development. During the past two decades, the way inwhich we utilize the Web to access and disseminate information has shifted from aunilateral experience to a multilateral phenomenon. Two hallmarks of Web 2.0 are itsinteractive nature and social networking capabilities (Treese, 2006). Prime examples of both these functions are encapsulated in current socialmedia tools such as Facebook, Twitter, and YouTube (CDC, 2011a). Kaplan andHaenlein (2010) defined social media as “a group of Internet-based applications thatbuild on the ideological and technological foundations of Web 2.0, and that allow thecreation and exchange of User Generated Content” (p. 61). In other words, socialmedia technologies allow for users to interact and actively participate in the contentthey are accessing rather than simply passively consuming information. As assertedby Brown (2009), Web 2.0 users have shifted from a consumer role to a participatory
  • 19  role with the assistance of social media applications. As a result, Web 2.0applications are particularly well suited to serve as a forum for the human-centereddesign process where the users input is a fundamental part of its method. 2.8 Philanthropy as a Change Agent Philanthropic foundations are in an ideal position to promote change andfoster innovation in our society. Furthermore, local philanthropies have the ability toproduce a great deal of change within the communities they serve. Meehan,Kaufmann, Carlin, & Palmer (2001) identified some of the most distinct advantageslocal philanthropies have when attempting to produce change. First, they noted that awell-designed philanthropic agenda could have a strong influence on the localcommunities served. Second, they have the ability to maintain a neutral and honestmediating position between the design and implementation of change into acommunity. Third, as a private foundation, they do not have the same level ofpolitical considerations as elected officials or departments. As a result, they may bein a position to fund or even implement more innovative and groundbreakingsolutions. Fourth, philanthropies have the ability to dispense smaller amounts offunds in a more strategic and targeted fashion than larger government organizationsand thus, are able to respond to a need more effectively and efficiently. Fifth, theycan uphold a reputation of reliability and integrity by championing causes that mayhave been previously discarded for financial or political reasons. Lastly, througheffective fundraising efforts, philanthropies can maintain a greater level of financialresources than other types of organizations in order to create an improved andsustainable system of care (Meehan et al., 2001).
  • 20   With health related issues being one of the foremost concerns addressed today,philanthropies have played a crucial role in advancing health care systems as well asthe well-being of underserved populations (Grantmakers In Health [GIH], 2005, 2010,2012). One of the most underserved populations includes individuals dealing withbehavioral health concerns. Philanthropies are particularly suited to navigate acomplex behavioral health care system and improve some of its deficiencies anddifficulties in order to increase its quality and access to care (Brousseau, Langill, &Pechura, 2003; LeRoy, Heldring, & Desjardins, 2006; Meehan et al., 2001). 2.8.1 Dorothy Rider Pool Health Care Trust A prime example of such a foundation is the Dorothy Rider Pool Health CareTrust (Pool Trust) located in Allentown, Pennsylvania. The Pool Trust was created in1975 with a mission to ensure quality health care for local residents and providefunding assets to Lehigh Valley Hospital that serves the region (Dorothy Rider PoolHealth Care Trust, n.d.; Meehan et al., 2001). In an effort to combat the increasingchallenges of the area’s psychiatric system, the Pool Trust attempted to reduce thenumber of patients who sought out psychiatric services through local emergencydepartments and redirect their treatment to community-based care. A second goalwas to implement a sustainable system that ensured the long-term support of thesepatients as well as their ability to thrive as functional members of the community(Meehan et al., 2001). Several notable achievements have been documented despite the fact that aformal evaluation of this initiative has not been conducted. First, over $5.2 million offunds were provided by the Pennsylvania Department of Public Welfare (DPW) tosupport the expansion of community-based behavioral health services. Thus, the
  • 21  amount of community services increased for patients classified at a high risk for in-patient care (Meehan et al., 2001). In addition, the utilization of services at AllentownState Hospital (ASH), which is a long-term and in-patient psychiatric facility, werereduced. This was demonstrated by the fact that more than 100 patients at ASH weredischarged and successfully integrated into the community. Additional services forpsychiatric crises and alternatives to in-patient hospitalization were also implementedas a result of this program (Meehan et al., 2001). In order to independently gauge thecommunity’s response to the program initiatives, local mental health consumers andtheir families created a Customer Satisfaction Team. They monitored the servicesprovided and evaluated the systems efforts through the use of surveys, which havedemonstrated positive results and sustained customer approval (Meehan et al., 2001). 2.8.2 Advancing Colorado’s Mental Health Care Local philanthropies can also collaborate among each other in order to fosterchange in a community. In 2002, eight local foundations collaborated to assess thestatus of mental health care in the state of Colorado. These foundations included:Caring for Colorado Foundation, The Colorado Trust, Daniels Fund, The DenverFoundation, First Data Western Union Foundation, HealthONE Alliance, RoseCommunity Foundation, and Rose Women’s Organization. They commissioned aprivate consulting group, TriWest Group and Heartland Network for Social Research(TriWest Group), to complete an evaluation of the private and public mental healthsystems in Colorado. The result of this assessment was released in the 2003 report,The Status of Mental Health Care in Colorado (TriWest Group, 2003). Thisevaluation revealed the extreme fragmentation of mental health services and how thisinhibited access to care for the state’s residents. Specifically, they noted that one in
  • 22  five residents are in need of mental health care, but only approximately a third ofthese individuals receive treatment. In addition, they identified that children andadolescents contribute to more than a third of the state’s severe mental health needs,but only comprise a quarter of the overall state’s population. Only half of childrenfrom households that were classified as low-income received necessary mental healthcare in 2000 (TriWest Group, 2003). In response to the alarming findings in this report, Advancing Colorado’sMental Health Care (ACMHC) was created through the joint funds of the Caring forColorado Foundation, the Colorado Trust, the Denver Foundation, and the ColoradoHealth Foundation (previously known as the Health ONE Alliance). Together theycommitted $4.25 million for a five-year project between 2005 and 2010 to improveColorado’s mental health care system by increasing the integration and coordinationof its services (TriWest Group, 2011a). The ACMHC project funded six grantees forthree integration-related project goals. The first funded two grantees for projects tointegrate mental health and substance use disorder services. The second funded twograntees for projects to integrate mental health and primary health care services. Thethird funded two grantees for projects to integrate mental health services with schoolsettings (TriWest Group, 2011a). In 2011, an updated report – The Status of Behavioral Health Care inColorado – was released that reviewed the successes of the ACMHC project as wellas what needs remained a concern for the state (TriWest Group, 2011b). This reportdemonstrated the number of mental health and substance use disorder practitionersincreased from 10,564 in 2003 to 14,217 in 2011. However, a high need remained forspecialists who are able to treat complex behavioral health issues and practitioners forservices in rural and frontier areas of the state (TriWest Group, 2011b). Spending on
  • 23  public mental health care across the state did increase between 2002 and 2009, with aper capita increase from $62 to $84 (TriWest Group, 2011b). In addition, severalefforts have been made to reduce system fragmentation in the state’s mental healthcare system. For example, oversight of the mental health and substance use disordercare systems are now both managed by their Division of Behavioral Health.Increased availability of medical home services for children and adolescents was alsoreported (TriWest Group, 2011b). 2.8.3 “Philanthropy 2.0” In the pursuit to find new ways to raise funds and create change for theirprioritized causes, philanthropies have begun to utilize Web 2.0 and social media intheir operational and communication strategies (Brest, 2012). The utilization of suchinnovations has ushered in the advent of “philanthropy 2.0” where the lines ofcommunication between the foundations, their grantees, and other partners are closerthan ever (Brest, 2012; Morozov, 2009). Another transformation in the field of philanthropy was the increased usage ofdesign thinking methods, which were initially developed within the for-profitindustry. Prior to its incorporation by philanthropic foundations, many non-profitorganizations began to adopt the for-profit design thinking approaches in order tocreate change and foster socially innovative ideas. This resulted in the differencesbetween non-profit and for-profit organizations becoming blurred and less distinct. Infact, the increased demand for and creation of social innovations has helped to bridgethe gap between non-profit and for-profit organizations (Phills, Jr. et al., 2008). Manyphilanthropic foundations have now begun to take inspiration from for-profit and non-profit organizations by incorporating design thinking techniques into their initiatives
  • 24  as well. Being that the organizational goals of philanthropies are already focused onadvancing social causes and thus human-centered, the application of design thinkingstrategies is a natural progression for their operational strategies. A current example of the recent changes to philanthropic strategies can befound in the Thomas Scattergood Behavioral Health Foundation of Philadelphia,Pennsylvania. With the assistance of Web 2.0 technology and design thinkingmethods, it continues to promote the creation of socially innovative solutions in orderto address behavioral health issues and concerns of the region. 3. THE SCATTERGOOD PROJECT 3.1 The Scattergood Foundation The roots of the Thomas Scattergood Behavioral Health Foundation can betraced back to 1811 when Thomas Scattergood, a Quaker minister moved by hispersonal and missionary experiences with mental illness, proposed creating an asylumfor individuals “deprived of the use of their reason” at the Philadelphia YearlyMeeting (Roby, 2011). In the following year, several Quaker community membersincluding Thomas Scattergood gathered in Philadelphia, Pennsylvania and establishedthe “Friends Asylum for Persons Deprived of the Use of Their Reason” (Roby, 2011).This asylum would later be founded as Friends Hospital in 1813 and was the firstprivate psychiatric hospital in the United States (Scattergood Foundation, 2012).Unfortunately, Thomas Scattergood died the following year of Typhus fever.However, his son, Joseph Scattergood, was given the opportunity to continue hisfather’s cause and was appointed one of the first managers of Friends Hospital. Inmemory of the man who pioneered the American mission to improve the treatmentand quality of life for individuals suffering from mental illness, the main building and
  • 25  heart of the Friends Hospital campus was named after Thomas Scattergood (Roby,2011; Scattergood Foundation, 2012). The Thomas Scattergood Behavioral Health Foundation is a philanthropicorganization that was established in 2005 as result of a joint venture between FriendsHospital and Horizon Health Systems (Scattergood Foundation, 2012). The missionof the Scattergood Foundation is to continue the advancement and awareness ofbehavioral health issues that Thomas Scattergood had advocated almost two centuriesbefore. With its headquarters located on the Friends Hospital campus, theScattergood Foundation has strived to carry forth the mission of Thomas Scattergoodinto the twenty-first century by fostering a dialogue and increasing learningopportunities in the behavioral health field and promoting innovative leadership andcommunity collaborations through philanthropic and grant-making opportunities(Scattergood Foundation, 2012). Since its creation, the Scattergood Foundation has made several contributionsto the advancement of behavioral health in the Southeastern Pennsylvania community.One example of its efforts included providing a grant to help found the ScattergoodProgram for the Applied Ethics of Behavioral Health at the University ofPennsylvania. Founded in June 2007, the Scattergood Ethics program is dedicated tothe promotion, evaluation, and training of the clinical issues and strategiessurrounding behavioral health care ethics (Scattergood Foundation, 2012). Inaddition, the Scattergood Foundation helped to advance the field of the mental healthjournalism by establishing a position at Philadelphia’s public broadcasting station,WHYY, with the objective of reporting on behavioral health current events and issues(Scattergood Foundation, 2012).
  • 26   3.2 The Scattergood Project In anticipation of the 200th anniversary of Friends Hospital, the ScattergoodFoundation set out to redesign its website and incorporate some interactive Web 2.0elements, including a design challenge initiative. By revitalizing the website design,the Scattergood Foundation sought to advance the level of community dialoguearound current behavioral health issues in the region and foster innovative ways toaddress such concerns. Over the course of the past nine months, the followingactivities were conducted in an effort to meet this goal (see Table 1).Table 1. Scattergood Project Timeline (2011 – 2012)Project Activity Sep Oct Nov Dec Jan Feb Mar Apr MayProject Development X XWebsite Development X X X X X X X X XIRB Submission/Approval X X* XInterview Recruitment X XPhase 1: Hear X X X* X*Phase 2: Create X* X* X*Phase 3: Deliver X* X*Report Writing X X X* X* X* X* X*Note. * Executive MPH student activity/participation 3.2.1 Project Development The inception of the Scattergood Project began when the president of theScattergood Foundation, Joseph Pyle, MA, approached faculty at the DrexelUniversity School of Public Health, Department of Health Management and Policy –Dennis Gallagher, MA, MPA and John A. Rich, MD, MPH – and requested Drexel tocollaborate with the Scattergood Foundation on an initiative to retool the Scattergood
  • 27  website. In addition, Jason Alexander, MA, of the public interest consulting firm,Capacity for Change, was brought on as a design thinking advisor for the project andLarry Geiger of Geiger Designs was enlisted as the project’s graphic designer to buildthe new website. A final component of the project team included the recruitment of Drexelstudents in the Master’s of Public Health (MPH) program. Initially, two full-timestudents, Katherine Carroll and Alyson Ferguson, were recruited to participate in thisinitiative for their Community-Based Master’s Project (CBMP), “Fostering SocialInnovation Through the Use of Web 2.0.” At a later point during the development ofthe project, I joined the team to collaborate with the full-time students for thecompletion of my Executive MPH Block VIII Independent Study. ThroughoutSeptember and October 2011, the full-time MPH students initially conceptualized theproject goals. As presented in a project proposal submitted to the Drexel UniversityIRB, these goals were identified as: • Identify and prioritize system and policy gaps in the behavioral health system in Southeastern Pennsylvania using the human-centered design process. • Evaluate the process of using human-centered design and Web 2.0 in respect to creating behavioral health content for public use on the internet. • Create a question(s) to post on the Scattergood website for the behavioral health community to discuss and potentially create a solution using the human-centered design thinking process.The students were tasked with collecting the necessary information and ultimatelycreating a design challenge question for the revised Scattergood Foundation website.The inspiration that would serve as the framework for the design challenge questionwas obtained by utilizing elements of the human-centered design methodology inorder to identify some of pressing barriers, issues, and concerns within the behavioralhealth community. The purpose of the design challenge was based on the dual goals
  • 28  of encouraging an open dialogue among community members and ultimately fosteringinnovative solutions to the proposed behavioral health challenge. It was noted that, as in any design project, the formulation of the goals andobjectives are the result of an iterative process, and subject to revision if necessary.For example, it was initially expected that this design challenge question would beposted in tandem with the release of the new website. As discussed during theDeliver phase of this project, it would later be determined that the design challengerelease would be postponed until after the website went live. 3.2.2 Website Development Starting in September 2011, Larry Geiger of Geiger Design began working onthe graphic design development of the new website and continued this process intandem with the rest of the project’s development. It was determined that the websitewould be divided into four main quadrants or portals entitled: The Foundation,Community Impact, Innovation Awards, and Design Thinking. The Foundationquadrant will provide background and contact information for the ScattergoodFoundation. The Community Impact quadrant will describe the impact grantmakingopportunities can have on communities, provide a database of current grants awardedby the Scattergood Foundation, as well as the criteria and guidelines for new grantapplications. Each year, the Scattergood Foundation presents an award for aninnovative behavioral health solution, policy or project. The Innovation Awardquadrant will provide a background about the annual Scattergood Innovation Award,a database of past winners and nominees, as well as the eligibility and judging criteriafor future contestants. The Design Thinking quadrant will provide some basicinformation about design thinking in general and provide an example of a design
  • 29  thinking application. This quadrant will also host the Design Challenge, where abehavioral health challenge question will be posed. Community members will beencouraged to participate and engage in this challenge issue as well as create andimplement an innovative solution. 3.2.3 IRB Submission To prepare the Institutional Review Board (IRB) application, the teamestablished the project mission, goals, methods, and overall timeline. In addition,appropriate research level training compliance was confirmed for all applicationslisted on the IRB submission by obtaining the following Collaborative InstitutionalTraining Initiative (CITI) program certificates: Human Subjects Research and HealthInformation Privacy Security. Once completed, an application for human subjectsresearch was submitted October 2011 to the Drexel University College of Medicine,Office of Regulatory Research Compliance. By November 2011, the project wasapproved and deemed to be exempt from IRB review since the source of the researchdata would be obtained from interviews with behavioral and public healthprofessionals. A secondary factor in this decision was based on the fact that theresearch data would not include the collection of identifying medical data nor directinteractions with behavioral health patients. 3.2.4 Interview Recruitment Once IRB approval was received, the project was presented to several keystakeholders in the community in order to recruit them for key informant interviews.Access to many of the prospective stakeholders was facilitated by referrals from theproject committee members at the Scattergood Foundation as well as Drexel
  • 30  University School of Public Health faculty. During November and December 2011,the Drexel full-time MPH students coordinated the interview recruitment process bycontacting these referrals, introducing a brief synopsis of the project, and setting uptimes to complete the interviews. 3.2.5 Phase 1: Hear The Hear phase consisted of a literature review and the completion of the keyinformant interviews. A review of the literature was conducted in order to further ouracademic knowledge base of the current behavioral health topics being explored.This took place for the full-time students during the summer of 2011 and throughoutthe spring of 2012 for myself. The key informant interviews began once IRB approval was received inNovember 2011. The interviews were conducted in order to collect qualitative datafrom key stakeholders regarding behavioral health issues, concerns, and barriers in theSoutheastern Pennsylvania region and national landscape. The information these keystakeholders offered during the interviews would serve as the framework for thedesign challenge question. In an effort to gain a rich perspective regarding theseneeds and concerns, a multi-disciplinary group of professionals were approached forthe interviews. As a result, we were able to collect stories and information fromindividuals that represented a wide breadth of knowledge in the behavioral healthcommunity and included backgrounds in: law, academic, city government, NGO andadvocate organizations, mental health practitioners, private insurance, and publicinsurance. The interview format remained informal to allow for a natural conversation toemerge between the interviewer and interviewee. However, an interview guide that
  • 31  included a prepared introduction about the project and a list of question prompts wasapproved by the IRB and utilized for the interviews (see Appendix A). In addition, ateam approach was incorporated into the process by having a primary interviewer leadthe discussion while a secondary interviewer listened and took notes. The discussionswere recorded with the interviewee’s permission so that the secondary interviewercould later transcribe the interview. The final interview was conducted in January2012, with the final transcription completed in March 2012. Beginning in January 2012, an initial design brief was created that includedthe content for the Design Thinking quadrant of the website. While this brief wascontinuously revised as the project progressed, the initial draft served as a frameworkfor the information that would be provided in this section of the website. By February2012, this initial design brief draft was released for the project team to review andutilize as a reference for the Design Thinking quadrant (see Appendix B). 3.2.6 Phase 2: Create The Create phase of the project was conducted between February and April2012. It consisted of analyzing and synthesizing the information collected during theHear phase. The initial goal was to code the data in order to make sense of andidentify patterns in the information amassed from the key informant interviews. Thiswas completed by individual preliminary analyses of interview transcripts where keyphrases, words, and topics concerning behavioral health were documented. We thencombined our individual analyses of the transcripts into a classification of key wordsand phrases. In order to verify our combined analyses of the data, the interviewtranscripts were then uploaded into a software program called NVivo, which wasdeveloped by QSR International specifically to analyze qualitative data. Using the
  • 32  descriptive words identified during the preliminary analyses, a query was run for theNVivo program to identify the primary themes, which are referred to as “nodes” inthe NVivo software. The output from this query resulted in several themes or nodecategories. The NVivo output was then reviewed to assess the quality of content ineach node and ensure that the context and classification of each categorization wascorrect. To do so, the output data was compared to preliminary individual dataanalyses to identify any missing references or descriptive words. This informationwas loaded back into NVivo in order to run an additional query. By March 2012 theprimary behavioral health themes that were identified from the data analysesincluded: public perception, funding, reimbursement, health care reform, workforce,integration, recovery, wellness, evidence-based practices, and trauma (see Table 2).Table 2. Key Informant Interview Themes Public Perception Funding Reimbursement Health Care Reform Workforce Integration Treatment Wellness Siloes Incentives Parity Evidence-based Practices Trauma 0 2 4 6 8 10 12Note. Represents the number of interviews to mention each theme. The secondary goal of the Create phase was to define the opportunities andcreate potential ideas for a design challenge question. This was achieved by
  • 33  conducting several brainstorming sessions with the project team during April 2012 inorder to progress the design thinking from a level of divergent to convergent thinking.These sessions evaluated the information collected and began to form distinct andconcrete criteria for the design challenge. 3.2.7 Phase 3: Deliver Once all of the abstract inspiration and ideas that were collected during theHear phase were synthesized into concrete design challenge opportunities during theCreate phase, the aim of the Deliver phase was to formulate the design challengemodel, finalize the design challenge question, and identify the steps needed for itsmarketing and implementation. This process began with the conceptualization of themodel by the full-time students in which the design challenge would be framed (seeTable 3). This model encompasses the individual components that are identified forthe design challenge question and will serve as the framework for its marketing andimplementation.Table 3. Design Challenge Model Product Ideas Amateur Individuals Participants Professional Individuals Sponsors Open and Free Recognition Incentives Social Value Participant Retain Ownership Intellectual Property Non-Exclusive License for Challenge Organization
  • 34   To ensure that an active level of interest and engagement was established forthe design challenge, several marketing plan strategies were devised. A part of themarketing plan included a presentation of the project during the 165th AmericanPsychiatric Association National Conference on May 6, 2012. In addition, a “ShareYour Story” campaign was expected to be released on the new Scattergood website.This campaign would provide a forum where individuals will be able to sharepersonal experiences relating to a mental health topic that would be posted on thewebsite. Another resource that was identified would be the email listserv of theScattergood Foundation grantees that could receive notifications and periodic updatesabout that the design challenge that could help build awareness and increase thenumber of participants for the challenge. In addition, the power of developingpartnerships with regional organizations was recognized as a useful tool to buildsupport and increase the level of community engagement in the design challenge. Several potential design challenge questions were conceived duringbrainstorming sessions in April 2012. Initially, it was determined that the designchallenge would be posted with the release of the new Scattergood Foundationwebsite on May 5, 2012. However, in keeping with the tradition of the designthinking as a nonlinear and iterative process, it was questioned whether thepresentation of the design challenge should be postponed and released on the websiteat a later date. In doing so, the Hear phase of the project would have been continuedan additional few weeks or months. The implementation of the final Deliver phaseincluding the release of the first design challenge would have been postponed untillate summer or early fall of 2012. This revised implementation plan was the result ofseveral meetings and brainstorming sessions where the potential design challengequestions were reviewed. During those meetings it was discussed whether there
  • 35  would be a sufficient level of community engagement in the design challenge by May2012. In an effort to heighten the level of interest, awareness, and engagement in thecommunity about this project, it was proposed that the process of divergent thinkingshould be continued in order to obtain additional feedback from the website usersabout potential design challenge questions as supplemental information to the keyinformant interviews. Apprehension regarding the level of community engagement was assuagedwhen the project received an official endorsement from Arthur C. Evans, Jr., PhD,Commissioner of the Philadelphia Department of Behavioral Health and IntellectualdisAbility Services (DBHIDS). In May 2012, he provided the following statement: It is important for our field to reframe the issues as behavioral health and wellness, over illness and diagnosis. My experience is that people find it difficult to talk about mental illness. People are much more receptive when you talk about what you can do to be healthy mentally. We need to develop innovative ways to have that conversation. This design challenge is an excellent strategy for involving the community in our ultimate goal of improving everyones mental wellness.In addition, the DBHIDS agreed to serve as a co-sponsor of the design challenge bypartnering with the Scattergood Foundation to provide consultation and feedbackthroughout the design challenge initiative. During the completion of the Scattergoodproject, DBHIDS was in the process of implementing Mental Health First Aid(MHFA) training sessions within the Philadelphia area (DBHIDS, 2012). MHFA isan international, evidence-based certification course designed to improve mentalhealth literacy (MHFA, 2009). The program provides early intervention training to allindividuals in order to assist fellow community members who are experiencingmental health issues. A key to this program is that it is designed for all communitymembers to participate regardless of whether they have a clinical or behavioral healthbackground. Trained individuals will be better equipped to recognize, comprehend,
  • 36  and respond to mental health issues or crises. In addition, they will be able to offertheir services until the crisis is resolved or professional treatment can be administered(DBHIDS, 2012; MHFA, 2009). To capitalize on this important public health initiative being undertaken by thecity of Philadelphia, the design challenge goals were modified to include a targetedeffort to support the MHFA program in some capacity. As of the completion of thisreport, the first design challenge question was not yet finalized. The release of thedesign challenge was due to be implemented by the end of May or June 2012. 3.2.8 Report Writing The report writing process consisted of the full-time students and myselfsynthesizing all of the information we amassed during this project as well asrecounting our experiences. Throughout my participation in this project I educatedmyself about the subjects addressed in the project including mental health carepolicies and treatment, social innovation, design thinking including human-centereddesign, Web 2.0 and social media, as well as the role of philanthropy as a changeagent. This was achieved by a literature review that included accessing governmentand NGO reports, journal publications, and media articles about these key topics. Inaddition to my review of the current literature, I recorded my thoughts and accountsregarding my participant in the active Scattergood project activities. These activitieswere concurrently completed during my participation as a team member of the projectbetween January and May of 2012.
  • 37   3.3 Future of the Scattergood Project As with any design thinking process, the search for further advancements andimprovements is ever present. Thus, the Scattergood Project set a precedent toconstantly be open to new opportunities in order to consistently grow and evolve fromtheir efforts. This is apparent in the decision to revise the implementation plan for thedesign challenge. With the release of the design challenge being postponed, itprovides an excellent opportunity for future Drexel MPH students to activelyparticipate in the implementation and management of the initial design challenge withthe Scattergood Foundation. The goal is for the collaboration with the DrexelUniversity School of Public Health to continue to grow and for future Drexel studentsto assist in the implementation of future design challenges on the ScattergoodFoundation website. In addition, it is hoped that the support provided by thePhiladelphia DBHIDS will encourage other partnership opportunities to develop. Eventually, it is expected that the winning design challenge solution will beimplemented within the community. This may serve not only to improve behavioralhealth care in the region, but also set an example for other communities to replicatethe innovative processes or programs presented in the winning proposal. In addition,it is hoped that such initiatives will serve as a foundation for future design challengesto be implemented by the Scattergood Foundation. Ultimately, I anticipate that thedialogue and opportunities generated from the design challenge initiatives willcontinue to foster innovative and sustainable advancements by the consumers,practitioners, and policymakers of our regional and national behavioral healthsystems.
  • 38   4. LESSONS LEARNED 4.1 Personal Narrative Being involved in the Scattergood Project presented an unexpectedopportunity for me to expand the resources from which I could learn more about thecurrent public health systems and issues faced by the Southeastern Pennsylvaniaregion and the nation overall. It was also a unique way to absorb a large amount ofinformation regarding current behavioral health issues and needed improvementsdirectly from some of the foremost service providers and policy makers in the region. My unconventional role in the project did result in some personal challengesthat I needed to address. Perhaps the greatest challenge was adjusting to my part-timestatus in a full-time project. The students with whom I was working were enrolled inthe program on a full-time basis and thus able to devote much more time to thisproject. Early in my involvement, I realized that my presence and participation wouldbe limited by my part-time status in the program and full-time job work commitments.For example, I was not able to attend certain meetings or other project activities thattook place during business hours. I tried to compensate for this by participating inany activities that took place during the evenings and, when possible, called intomeetings and some key informant interviews by phone. In doing so, my goal was todemonstrate my dedication to the project while also not committing to more than Iwas capable of providing due to the time and scheduling restraints. It quickly became clear to me that I primarily had to adjust to expectations formyself rather then my project team members. In fact, my team members were alwaysappreciative of any contribution I was able to make to the project and easilymaintained reasonable expectations regarding my level of participation. Due to mypersonal dedication to the advancement of mental health issues and the reduction of
  • 39  mental illness stigmatization, I found it difficult to not devote the majority of my timeto this project. However, I knew that it would irresponsible of me to commit moretime than I was capable of delivering. Therefore, for the benefit of the project and myown time management responsibilities, I had to realistically establish what I would becapable of contributing. Once these expectations were established and my functionwithin the project became better defined, I eventually adjusted to this role. Some of the more overarching project challenges identified by my teammembers included adjusting to the application of design thinking methodology. Indoing so, we had to consistently remind ourselves that design thinking is a nonlinearprocess that may include several iterations of the process as well as its expectedoutcomes. This experimental and non-standardized approach first became apparentduring the key informant interviews as they were conducted in a conversational ratherthan survey format in order to retain the consumer’s voice and opinion in our data.Ultimately, this led to a richer experience as well as the collection of more compellingand valuable information. A few technical challenges were also experienced with theutilization of the NVivo program to code the project data. First, the NVivo softwarelicense only permitted a maximum of two coders. Second, the program was onlyavailable on one computer, which was located on the Drexel University campus. As aresult, the program was only accessible during business hours when the building itselfwas open. This was particularly challenging for me since I maintained a full-time jobduring this program and my participation in the project activities were primarilyconducted after standard business hours. My overall experience in this project was primarily an extremely positive one.Perhaps the most compelling and unanticipated result of this project experience wasthe beginning inspiration towards a new career path for myself. I entered this
  • 40  program with the general and vague expectation that I would be attempting a careerchange upon graduation. However, during the majority of this program, I had noclear idea of what new direction my career path would take. My personal interests ofmental health and health care as well as my background in clinical research motivatedme to choose a public health program over business school or public policy-centeredprograms. However I did not yet know how or where I wanted to transition from acareer in pharmaceutical clinical research. During the course of this program, I foundmyself instinctively drawn to areas of focus that were tied to my personal interestswhile also demonstrating an unmet need as possible opportunities for a meaningfulcontribution to society. I believe that I discovered three areas of interest that fit thesedesired criteria. First, the field of public health needs to improve and increase the integrationof mental health prevention and promotion initiatives into its academic research andcurriculum, its field-based interventions, as well as its overall frame of thought as thefield itself continues to gain awareness and a more prominent position in society’sinfrastructure. Secondly, the field of mental health needs to take advantage of the increasedfocus on health care reform and utilize this momentum to advance the quality of andaccess to mental health care. In addition, this is an opportunity to further promote theintegration of mental and physical health care into a unified health care system. Byparticipating in such a dialogue, mental health may finally establish itself as a vitaland integral part of overall health care and wellness. Lastly, the increased use of design thinking methods has the potential torevolutionize our increasingly fragmented health care system. In addition, this schoolof thought and practice presents an exceptional opportunity to increase the
  • 41  understanding and awareness of mental health issues in our society as well as theimportance of mental wellness while also reducing stigma. This may just be thedisruptive innovation that is needed in order to fundamentally shift the way we view,address, and discuss mental health concerns. Had I followed the path of a more traditional Block VIII project in the form ofa research paper, I doubt I would have come to these same meaningful conclusions.Instead I drew a tremendous amount of inspiration from behavioral health communityleaders we interviewed as well as the project group discussions with the advisors andfull-time students concerning topics such as Web 2.0, social media, design thinking,and human-centered design to achieve socially innovative solutions. Theseexperiences led me to incorporate additional readings about these unfamiliar subjectswith my previously anticipated research on mental health and health care reform. Asa result, I feel that my project took a direction that I would not have considered had Ibeen left to my own devices while conducting traditional and solitary research for aliterature review based project. Luckily, I was able to participate as an active memberof a project team rather than simply as a passive consumer of information. Thisexpanded my horizons and opened me up to a new way of evaluating the currentsystemic, policy, and social issues affecting behavioral health care. 4.2 Future Executive MPH Student Opportunities At the inception of this collaboration between Drexel University and theScattergood Foundation, the goal has always been maintained that future MPHstudents could participate in this project as it continues to evolve. Initially, it wasassumed that only full-time MPH students would participate as a part of theiryearlong CBMP. However, the opportunity fortuitously presented itself for me to
  • 42  contribute as an Executive MPH student in fulfillment of my Block VIII IndependentStudy requirement. After having completed this project, I can conclude that this ismay serve as an exceptional opportunity for future Executive MPH students tocomplete their Block VIII project and one that is ideally suited for someone who isconsidering a career change or advancement after graduation. The aspects of thisproject afford students the chance to meet many prominent professionals in the localbehavioral and public health communities. One is not as likely to receive this level ofexposure when completing the relatively solitary task of writing a traditional researchpaper. By virtue of collecting qualitative data from behavioral and public healthprofessionals and implementing a design challenge with the same target audience inmind as participants, future students may have several opportunities to engage withsuch professionals on a remarkable level. Since I believe students of public health should include behavioral health in allaspects of their education, I may be biased in my willingness to promote working onproject that directly addresses behavioral health concerns of the region. However, itis my opinion that the in-depth focus on social innovation and the usage of designthinking techniques in this type of project will add a unique perspective andunparalleled learning experience for Executive MPH students. I believe that theapplication of design techniques to achieve socially innovative solutions is adiscipline that is still evolving and has yet to reach its full potential, particularly in thefield of public health. Therefore, this may serve as an ideal setting for ExecutiveMPH students at Drexel University to “get in on the ground floor” so to speak, expandtheir skill set, and enable their public health career to advance in an exciting directionthey may have not previously considered.
  • 43   LIST OF REFERENCESBarr, D.A. (2011). Introduction to U.S. health policy: The organization, financing, and delivery of health care in America. Baltimore, MD: The Johns Hopkins University Press.Barry, C.L. & Huskamp, H.A. (2011). Moving beyond parity – Mental health and addiction care under the ACA. New England Journal of Medicine, 365(11), 973-975. doi: 10.1056/NEJMp1108649Brest, P. (2012, Spring). A decade of outcome-oriented philanthropy. Stanford Social Innovation Review, 42-47. Retrieved from http://www.ssireview.org/articles/entry/a_decade_of_outcome_oriented_phila nthropyBrousseau, R.T., Langill, D., & Pechura, C.M. (2003). Are foundations overlooking mental health? Health Affairs, 22(5), 222-229. doi: 10.1377/hlthaff.22.5.222Brown, T. (2009). Change by design: How design thinking transforms organizations and inspires innovation. New York, NY: HarperCollins Publishers.Brown, T. & Wyatt, J. (2010, Winter). Design thinking for social innovation. Stanford Social Innovation Review, 31-35. Retrieved from http://www.ssireview.org/articles/entry/design_thinking_for_social_innovationCenters for Disease Control and Prevention. (2011a, July). The health communicator’s social media toolkit. Retrieved from http://www.cdc.gov/socialmedia/Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Adult and Community Health. (2011b). Public health action plan to integrate mental promotion and mental illness prevention with chronic disease prevention, 2011-2015. Retrieved from www.cdc.gov/mentalhealthChapman, D.P., Perry, G.S., & Strine, T.W. (2005). The vital link between chronic disease and depressive disorders. Preventing Chronic Disease [serial online], 2(1). Retrieved from http://www.cdc.gov/pcd/issues/2005/jan/04_0066.htm
  • 44  Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist, 59(7), 614-625. doi: 10.1037/0003-066X.59.7.614Corrigan, P.W., Markowitz, F.E., & Watson, A.C. (2004). Structural levels of mental illness stigma and discrimination. Schizophrenia Bulletin, 30(3), 481-491. Retrieved from http://schizophreniabulletin.oxfordjournals.org/Department of Behavioral Health and Intellectual disAbility Services. (2012). DBHIDS launches Mental Health First Aid. Retrieved from http://www.dbhids.org/dbhids-launches-mental-health-first-aidDepartment of Public Welfare. (2010a). HealthChoices General Information. Retrieved from http://www.dpw.state.pa.us/foradults/healthcaremedicalassistance/healthchoic esgeneralinformation/index.htmDepartment of Public Welfare. (2010b). Office of Medical Assistance Programs. Retrieved from http://www.dpw.state.pa.us/dpworganization/officeofmedicalassistanceprogra ms/index.htmDepartment of Public Welfare. (2012). Office of Mental Health and Substance Abuse Services. Retrieved from http://www.dpw.state.pa.us/dpworganization/officeofmentalhealthandsubstanc eabuseservices/index.htmDorothy Rider Pool Health Care Trust. (n.d.). About us: The Dorothy Rider Pool Health Care Trust. Retrieved from http://www.pooltrust.com/hct/default.htmlFrank, R.G. & Giled, S.A. (2006). Better but not well: Mental health policy in the United States since 1950. Baltimore, MD: The Johns Hopkins University Press.Frank, R.G. & Giled, S.A. (2007). Mental health in the mainstream of health care. Health Affairs, 26(6), 1539-1541. doi: 10.1377/hlthaff.26.6.1539Garfield, R.L., Lave, J.R., Donohue, J.M. (2010). Health reform and the scope of benefits for mental health and substance use disorder services. Psychiatric Services, 61(11), 1081-1086. Retrieved from http://ps.psychiatryonline.org
  • 45  Garfield, R.L., Zuvekas, S.H., Lave, J.R., & Donohue, J.M. (2011). The impact of national health care reform on adults with severe mental disorders. American Journal of Psychiatry, 168(5), 486-494. doi: 10.1176/appi.ajp.2010.10060792Giled, S.A. & Frank, R.G. (2009). Better but not best: Recent trends in the well- being of the mentally ill. Health Affairs, 28(3), 637-648. doi: 10.1377/hlthaff.28.3.637      Goodell, S., Druss, B.G., & Walker, E.R. (2011, February). Mental disorders and medical comorbidity. (Robert Wood Johnson Foundation, The Synthesis Project, Policy Brief No. 21). Retrieved from http://www.rwjf.org/pr/product.jsp?id=71883Grantmakers in Health. (2005, February). Agents of change: Health philanthropy’s role in transforming systems. Retrieved from http://www.gih.org/Publications/MeetingReportsDetail.cfm?ItemNumber=4087Grantmakers in Health. (2010, March). Taking risks at a critical time. Retrieved from http://www.gih.org/Publications/MeetingReportsDetail.cfm?ItemNumber=4073Grantmakers in Health. (2012, March). Transforming health care delivery: Why it matters and what it will take. Retrieved from http://www.gih.org/Publications/StrageticDetail.cfm?ItemNumber=4628Henry J. Kaiser Family Foundation, The Kaiser Commission on Medicaid and the Uninsured. (2011). Mental health financing in the United States: A primer. (Publication No. 8182). Retrieved from http://www.kff.org/medicaid/8182.cfmHenry J. Kaiser Family Foundation, The Kaiser Commission on Medicaid and the Uninsured. (2012, January). State Medicaid Fact Sheet: Pennsylvania & United States. Retrieved from http://www.kff.org/MFS/IDEO. (2009). Human-centered design toolkit (2nd ed.). Retrieved from http://www.ideo.com/work/human centered-design-toolkit/Institute of Medicine, Board on Health Care Services. (2006). Improving the quality of health care for mental and substance-use conditions: Quality chasm series. Retrieved from http://www.nap.edu/catalog/11470.html
  • 46  IT Governance Research Team. (2008). Web 2.0: Trends, benefits, and risks [Books24x7 version]. Retrieved from http://common.books24x7.com.ezproxy2.library.drexel.edu/toc.aspx?bookid= 36120Kaplan, A.M. & Haenlein, M. (2010). Users of the world, unite! The challenges and opportunities of social media. Business Horizons, 53(1), 59-68. doi: 10.1016/j.bushor.2009.09.003Kessler, R.C. & Wang, P.S. (2008). The descriptive epidemiology of commonly occurring mental disorders in the United States. The Annual Review of Public Health, 29(1), 115-129. doi: 10.1146/annurev.publhealth.29.020907.090847Kolko, J. (2012). Wicked problems: Problems worth solving. Austin, TX: Austin Center for Design. Retrieved from https://www.wickedproblems.com/read.phpLeRoy, L., Heldring, M., & Desjardins, E. (2006). Foundations’ roles in transforming the mental health care system. Health Affairs, 25(4), 1168-1171. doi: 10.1377/hlthaff.25.4.1168Liedtka, J. & Ogilvie, T. (2011). Designing for growth: A designing thinking tool kit for managers. New York, NY: Columbia University Press.Meehan, E.F., Kaufmann, M.W., Carlin, P.J., & Palmer, H.P. (2001). Reinventing a multicounty behavioral health care system: The local philanthropy as change agent. Health Affairs, 20(4), 239-241. doi: 10.1377/hlthaff.20.4.239    Mental Health First Aid. (2009). About the program: FAQs. Retrieved from http://www.mentalhealthfirstaid.org/cs/faqsMorozov, E. (2009, September/ October). Philanthropy 2.0. Foreign Policy, 174, p. B21-B22. Retrieved from http://search.proquest.com/docview/224021856?accountid=10559New York Times. (2012, March 28). Times topics: Health care reform and the Supreme Court (Affordable Care Act). Retrieved from http://www.nytimes.com/pages/topics/
  • 47  Parks, J., Svendsen, D., Singer, P., & Foti, M.E. (2006). Morbidity and Mortality in People with Serious Mental Illness. National Association of State Mental Health Program Directors Medical Directors Council Technical Report. Retrieved from http://www.nasmhpd.org/publicationsmeddir.cfmPhills, Jr., J.A., Deiglmeier, K., & Miller, D.T. (2008, Fall). Rediscovering social innovation. Stanford Social Innovation Review, 34-43. Retrieved from http://www.ssireview.org/articles/entry/rediscovering_social_innovation/Rittel, H.W.J. & Webber, M.M. (1973). Dilemmas in a general theory of planning. Policy Sciences, 4(2), 155-169. doi: 10.1007/BF01405730Roby, D. (2011). Quaker minister pioneers mental health reform in America: Tomas Scattergood (1748-1814). Retrieved from http://www.scattergoodethics.org/thomas-scattergoodShaywitz, D.A. (2011, October). Design can improve healthcare; Can it also lead to new cures? The Atlantic (electronic edition). Retrieved from http://www.theatlantic.com/health/archive/2011/10/design-can-improve- healthcare-can-it-also-lead-to-new-cures/246437/Smaldone, A. & Cullen-Drill, M. (2010). Mental health parity legislation: Understanding the pros and cons. Journal of Psychosocial Nursing, 48(9), 26- 34. doi: 10.3928/02793695-20100730-06Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health. (2011). State estimates of substance use and mental disorders from the 2008- 2009 national surveys on drug use and health. (NSDUH Series H-40, DHHS Publication No. (SMA) 11-4641). Retrieved from http://store.samhsa.gov/product/State-Estimates-of-Substance-Use-and- Mental-Disorders-from-the-2008-2009-National-Survey-on-Drug-Use-and- Health-NSDUH-/SMA11-4641Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health. (2012a). The NSDUH Report: Physical health conditions among adult with mental illnesses. (NSDUH Report No. 103). Retrieved from http://www.samhsa.gov/data/2k12/NSDUH103/SR103AdultsAMI2012.htm
  • 48  Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health. (2012b). Results from the 2010 National Survey on Drug Use and Health: Mental health findings. (NSDUH Series H-42, HHS Publication No. (SMA) 11-4667). Retrieved from http://www.samhsa.gov/data/NSDUH/2k10MH_Findings/index.aspxSubstance Abuse and Mental Health Services Administration, Center for Mental Health Services, 2010 CMHS Uniform Reporting System Output Tables. (2010). Pennsylvania 2010 mental health national outcome measures (NOMS), CHMS uniform reporting system. Retrieved from http://www.samhsa.gov/dataoutcomes/urs/urs2010.aspxThomas Scattergood Behavioral Health Foundation. (2012). Who we are: A new window on mental health. Retrieved from http://www.scattergoodfoundation.orgTreese, W. (2006). Web 2.0: Is it really different? Association For Computing Machinery, 10(2), 15-17. doi: 10.1145/1138096.1138106TriWest Group and Heartland Network for Social Research. (2003). The status of behavioral health care in Colorado. The Mental Health Funders Collaborative: Caring for Colorado Foundation, The Colorado Trust, Daniels Fund, The Denver Foundation, First Data Western Union Foundation, HealthONE Alliance, Rose Community Foundation, and Rose Women’s Organization: Denver, CO. Retrieved from http://www.coloradotrust.org/publications/evaluation-reportsTriWest Group and Heartland Network for Social Research. (2011a). Advancing Colorado’s mental health care: Final grantee report. Advancing Colorado’s Mental Health Care: Caring for Colorado Foundation, The Colorado Health Foundation, The Colorado Trust, and The Denver Foundation: Denver, CO. Retrieved from http://www.coloradotrust.org/grants/show-grant?id=45TriWest Group and Heartland Network for Social Research. (2011b). The status of behavioral health care in Colorado. Advancing Colorado’s Mental Health Care: Caring for Colorado Foundation, The Colorado Health Foundation, The Colorado Trust, and The Denver Foundation: Denver, CO. Retrieved from http://www.coloradomentalhealth.org/2011-status-report
  • 49  U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health. (1999). Mental health: A report of the Surgeon General. Retrieved from http://www.surgeongeneral.gov/library/mentalhealth/home.htmlWorld Health Organization. (1946). Constitution of the World Health Organization. Retrieved from http://www.who.int/governance/eb/constitution/en/index.htmlWorld Health Organization. (2002). Prevention and promotion in mental health. Retrieved from http://www.who.int/mental_health/media/en/545.pdfZuvekas, S.H. (2005). Prescription drugs and the changing patterns of treatment for mental disorders, 1996-2001. Health Affairs, 24(1), 195-205. doi: 10.1377/hlthaff.24.1.195  
  • 50   APPENDIX A: INTERVIEW GUIDEIntroduction[Introduce interviewers] Thank you for taking the time to speak with us. Thisinterview is taking place during the initial phase of our community-based Master’sproject at Drexel University. The purpose is to provide us with a birds-eye view ofthe current climate surrounding behavioral health issues in the Southeastern PAregion. We are seeking your input on what kinds of problems exist in the regionalbehavioral health system, which of these problems you consider most urgent, andwhat kinds of opportunities you believe exist around these issues. We do have a set ofquestions to ask you but encourage you to share any information or opinions that youthink are relevant. The information from the interview will be used to help inform thedevelopment of an online design challenge [Hand out information brief on theproject].Following this first round of key informant interviews, we will administer a survey toa larger population of providers, academics and students. We will use the survey tofurther explore themes that arose during the interviews. Ultimately, the purpose ofthese actions is to develop a question for our online design challenge that is relevant,significant and informed by the community. It is our hope that the design challengewill foster innovative thinking and provide an online platform for engaging theregional community in an ongoing dialogue about behavioral health.Topic Area 1: Identifying Behavioral Health Issues(We are going to start off with a discussion around current and pressing behavioralhealth issues)We’d to like to start off just by hearing a bit about your “story” with regard to thefield of behavioral health. Can you speak a bit about some of the experiences thathave gotten you to this point in your career?How would you describe the current level of interest and engagement aboutbehavioral health policy in our region?How might we raise the level of interest, engagement and excitement aboutbehavioral health policy?What specific issues or questions within behavioral health policy should weprioritize?Optional Follow-Up:Who is affected?How are they affected?What kinds of barriers exist in addressing this issue?
  • 51  What ways could we engage more policymakers, providers, researchers and studentsthis conversation?Who else needs to be a part of this conversation?Optional Follow-Up:Specifically, what are some other disciplines or professional fields that you believeshould be involved?Topic Area 2: Successful examples in the community(Now we would like to explore what “success” in behavioral health policy means toyou.)Can you give an example of a program, organization or policy in the region that youbelieve has had a positive impact on the behavioral health system?Optional Follow-up:Can you describe some of the components that contributed to the success of the[program, organization or policy]?What were some barriers that [program, organization or policy] faced or faces?How did [program, organization or policy] circumvent or overcome these barriers?How would you describe the impact that [program, organization, or policy] has orhad?Topic Area 3: Further Recommendations(Lastly, we’d like to close out the interview by asking you for recommendationsabout our project.)Do you have any recommendations for other professionals or organizations that weshould consider including in our survey?Do you have any recommendations for how we will advertise and recruit participationin our online design challenge?Are there any additional questions, concerns, or suggestions that you have for us?
  • 52   APPENDIX B: DESIGN BRIEF DRAFTWhat is The Scattergood Design Challenge?The Scattergood Design Challenge is a public web space dedicated to hostingconversations about innovation in the behavioral health system. Inspired by human-centered design methodology [see below], these design challenges will be primarilydriven by site visitors. In other words, we’ll provide a question and some guidelines,but progress is dependent on user participation and collaboration. We envision theDesign Challenge as a safe space for users to share ideas and inspirations so that wecan work together to cultivate innovative ideas about behavioral health in the regionand beyond.What is human-centered design?Human centered design is a process and set of techniques for generating innovativesolutions. It is comprised of three phases: hear, create, and deliver. The Hear phaserevolves around collecting inspiration from the people directly affected by theproblem. The Create phase utilizes a workshop format to translate these inspirationsinto frameworks, prototypes, and/or solutions. In this phase, group members firstbrainstorm many options (divergent thinking) and then work to eliminate them(convergent thinking). The ideas that are selected to continue through the process arethose that exist in an overlap of three lenses: desirability, feasibility and viability. TheDesign phase entails planning the transition from workshop to real world, throughcost modeling, assessments, and implementation planning for the ideas that wereemerged during Create.Who is allowed to participate?The Scattergood Foundation encourages all individuals or groups that have anexisting interest or growing curiosity about their community’s behavioral health toparticipate in this design challenge.How will challenges be structured?The specific structure of each challenge will be built around the nature of the questionand will vary from challenge to challenge. However, all challenges will follow thethree key rules of human-centered design: 1. Use multi-disciplinary teams (all backgrounds are encouraged to participate) 2. Use dedicated spaces (the Design Challenge quadrant) 3. Use finite timelines (Each challenge will have a beginning, middle, and end with set deadlines)What is the scope of the challenges?Although the design challenge will be presented within the regional context ofSoutheastern Pennsylvania, we believe that the issues and discussions presented herewill have relevance in communities across the country and encourage users from allover to participate. In addition, the behavioral health issues addressed within thischallenge will be examined through a public health lens in an effort to create solutionsthat will generate system-wide changes for the targeted interventions and theirprograms.
  • 53  Will Scattergood implement the winning ideas? No, we envision the Challenge web space as a database of ideas. The larger scope ofthis project hopes to see community organizations and policymakers borrowinspiration from this database and take ownership of implementation. In addition, ourgoal is to address behavioral health issues and concerns that are of particularimportance to community organizations and advocacy groups, and thus encourageorganizations to submit challenge questions. [Contact info for submitting challenges?]What are the expected outcomes?The Scattergood Design Challenge does not only create solutions to genuinebehavioral health problems but, also makes a positive impact in the field of behavioralhealth by creating a conversation and fostering innovation around policy and systemissues. This challenge allows for community organizations, individuals, and othergroups to exercise their creative thoughts, promote and nurture growth of currentprograms and initiatives, create new programs and initiatives, and attract positiveparticipation and discussion about behavioral health.What does “success” look like?Success will be gauged by the types of interaction and collaboration, the long-termimpact and influence, and community awareness and utility. The freshness ofmaterial, amount and type of feedback provided, and the continual evolution is ofgreat importance to the project and will be tracked.
  • 54   APPENDIX C: LINKS FOR ADDITIONAL INFORMATIONFor additional information about the organizations and programs mentioned, pleaseaccess the following links:Thomas Scattergood Behavioral Health Foundationhttp://www.scattergoodfoundation.org/Department of Behavioral Health and Intellectual disAbility Services (DBHIDS)http://dbhids.org/DBHIDS: Philadelphia Launch of Mental Health First Aidhttp://www.dbhids.org/dbhids-launches-mental-health-first-aidMental Health First Aid USAhttp://www.mentalhealthfirstaid.org/cs/
  •