The thesis by Kimberly D. Williams explores the critical link between mental health and overall health, advocating for the integration of mental health into public health strategies. It highlights the ongoing challenges in behavioral health care, including stigma, access, and system fragmentation, while presenting innovative solutions through the Scattergood Project and design thinking methodologies. The document also emphasizes the role of philanthropy and social media in enhancing community engagement for behavioral health improvements.

1. 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

2.
© Copyright 2012
Kimberly D. Williams. All Rights Reserved.

3. iii
ACKNOWLEDGMENTS
I would like to thank my advisor, Dennis Gallagher, MA, MPA. The
opportunity for me to participate in this project would not have been possible without
his recommendation. I am truly indebted and thankful for his generous guidance,
motivating questions, thoughtful feedback, and unwavering support to both the overall
project as well as the completion of this thesis.
I would like to express my appreciation and thanks to Joe Pyle, MA of the
Thomas Scattergood Behavioral Health Foundation for spearheading this project and
initiating the collaboration with Drexel University. His commitment to the
advancement of behavioral health care through collaborative and innovative efforts
has been truly inspiring.
Additionally, I would like to thank Jason D. Alexander, MA of Capacity for
Change, Larry Geiger of Geiger Design, and John A. Rich, MD, MPH of Drexel
University School of Public Health for their invaluable contributions throughout the
entire course of this project.
I would like to extend my gratitude to the preeminent community stakeholders
who generously offered their time to participate in our key informant interviews.
Their invaluable feedback regarding the current status behavioral health care elevated
our project as well as my personal knowledge to a level of appreciation and awareness
for which I am very grateful.
Special thanks to Arthur C. Evans, Jr., PhD of the Philadelphia Department of
Behavioral Health and Intellectual disAbility Services for his additional support and
endorsement of the Scattergood Foundation design challenge.
Last but certainly not least, I would like to thank Katherine Carroll and Alyson
Ferguson for graciously allowing me to contribute to their Community-Based Mater’s
Project as a part of my Block VIII Independent Study. Without their steadfast
dedication to the project, this opportunity would not have been possible for me. I am
sincerely thankful for their support, patience, and insight. I have no doubt that they
will each make an immeasurable contribution to the field of public health in the years
to come.

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TABLE OF CONTENTS
LIST OF TABLES ....................................................................................................... v
LIST OF FIGURES ....................................................................................................vi
1. INTRODUCTION ................................................................................................... 1
2. 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” ....................................................................................... 23
3. 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 ....................................................................... 37
4. LESSONS LEARNED........................................................................................... 38
4.1 Personal Narrative .............................................................................................. 38
4.2 Future Executive MPH Student Opportunities................................................... 41
LIST OF REFERENCES.......................................................................................... 43
APPENDIX A: INTERVIEW GUIDE.................................................................... 50
APPENDIX B: DESIGN BRIEF DRAFT .............................................................. 52
APPENDIX C: LINKS FOR ADDITIONAL INFORMATION.......................... 54

5. v
LIST OF TABLES
1. Scattergood Project Timeline (2011 – 2012)........................................................ 26
2. Key Informant Interview Themes ........................................................................ 32
3. Design Challenge Model ........................................................................................ 33

6. vi
LIST OF FIGURES
1. Human-Centered Design: Desirability, Feasibility, Viability ........................... 16
2. Human-Centered Design: Hear, Create, Deliver ............................................... 18

8. 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 of
mental and physical health systems, the field of public health should improve the
extent to which mental health factors are incorporated into its objectives and
strategies.
Over the past 50 years, there have been numerous legislative advancements to
improve that quality of and access to health care for undeserved Americans including
Medicaid, Medicare, and most recently the Patient Protection and Affordable Care
Act (PPACA) (Barr, 2011). In addition to these measures, specific improvements
have been implemented to improve behavioral health care including the Mental
Health Parity Act (MHPA) as well as the expanded Paul Wellstone and Pete
Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) (Frank &
Giled, 2006). However, the national prevalence and incidence of mental disorders
remains 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 a
pressing concern. In addition to financial concerns that reduce access to health
insurance coverage and health care services, another major barrier is the persistence
of 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 the
behavioral health care systems may be classified as “wicked problems.” Rittel and
Webber (1973) cited that due to their complex nature, wicked problems cannot be
addressed by utilizing traditional scientific methods. Instead, sources of wicked
problems could be mitigated by the creation and administration of disruptive social

9. 2
innovations (Brown & Wyatt, 2010; Kolke, 2012). Employing the use of design
techniques 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 socially
innovative solutions.
As design practice has evolved into the application of design thinking methods
for social causes and concerns, the world of technology has also progressed. Two
primary examples include the evolution of the World Wide Web into what has been
coined “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 on
the inherently interactive nature and social networking potential of this technology
(Treese, 2006). As a result, users provide as much information as they receive and
thus, 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 significant
contributions to society, philanthropic foundations have also served as a unique agent
of change. Specifically, philanthropies have played an integral part in improving the
health of the local communities they serve. Examples of two local foundations which
exemplify innovative ways to improve the health of their communities include the
Dorothy 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 development
of philanthropic foundation operations. This has been precipitated by their utilization
of Web 2.0 and social media applications to increase the level of communication

10. 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 2.0
strategies. 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 of
behavioral health (Thomas Scattergood Behavioral Health Foundation [Scattergood
Foundation], 2012). In addition, the Scattergood Foundation has taken inspiration
from design thinking methodologies in order to promote social innovations for
behavioral health care.
In anticipation of the 200th anniversary of the affiliated Friends Hospital, the
Scattergood Foundation set out to retool its website. In doing so, it collaborated with
the Drexel University School of Public Health, Geiger Design, as well as a public
interest consulting group, Capacity for Change, to implement this project. The
primary goal of the project was to utilize design thinking practices and Web 2.0
applications in order to develop a design challenge for the local community. Steps
from the human-centered design process were conducted in an effort to achieve this
goal. The revised website went live on May 6, 2012. However, the implementation
of the initial Scattergood design challenge was postponed until after additional
feedback and engagement from website users in the community could be obtained.
The delayed implementation of the Scattergood design challenge presents an
ideal opportunity for future Drexel Master of Public Health students to actively
participate in this project. Ultimately, it is anticipated that the design challenges
presented on the Scattergood website will foster innovative and sustainable
advancements for the regional and national arenas of behavioral health.

11. 4
2. BACKGROUND
2.1 No Health Without Mental Health
The fields of mental health and public health are not mutually exclusive. The
World Health Organization (WHO) asserted as such in their Constitution when they
defined health as “a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity” (1946, p. 1). Just as calls to integrate
mental and physical health care increase, public health should continue this trend by
improving the extent in which mental health is incorporated into its policies,
educational programs, communication strategies, prevention research, surveillance
practices, and epidemiological reviews (Centers for Disease Control and Prevention
[CDC], 2011b; WHO, 2002).
Coinciding with the release of the seminal Surgeon General report on mental
health (U.S. Department of Health and Human Services [DHHS], 1999), Dr. David
Satcher echoed the sentiments of the WHO Constitution and declared, “there is no
health without mental health.” However, what if we took this one step further and
concluded that there is no public health without mental health? In essence, true
wellness cannot be achieved without holistically addressing the physical, mental, and
social factors that play a role in our health and well-being. In doing so, it may be
possible to expand the framework of public health promotion and prevention
strategies 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 integrated
health care system where mental health will be accepted as an undeniable and
invaluable factor in health and wellness.

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2.2 National and Regional Mental Health Care Policy
In an effort to offset the rising burden of costs as well as improve the quality
of and access to services, several reforms to our health care system have been
implemented during the past 50 years. As a result, our mental health care policies
have undergone some critical revisions, which have led to dramatic improvements in
the accessibility and quality of mental health care as well as how society addresses
and views mental illness. Unfortunately, issues with cost, access to care, system
fragmentation, 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 to
the existing Social Security Act and thus, referred to as Title XVIII and XIX
respectively. The passage of both federal programs marked one of the most
significant chapters in our country’s history by increasing access to health care for
millions of Americans. In addition, both reform measures would contribute to
changing the landscape in which health care services are evaluated and administered
(Barr, 2011).
Medicare provides health insurance coverage primarily for individuals who
are eligible for Social Security benefits and 65 years of age or older. However, it was
revised a few years later to also include two additional categories of individuals under
this age limit: those deemed permanently disabled and those in end-stage renal
disease or what is referred to as kidney failure (Barr, 2011).
Medicaid currently provides coverage for specified groups of low-income
individuals and their families or disabled individuals who meet the mandated
qualifications. Unlike Medicare, which is universally available for all elderly
individuals, Medicaid was not initially intended to provide coverage for all people

13. 6
who fall below the federal poverty line (FPL) and was only made available to certain
subgroups that met the eligibility requirements (Barr, 2011). Another notable
difference between the two programs is that Medicaid is managed by the state and
local governments with a percentage of program costs being funded by federal
reimbursements, whereas the federal government solely administers Medicare (Barr,
2011).
While Medicaid was not specifically created to increase coverage for
individuals with mental health concerns, it did considerably reduce the state’s cost of
mental health care. As a result, the number of individuals with diagnosable mental
disorders who received coverage through Medicaid dramatically increased over the
years (Frank & Giled, 2006; Henry J. Kaiser Family Foundation [KFF], 2011). As of
2011, approximately 24% of adult Americans enrolled in Medicaid reportedly had a
diagnosable mental disorder (Garfield, Zuvekas, Lave, & Donohue, 2011).
One of the mandates included in the initial implementation of Medicaid was
that services at state and county mental health hospitals or private psychiatric facilities
would 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 the
federal budget. Another goal was to encourage state health systems to transition from
primarily long-term, in-patient mental health care to programs that focused on
community-based treatments (Frank & Giled, 2006; KFF, 2011). It is now clear that
the Medicaid IMD exclusion only partially succeeded in this effort. Indeed, Medicaid
is considered to have played a significant role in the deinstitutionalization of mental
health services by the dramatic decrease of patients at state and county mental
hospitals. After a peak of over 550,000 in-patient residents in 1955, there was a
steady decrease of 1.5% per year during the next ten years. Starting in 1965, the rate

14. 7
jumped to a patient decrease of 8% per year. This was especially evident in the rapid
reduction of elderly in-patients from these facilities, which totaled about 70.6%
between 1955 and 1973 (Frank & Giled, 2006). However, many patients were in fact
only transferred to other types of in-patient care, specifically psychiatric wards in
general hospitals and nursing homes. In particular, there was a 74% increase of
elderly patient residents in nursing homes between 1960 and 1970 (Frank & Giled,
2006).
Despite some improvements, the marginalization of behavioral health care
continued and the fragmentation between behavioral and physical health care was
only perpetuated by these new legislations (Frank & Giled, 2006). In fact behavioral
health services were literally “carved out” of the general health system and thus
managed under a separate funding structure (Frank & Giled, 2006; Zuvekas, 2005).
A prime example of the fragmentation of mental health care can be seen in
Pennsylvania’s public welfare system. Under the state’s Department of Public
Welfare (DPW), the HealthChoices program consists of two divisions that administer
managed care programs for residents who receive medical assistance (DPW, 2010a).
The Office of Mental Health and Substance Abuse Services (OMHSAS) division runs
the behavioral health managed care organizations (DPW, 2012). The Office of
Medical Assistance Programs (OMAP) runs the physical health managed care
organizations and administers the Medicaid program for the state (DPW, 2010b). As
such, state residents in need of medical assistance are forced to navigate between two
complex health systems in order to receive comprehensive care for behavioral and
physical conditions.
While many new Americans obtained health care coverage through the
creation of Medicaid and Medicare, the costs for health care rapidly increased since

15. 8
their inception (Barr, 2011). One response to these rising costs was the increased
utilization of managed health maintenance organizations (HMOs) and managed
behavioral health care organizations (MBHOs) during the 1980s and 1990s (Barr,
2011; KFF, 2011). However, the increase usage of managed care organizations
contributed to furthering the marginalization and fragmentation of behavioral health
care 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 enacted
in 1996. The MHPA set a historic precedent by mandating that insurance carriers
provide mental health care benefits and limits that are equal to medical and surgical
health care benefits and limits (KFF, 2011; Smaldone & Cullen-Drill, 2010). In 2008,
the benefits provided by the MHPA were further increased with the Paul Wellstone
and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA). The
parity requirements under the MHPAEA were expanded to include substance use
disorders as a mental health condition and eliminated arbitrary limits on the frequency
of outpatient treatment services or inpatient days of coverage (Smaldone & Cullen-
Drill, 2010). The additional mandates in the 2008 MHPAEA went into effect on
January 1, 2010 (Smaldone & Cullen-Drill, 2010).
That same year would mark a historic evolution for general as well as
behavioral health care with the passage of the Patient Protection and Affordable Care
Act (PPACA), which was signed into law on March 23, 2010 (Garfield, Lave, &
Donohue, 2010). While the MHPAEA sought to equalize the mental and physical
health care coverage, the PPACA attempted to take health care to the next level by
increasing accessibility, improving quality, as well as integrating mental and physical
health services (Barry & Huskamp, 2011; Garfield et al., 2010). The principle behind

16. 9
the PPACA was that all Americans should be provided access to affordable health
care insurance in order to have access adequate health care services and thus, improve
to overall health status of the nation (Barry & Huskamp, 2011; Garfield et al., 2010).
Of the 59 million people currently enrolled in Medicaid, approximately only
5% are eligible directly due to a mental disorder. The majority of people currently
qualify for Medicaid based on their family or low-income status (KFF, 2011). As a
direct result of the PPACA, approximately 2 million additional Americans who meet
the criteria for a mental disorder will be eligible for Medicaid after the full PPACA
provisions are enforced by 2014 (KFF, 2011). This increased rate of coverage will
primarily be possible due to updated eligibility requirements (Garfield et al., 2011).
Specifically, Medicaid will be expanded to include all persons with household
incomes up to 133% of the FPL (Barr, 2011; KFF, 2011). In addition, persons with
household incomes up to 400% of the FPL will be eligible for subsidies to supplement
the purchase of health care coverage through health insurance exchanges (Barr, 2011;
KFF, 2011).
Another crucial and historic component of the PPACA for the mental health
community is the inclusion of behavioral health care services as an essential health
benefit (Garfield et al., 2010). This will prohibit affected health insurance plans from
excluding individuals with pre-existing behavioral health conditions. As a result,
many more individuals with diagnosed mental illnesses or substance use disorders
who were previously unable to obtain private insurance or Medicaid benefits, will
now be eligible for some form of health insurance that will cover their physical and
behavioral health care needs (Garfield et al., 2010). It is expected that approximately
3.7 million Americans with mental disorders will be able to obtain some form of
health care coverage by 2019 (Garfield et al., 2011; KFF, 2011). The PPACA has the

17. 10
potential to reshape the way behavioral health services are delivered in this country
and could measurably reduce the system fragmentation between behavioral and
physical health care (Barry & Huskamp, 2011; Garfield et al., 2011).
As of May 2012, the U.S. Supreme Court was currently debating the
constitutionality of the PPACA. It remains to be seen whether the court will uphold
the full PPACA, only certain provisions such as the individual mandate to purchase
health 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 are
needed to ensure that Americans receive truly adequate behavioral health care
treatment and services. In addition, more needs to be done to change society’s
outlook 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 mental
disorders remains exceedingly prohibitive. In their epidemiological review of mental
disorders – as categorized in the Diagnostic and Statistical Manual of Mental
Disorders 4th Edition (DSM-IV) – they reported that approximately half (46.4%) of
the U.S. population would meet the diagnosable criteria for one or more disorder
during their lifetime. In addition, more than a quarter (26.2%) of the U.S. population
would 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 average
with approximately 17.74% of adults over the age of 18 meeting the criteria for a
diagnosable mental illness between 2008 and 2009 (Substance Abuse and Mental
Health Services Administration [SAMHSA], 2011). However, 26.24% of young
adults between the ages of 18 and 25 did meet the criteria for a diagnosable mental

18. 11
illness, which is an alarming rate for this age category and more in line with national
prevalence rates of adults (SAMHSA, 2011).
The percentage of individuals who exhibit co-occurring mental health
disorders as well as comorbid physical health conditions has been identified as
another 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 their
lifetime and that approximately 17% are at risk for experiencing three or more mental
disorders. In addition, several studies have confirmed that adults with mental
disorders are more likely to be afflicted with comorbid physical health conditions
such 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 utilize
emergency department (ER) services (38.8%) or be hospitalized (15.1.%) than those
who do not have a diagnosed mental disorder (27.1% and 10.1% respectively)
(SAMHSA, 2012a). The origin of such differences between the health status of
individuals with and without mental disorders has yet to be empirically identified.
However, it is clear that individuals with mental disorders disproportionately suffer
from chronic health conditions and thus demonstrate a greater need for physical health
care treatment in addition to mental health services (SAMHSA, 2012a; Goodell et al.,
2011).
Despite the known prevalence of mental health disorders as well as their
association with an increased risk of comorbid physical health conditions, many
individuals fail to seek out treatment for behavioral health related concerns nor follow
through with recommended services (Corrigan, 2004; Corrigan et al., 2004; KFF,

19. 12
2011). In fact, as many as 60% of adults with a diagnosable mental disorder were
reported to not have received necessary mental health care services (KFF, 2011). One
confirmed reason is due to the continuing high rates of individuals who do not have
health insurance coverage and could not afford the cost of such services (Garfield et
al., 2011; KFF, 2011, SAMHSA, 2012b). In 2010, about 43.7% of adults reported
that the primary reason they did not receive necessary mental health services was
directly due to issues with the cost of such care (SAMHSA, 2012b). In addition to the
known financial barriers to care, many individuals do not obtain necessary behavioral
health 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 plague
our society and, due to the complex social systems in which they are entrenched,
cannot be tackled with traditional scientific applications. Instead, the exploration and
creation of disruptive innovations have been identified as a possible means to mitigate
the factors that contribute to the wicked problems of our society (Brown & Wyatt,
2010; Kolke, 2012). Thus a movement has been initiated to develop social
innovations through alternative means in order to effectively address such wicked
problems (Brown & Wyatt, 2010; Phills, Jr., Deiglmeier, & Miller, 2008). In
response to this movement, the utilization of modified design techniques have been
touted 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 of
behavioral health services, disruptive social innovations may be the best solution to

20. 13
their wicked problems. The application of design thinking practices, including
human-centered design, may thus be an opportune way to foster socially innovative
thinking and create tangible solutions to some of the critical systemic and cultural
behavioral health concerns that affect our society.
2.5 Design Thinking
In his book, Change By Design, Tim Brown asserted that “design thinking” is
a systematic and integral approach for achieving innovated solutions (2009). Some
identified best practices for the design thinking process include the use of dedicated
spaces, finite or well-defined timeframes, and multi-disciplinary teams (IDEO, 2009).
In addition, Brown asserted that the design process includes three fundamental levels
or spaces of thinking when trying to develop an innovative solution: inspiration,
ideation, and implementation (Brown, 2009; Brown & Wyatt, 2010). These spaces of
thoughts are not classified as distinct steps in a process because design thinking is
iterative (Brown, 2009; Liedtka & Ogilvie, 2011). In fact, such levels of thinking are
not necessarily completed sequentially and may be repeated throughout the process of
developing a product or solution (Brown, 2009; Brown & Wyatt, 2010; Liedtka &
Ogilvie, 2011).
The initial level of inspiration may involve creating a brief, which documents
the facts and background concerning the issue at hand and defines the problem. It
also includes the process of exploring the issues, needs and barriers of the target
population affected by the problem. This can best be achieved by immersing oneself
into the daily lives and routines of individuals and observing them in natural
environment (Brown & Wyatt, 2010).

21. 14
The second concept, ideation, involves analyzing and synthesizing the
information that was collected in order to eventually formulate potential solutions.
Ideation largely involves active divergent thinking in which many thoughts and ideas
are generated in order to facilitate the creation of potential options or solutions.
Ideally, this involves brainstorming sessions with multi-disciplinary teams that
provide varied backgrounds and alternative perspectives, which advance the divergent
thinking process (Brown, 2009; Brown & Wyatt, 2010). In addition, design
challenges have also proven to further develop divergent thinking by successfully
fostering multiple ideas and potential solutions for the problem in question. The
design challenge process is initiated when a challenge question is posted in some
central location for individuals or teams to review, offer comments, and design
potential solutions (Brown & Wyatt, 2010). Aside from generating multiple thoughts
and idea, participating can elevate people from a passive position to an active one
where 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 from
a level of divergent thinking to a level of convergent thinking where the abstract
information 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 setting
up a plan for implementation to final solution. This also may involve the creation of a
communication strategy and prototypes to ensure that the solution is effectively and
efficiently implemented (Brown, 2009; Brown & Wyatt, 2010).

22. 15
2.6 Human-Centered Design
One of the core principles in design thinking is to maintain processes and
goals that are fundamentally human-centered (Brown, 2009; Brown & Wyatt, 2010).
As a result, the human-centered design methodology was created in an effort to
systematically incorporate the needs of the people for whom the design product is
intended. Originally created to enable for-profit corporations a way to design
products and create innovative solutions or concepts for their businesses, the tools in
human-centered design have been discovered to be an innovative way to create
solutions 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 people
it is tasked with supporting through its innovations. Constantly keeping the
framework focused on the human component of the project and involving the
consumers throughout the design process ensures that the final product is truly
desirable, 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 the
team 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 of
all human-centered thinking and processes. The consideration of what the target
population desires and not what the evaluator believes that they need is the framework
from which future solutions or concepts are derived (Brown, 2009; IDEO, 2009). The
second lens, Feasibility, reminds the team to ensure that all solutions are anchored in

23. 16
proposals that are considered organizationally and technically feasible (Brown, 2009;
IDEO, 2009). Finally, even the most organizationally and technically feasible
solution cannot be sustainably implemented without being financially viable.
Therefore, the third lens of Viability maintains that the solutions achieved retain a
realistic and practical approach in their implementation (Brown, 2009; IDEO, 2009).
If the final solutions created from a human-centered design process encompass all
three of these lenses in their product or concept then it increases the likelihood that
they will be successfully implemented and received by the community for which they
were 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.

24. 17
2.6.2. Hear, Create, Deliver
The actual steps of a human-centered design process are implemented by
utilizing techniques and specific activities in three distinct phases: Hear, Create, and
Deliver (see Figure 2) (IDEO, 2009). These phases mirror the concepts of inspiration,
ideation, and implementation that Brown asserted are instrumental in the design
thinking process (Brown, 2009; Brown & Wyatt, 2010). The Hear phase begins with
compiling concrete information and facts about the problem at hand as well as the
people affected by this problem. This information is obtained by conducting field
research where people are observed in their environment and encouraged to provide
stories about their daily lives and routines (IDEO, 2009). During the Create phase,
the concrete information collected is analyzed and expanded into abstract themes or
concepts. These multiple ideas are then synthesized into opportunities or options and
eventually into concrete solutions for the problem (IDEO, 2009). The Deliver phase
prepares for the release of the agreed upon solution. This may involve the
development of prototypes or models to serve as a guide for the solution concept. In
addition, an implementation plan is created and eventually initiated in order to
effectively release the final solution into the community (IDEO, 2009).

25. 18
Figure 2. Human-Centered Design Phases: Hear, Create, Deliver. Adapted from
Human-Centered Design Toolkit, 2nd Edition by IDEO, 2009, p. 7. Copyright 2012
by IDEO.
2.7 “Web 2.0” and Social Media
Technology is a continuously evolving factor within the development of our
society. 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 in
which we utilize the Web to access and disseminate information has shifted from a
unilateral experience to a multilateral phenomenon. Two hallmarks of Web 2.0 are its
interactive nature and social networking capabilities (Treese, 2006).
Prime examples of both these functions are encapsulated in current social
media tools such as Facebook, Twitter, and YouTube (CDC, 2011a). Kaplan and
Haenlein (2010) defined social media as “a group of Internet-based applications that
build on the ideological and technological foundations of Web 2.0, and that allow the
creation and exchange of User Generated Content” (p. 61). In other words, social
media technologies allow for users to interact and actively participate in the content
they are accessing rather than simply passively consuming information. As asserted
by Brown (2009), Web 2.0 users have shifted from a consumer role to a participatory

26. 19
role with the assistance of social media applications. As a result, Web 2.0
applications are particularly well suited to serve as a forum for the human-centered
design 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 and
foster innovation in our society. Furthermore, local philanthropies have the ability to
produce a great deal of change within the communities they serve. Meehan,
Kaufmann, Carlin, & Palmer (2001) identified some of the most distinct advantages
local philanthropies have when attempting to produce change. First, they noted that a
well-designed philanthropic agenda could have a strong influence on the local
communities served. Second, they have the ability to maintain a neutral and honest
mediating position between the design and implementation of change into a
community. Third, as a private foundation, they do not have the same level of
political considerations as elected officials or departments. As a result, they may be
in a position to fund or even implement more innovative and groundbreaking
solutions. Fourth, philanthropies have the ability to dispense smaller amounts of
funds in a more strategic and targeted fashion than larger government organizations
and thus, are able to respond to a need more effectively and efficiently. Fifth, they
can uphold a reputation of reliability and integrity by championing causes that may
have been previously discarded for financial or political reasons. Lastly, through
effective fundraising efforts, philanthropies can maintain a greater level of financial
resources than other types of organizations in order to create an improved and
sustainable system of care (Meehan et al., 2001).

27. 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 as
the well-being of underserved populations (Grantmakers In Health [GIH], 2005, 2010,
2012). One of the most underserved populations includes individuals dealing with
behavioral health concerns. Philanthropies are particularly suited to navigate a
complex behavioral health care system and improve some of its deficiencies and
difficulties 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 Care
Trust (Pool Trust) located in Allentown, Pennsylvania. The Pool Trust was created in
1975 with a mission to ensure quality health care for local residents and provide
funding assets to Lehigh Valley Hospital that serves the region (Dorothy Rider Pool
Health Care Trust, n.d.; Meehan et al., 2001). In an effort to combat the increasing
challenges of the area’s psychiatric system, the Pool Trust attempted to reduce the
number of patients who sought out psychiatric services through local emergency
departments and redirect their treatment to community-based care. A second goal
was to implement a sustainable system that ensured the long-term support of these
patients 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 a
formal evaluation of this initiative has not been conducted. First, over $5.2 million of
funds were provided by the Pennsylvania Department of Public Welfare (DPW) to
support the expansion of community-based behavioral health services. Thus, the

28. 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 Allentown
State Hospital (ASH), which is a long-term and in-patient psychiatric facility, were
reduced. This was demonstrated by the fact that more than 100 patients at ASH were
discharged and successfully integrated into the community. Additional services for
psychiatric crises and alternatives to in-patient hospitalization were also implemented
as a result of this program (Meehan et al., 2001). In order to independently gauge the
community’s response to the program initiatives, local mental health consumers and
their families created a Customer Satisfaction Team. They monitored the services
provided and evaluated the systems efforts through the use of surveys, which have
demonstrated 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 foster
change in a community. In 2002, eight local foundations collaborated to assess the
status of mental health care in the state of Colorado. These foundations included:
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. They commissioned a
private consulting group, TriWest Group and Heartland Network for Social Research
(TriWest Group), to complete an evaluation of the private and public mental health
systems in Colorado. The result of this assessment was released in the 2003 report,
The Status of Mental Health Care in Colorado (TriWest Group, 2003). This
evaluation revealed the extreme fragmentation of mental health services and how this
inhibited access to care for the state’s residents. Specifically, they noted that one in

29. 22
five residents are in need of mental health care, but only approximately a third of
these individuals receive treatment. In addition, they identified that children and
adolescents 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 children
from households that were classified as low-income received necessary mental health
care in 2000 (TriWest Group, 2003).
In response to the alarming findings in this report, Advancing Colorado’s
Mental Health Care (ACMHC) was created through the joint funds of the Caring for
Colorado Foundation, the Colorado Trust, the Denver Foundation, and the Colorado
Health Foundation (previously known as the Health ONE Alliance). Together they
committed $4.25 million for a five-year project between 2005 and 2010 to improve
Colorado’s mental health care system by increasing the integration and coordination
of its services (TriWest Group, 2011a). The ACMHC project funded six grantees for
three integration-related project goals. The first funded two grantees for projects to
integrate mental health and substance use disorder services. The second funded two
grantees for projects to integrate mental health and primary health care services. The
third funded two grantees for projects to integrate mental health services with school
settings (TriWest Group, 2011a).
In 2011, an updated report – The Status of Behavioral Health Care in
Colorado – was released that reviewed the successes of the ACMHC project as well
as what needs remained a concern for the state (TriWest Group, 2011b). This report
demonstrated the number of mental health and substance use disorder practitioners
increased from 10,564 in 2003 to 14,217 in 2011. However, a high need remained for
specialists who are able to treat complex behavioral health issues and practitioners for
services in rural and frontier areas of the state (TriWest Group, 2011b). Spending on

30. 23
public mental health care across the state did increase between 2002 and 2009, with a
per capita increase from $62 to $84 (TriWest Group, 2011b). In addition, several
efforts have been made to reduce system fragmentation in the state’s mental health
care system. For example, oversight of the mental health and substance use disorder
care systems are now both managed by their Division of Behavioral Health.
Increased availability of medical home services for children and adolescents was also
reported (TriWest Group, 2011b).
2.8.3 “Philanthropy 2.0”
In the pursuit to find new ways to raise funds and create change for their
prioritized causes, philanthropies have begun to utilize Web 2.0 and social media in
their operational and communication strategies (Brest, 2012). The utilization of such
innovations has ushered in the advent of “philanthropy 2.0” where the lines of
communication between the foundations, their grantees, and other partners are closer
than ever (Brest, 2012; Morozov, 2009).
Another transformation in the field of philanthropy was the increased usage of
design thinking methods, which were initially developed within the for-profit
industry. Prior to its incorporation by philanthropic foundations, many non-profit
organizations began to adopt the for-profit design thinking approaches in order to
create change and foster socially innovative ideas. This resulted in the differences
between non-profit and for-profit organizations becoming blurred and less distinct. In
fact, the increased demand for and creation of social innovations has helped to bridge
the gap between non-profit and for-profit organizations (Phills, Jr. et al., 2008). Many
philanthropic foundations have now begun to take inspiration from for-profit and non-
profit organizations by incorporating design thinking techniques into their initiatives

31. 24
as well. Being that the organizational goals of philanthropies are already focused on
advancing social causes and thus human-centered, the application of design thinking
strategies is a natural progression for their operational strategies.
A current example of the recent changes to philanthropic strategies can be
found in the Thomas Scattergood Behavioral Health Foundation of Philadelphia,
Pennsylvania. With the assistance of Web 2.0 technology and design thinking
methods, it continues to promote the creation of socially innovative solutions in order
to 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 be
traced back to 1811 when Thomas Scattergood, a Quaker minister moved by his
personal and missionary experiences with mental illness, proposed creating an asylum
for individuals “deprived of the use of their reason” at the Philadelphia Yearly
Meeting (Roby, 2011). In the following year, several Quaker community members
including Thomas Scattergood gathered in Philadelphia, Pennsylvania and established
the “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 first
private 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 his
father’s cause and was appointed one of the first managers of Friends Hospital. In
memory of the man who pioneered the American mission to improve the treatment
and quality of life for individuals suffering from mental illness, the main building and

32. 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 philanthropic
organization that was established in 2005 as result of a joint venture between Friends
Hospital and Horizon Health Systems (Scattergood Foundation, 2012). The mission
of the Scattergood Foundation is to continue the advancement and awareness of
behavioral health issues that Thomas Scattergood had advocated almost two centuries
before. With its headquarters located on the Friends Hospital campus, the
Scattergood Foundation has strived to carry forth the mission of Thomas Scattergood
into the twenty-first century by fostering a dialogue and increasing learning
opportunities in the behavioral health field and promoting innovative leadership and
community collaborations through philanthropic and grant-making opportunities
(Scattergood Foundation, 2012).
Since its creation, the Scattergood Foundation has made several contributions
to the advancement of behavioral health in the Southeastern Pennsylvania community.
One example of its efforts included providing a grant to help found the Scattergood
Program for the Applied Ethics of Behavioral Health at the University of
Pennsylvania. Founded in June 2007, the Scattergood Ethics program is dedicated to
the promotion, evaluation, and training of the clinical issues and strategies
surrounding behavioral health care ethics (Scattergood Foundation, 2012). In
addition, the Scattergood Foundation helped to advance the field of the mental health
journalism 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).

33. 26
3.2 The Scattergood Project
In anticipation of the 200th anniversary of Friends Hospital, the Scattergood
Foundation set out to redesign its website and incorporate some interactive Web 2.0
elements, including a design challenge initiative. By revitalizing the website design,
the Scattergood Foundation sought to advance the level of community dialogue
around current behavioral health issues in the region and foster innovative ways to
address such concerns. Over the course of the past nine months, the following
activities 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 May
Project Development X X
Website Development X X X X X X X X X
IRB Submission/Approval X X* X
Interview Recruitment X X
Phase 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 the
Scattergood Foundation, Joseph Pyle, MA, approached faculty at the Drexel
University School of Public Health, Department of Health Management and Policy –
Dennis Gallagher, MA, MPA and John A. Rich, MD, MPH – and requested Drexel to
collaborate with the Scattergood Foundation on an initiative to retool the Scattergood

34. 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 and
Larry Geiger of Geiger Designs was enlisted as the project’s graphic designer to build
the new website.
A final component of the project team included the recruitment of Drexel
students in the Master’s of Public Health (MPH) program. Initially, two full-time
students, Katherine Carroll and Alyson Ferguson, were recruited to participate in this
initiative for their Community-Based Master’s Project (CBMP), “Fostering Social
Innovation Through the Use of Web 2.0.” At a later point during the development of
the project, I joined the team to collaborate with the full-time students for the
completion of my Executive MPH Block VIII Independent Study. Throughout
September and October 2011, the full-time MPH students initially conceptualized the
project goals. As presented in a project proposal submitted to the Drexel University
IRB, 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 ultimately
creating a design challenge question for the revised Scattergood Foundation website.
The inspiration that would serve as the framework for the design challenge question
was obtained by utilizing elements of the human-centered design methodology in
order to identify some of pressing barriers, issues, and concerns within the behavioral
health community. The purpose of the design challenge was based on the dual goals

35. 28
of encouraging an open dialogue among community members and ultimately fostering
innovative solutions to the proposed behavioral health challenge.
It was noted that, as in any design project, the formulation of the goals and
objectives 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 be
posted in tandem with the release of the new website. As discussed during the
Deliver phase of this project, it would later be determined that the design challenge
release 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 on
the graphic design development of the new website and continued this process in
tandem with the rest of the project’s development. It was determined that the website
would be divided into four main quadrants or portals entitled: The Foundation,
Community Impact, Innovation Awards, and Design Thinking. The Foundation
quadrant will provide background and contact information for the Scattergood
Foundation. The Community Impact quadrant will describe the impact grantmaking
opportunities can have on communities, provide a database of current grants awarded
by the Scattergood Foundation, as well as the criteria and guidelines for new grant
applications. Each year, the Scattergood Foundation presents an award for an
innovative behavioral health solution, policy or project. The Innovation Award
quadrant will provide a background about the annual Scattergood Innovation Award,
a database of past winners and nominees, as well as the eligibility and judging criteria
for future contestants. The Design Thinking quadrant will provide some basic
information about design thinking in general and provide an example of a design

36. 29
thinking application. This quadrant will also host the Design Challenge, where a
behavioral health challenge question will be posed. Community members will be
encouraged to participate and engage in this challenge issue as well as create and
implement an innovative solution.
3.2.3 IRB Submission
To prepare the Institutional Review Board (IRB) application, the team
established the project mission, goals, methods, and overall timeline. In addition,
appropriate research level training compliance was confirmed for all applications
listed on the IRB submission by obtaining the following Collaborative Institutional
Training Initiative (CITI) program certificates: Human Subjects Research and Health
Information Privacy Security. Once completed, an application for human subjects
research was submitted October 2011 to the Drexel University College of Medicine,
Office of Regulatory Research Compliance. By November 2011, the project was
approved and deemed to be exempt from IRB review since the source of the research
data would be obtained from interviews with behavioral and public health
professionals. A secondary factor in this decision was based on the fact that the
research data would not include the collection of identifying medical data nor direct
interactions with behavioral health patients.
3.2.4 Interview Recruitment
Once IRB approval was received, the project was presented to several key
stakeholders in the community in order to recruit them for key informant interviews.
Access to many of the prospective stakeholders was facilitated by referrals from the
project committee members at the Scattergood Foundation as well as Drexel

37. 30
University School of Public Health faculty. During November and December 2011,
the Drexel full-time MPH students coordinated the interview recruitment process by
contacting these referrals, introducing a brief synopsis of the project, and setting up
times to complete the interviews.
3.2.5 Phase 1: Hear
The Hear phase consisted of a literature review and the completion of the key
informant interviews. A review of the literature was conducted in order to further our
academic knowledge base of the current behavioral health topics being explored.
This took place for the full-time students during the summer of 2011 and throughout
the spring of 2012 for myself.
The key informant interviews began once IRB approval was received in
November 2011. The interviews were conducted in order to collect qualitative data
from key stakeholders regarding behavioral health issues, concerns, and barriers in the
Southeastern Pennsylvania region and national landscape. The information these key
stakeholders offered during the interviews would serve as the framework for the
design challenge question. In an effort to gain a rich perspective regarding these
needs and concerns, a multi-disciplinary group of professionals were approached for
the interviews. As a result, we were able to collect stories and information from
individuals that represented a wide breadth of knowledge in the behavioral health
community and included backgrounds in: law, academic, city government, NGO and
advocate organizations, mental health practitioners, private insurance, and public
insurance.
The interview format remained informal to allow for a natural conversation to
emerge between the interviewer and interviewee. However, an interview guide that

38. 31
included a prepared introduction about the project and a list of question prompts was
approved by the IRB and utilized for the interviews (see Appendix A). In addition, a
team approach was incorporated into the process by having a primary interviewer lead
the discussion while a secondary interviewer listened and took notes. The discussions
were recorded with the interviewee’s permission so that the secondary interviewer
could later transcribe the interview. The final interview was conducted in January
2012, with the final transcription completed in March 2012.
Beginning in January 2012, an initial design brief was created that included
the content for the Design Thinking quadrant of the website. While this brief was
continuously revised as the project progressed, the initial draft served as a framework
for the information that would be provided in this section of the website. By February
2012, this initial design brief draft was released for the project team to review and
utilize 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 April
2012. It consisted of analyzing and synthesizing the information collected during the
Hear phase. The initial goal was to code the data in order to make sense of and
identify patterns in the information amassed from the key informant interviews. This
was completed by individual preliminary analyses of interview transcripts where key
phrases, words, and topics concerning behavioral health were documented. We then
combined our individual analyses of the transcripts into a classification of key words
and phrases. In order to verify our combined analyses of the data, the interview
transcripts were then uploaded into a software program called NVivo, which was
developed by QSR International specifically to analyze qualitative data. Using the

39. 32
descriptive words identified during the preliminary analyses, a query was run for the
NVivo program to identify the primary themes, which are referred to as “nodes” in
the NVivo software. The output from this query resulted in several themes or node
categories. The NVivo output was then reviewed to assess the quality of content in
each node and ensure that the context and classification of each categorization was
correct. To do so, the output data was compared to preliminary individual data
analyses to identify any missing references or descriptive words. This information
was loaded back into NVivo in order to run an additional query. By March 2012 the
primary behavioral health themes that were identified from the data analyses
included: 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 12
Note. Represents the number of interviews to mention each theme.
The secondary goal of the Create phase was to define the opportunities and
create potential ideas for a design challenge question. This was achieved by

40. 33
conducting several brainstorming sessions with the project team during April 2012 in
order to progress the design thinking from a level of divergent to convergent thinking.
These sessions evaluated the information collected and began to form distinct and
concrete criteria for the design challenge.
3.2.7 Phase 3: Deliver
Once all of the abstract inspiration and ideas that were collected during the
Hear phase were synthesized into concrete design challenge opportunities during the
Create phase, the aim of the Deliver phase was to formulate the design challenge
model, finalize the design challenge question, and identify the steps needed for its
marketing and implementation. This process began with the conceptualization of the
model by the full-time students in which the design challenge would be framed (see
Table 3). This model encompasses the individual components that are identified for
the design challenge question and will serve as the framework for its marketing and
implementation.
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

41. 34
To ensure that an active level of interest and engagement was established for
the design challenge, several marketing plan strategies were devised. A part of the
marketing plan included a presentation of the project during the 165th American
Psychiatric Association National Conference on May 6, 2012. In addition, a “Share
Your Story” campaign was expected to be released on the new Scattergood website.
This campaign would provide a forum where individuals will be able to share
personal experiences relating to a mental health topic that would be posted on the
website. Another resource that was identified would be the email listserv of the
Scattergood Foundation grantees that could receive notifications and periodic updates
about that the design challenge that could help build awareness and increase the
number of participants for the challenge. In addition, the power of developing
partnerships with regional organizations was recognized as a useful tool to build
support and increase the level of community engagement in the design challenge.
Several potential design challenge questions were conceived during
brainstorming sessions in April 2012. Initially, it was determined that the design
challenge would be posted with the release of the new Scattergood Foundation
website on May 5, 2012. However, in keeping with the tradition of the design
thinking as a nonlinear and iterative process, it was questioned whether the
presentation of the design challenge should be postponed and released on the website
at a later date. In doing so, the Hear phase of the project would have been continued
an additional few weeks or months. The implementation of the final Deliver phase
including the release of the first design challenge would have been postponed until
late summer or early fall of 2012. This revised implementation plan was the result of
several meetings and brainstorming sessions where the potential design challenge
questions were reviewed. During those meetings it was discussed whether there

42. 35
would be a sufficient level of community engagement in the design challenge by May
2012. In an effort to heighten the level of interest, awareness, and engagement in the
community about this project, it was proposed that the process of divergent thinking
should be continued in order to obtain additional feedback from the website users
about potential design challenge questions as supplemental information to the key
informant interviews.
Apprehension regarding the level of community engagement was assuaged
when the project received an official endorsement from Arthur C. Evans, Jr., PhD,
Commissioner of the Philadelphia Department of Behavioral Health and Intellectual
disAbility 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 everyone's mental wellness.
In addition, the DBHIDS agreed to serve as a co-sponsor of the design challenge by
partnering with the Scattergood Foundation to provide consultation and feedback
throughout the design challenge initiative. During the completion of the Scattergood
project, DBHIDS was in the process of implementing Mental Health First Aid
(MHFA) training sessions within the Philadelphia area (DBHIDS, 2012). MHFA is
an international, evidence-based certification course designed to improve mental
health literacy (MHFA, 2009). The program provides early intervention training to all
individuals in order to assist fellow community members who are experiencing
mental health issues. A key to this program is that it is designed for all community
members to participate regardless of whether they have a clinical or behavioral health
background. Trained individuals will be better equipped to recognize, comprehend,

43. 36
and respond to mental health issues or crises. In addition, they will be able to offer
their 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 the
city of Philadelphia, the design challenge goals were modified to include a targeted
effort to support the MHFA program in some capacity. As of the completion of this
report, the first design challenge question was not yet finalized. The release of the
design 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 myself
synthesizing all of the information we amassed during this project as well as
recounting our experiences. Throughout my participation in this project I educated
myself about the subjects addressed in the project including mental health care
policies and treatment, social innovation, design thinking including human-centered
design, Web 2.0 and social media, as well as the role of philanthropy as a change
agent. This was achieved by a literature review that included accessing government
and NGO reports, journal publications, and media articles about these key topics. In
addition to my review of the current literature, I recorded my thoughts and accounts
regarding my participant in the active Scattergood project activities. These activities
were concurrently completed during my participation as a team member of the project
between January and May of 2012.

44. 37
3.3 Future of the Scattergood Project
As with any design thinking process, the search for further advancements and
improvements is ever present. Thus, the Scattergood Project set a precedent to
constantly be open to new opportunities in order to consistently grow and evolve from
their efforts. This is apparent in the decision to revise the implementation plan for the
design challenge. With the release of the design challenge being postponed, it
provides an excellent opportunity for future Drexel MPH students to actively
participate in the implementation and management of the initial design challenge with
the Scattergood Foundation. The goal is for the collaboration with the Drexel
University School of Public Health to continue to grow and for future Drexel students
to assist in the implementation of future design challenges on the Scattergood
Foundation website. In addition, it is hoped that the support provided by the
Philadelphia DBHIDS will encourage other partnership opportunities to develop.
Eventually, it is expected that the winning design challenge solution will be
implemented within the community. This may serve not only to improve behavioral
health care in the region, but also set an example for other communities to replicate
the 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 challenges
to be implemented by the Scattergood Foundation. Ultimately, I anticipate that the
dialogue and opportunities generated from the design challenge initiatives will
continue to foster innovative and sustainable advancements by the consumers,
practitioners, and policymakers of our regional and national behavioral health
systems.

45. 38
4. LESSONS LEARNED
4.1 Personal Narrative
Being involved in the Scattergood Project presented an unexpected
opportunity for me to expand the resources from which I could learn more about the
current public health systems and issues faced by the Southeastern Pennsylvania
region and the nation overall. It was also a unique way to absorb a large amount of
information regarding current behavioral health issues and needed improvements
directly from some of the foremost service providers and policy makers in the region.
My unconventional role in the project did result in some personal challenges
that I needed to address. Perhaps the greatest challenge was adjusting to my part-time
status in a full-time project. The students with whom I was working were enrolled in
the program on a full-time basis and thus able to devote much more time to this
project. Early in my involvement, I realized that my presence and participation would
be 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 that
took place during business hours. I tried to compensate for this by participating in
any activities that took place during the evenings and, when possible, called into
meetings and some key informant interviews by phone. In doing so, my goal was to
demonstrate my dedication to the project while also not committing to more than I
was capable of providing due to the time and scheduling restraints.
It quickly became clear to me that I primarily had to adjust to expectations for
myself rather then my project team members. In fact, my team members were always
appreciative of any contribution I was able to make to the project and easily
maintained reasonable expectations regarding my level of participation. Due to my
personal dedication to the advancement of mental health issues and the reduction of

46. 39
mental illness stigmatization, I found it difficult to not devote the majority of my time
to this project. However, I knew that it would irresponsible of me to commit more
time than I was capable of delivering. Therefore, for the benefit of the project and my
own time management responsibilities, I had to realistically establish what I would be
capable of contributing. Once these expectations were established and my function
within the project became better defined, I eventually adjusted to this role.
Some of the more overarching project challenges identified by my team
members included adjusting to the application of design thinking methodology. In
doing so, we had to consistently remind ourselves that design thinking is a nonlinear
process that may include several iterations of the process as well as its expected
outcomes. This experimental and non-standardized approach first became apparent
during the key informant interviews as they were conducted in a conversational rather
than 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 compelling
and valuable information. A few technical challenges were also experienced with the
utilization of the NVivo program to code the project data. First, the NVivo software
license only permitted a maximum of two coders. Second, the program was only
available on one computer, which was located on the Drexel University campus. As a
result, the program was only accessible during business hours when the building itself
was open. This was particularly challenging for me since I maintained a full-time job
during this program and my participation in the project activities were primarily
conducted 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 was
the beginning inspiration towards a new career path for myself. I entered this

47. 40
program with the general and vague expectation that I would be attempting a career
change upon graduation. However, during the majority of this program, I had no
clear idea of what new direction my career path would take. My personal interests of
mental health and health care as well as my background in clinical research motivated
me to choose a public health program over business school or public policy-centered
programs. However I did not yet know how or where I wanted to transition from a
career in pharmaceutical clinical research. During the course of this program, I found
myself instinctively drawn to areas of focus that were tied to my personal interests
while also demonstrating an unmet need as possible opportunities for a meaningful
contribution to society. I believe that I discovered three areas of interest that fit these
desired criteria.
First, the field of public health needs to improve and increase the integration
of mental health prevention and promotion initiatives into its academic research and
curriculum, its field-based interventions, as well as its overall frame of thought as the
field itself continues to gain awareness and a more prominent position in society’s
infrastructure.
Secondly, the field of mental health needs to take advantage of the increased
focus on health care reform and utilize this momentum to advance the quality of and
access to mental health care. In addition, this is an opportunity to further promote the
integration of mental and physical health care into a unified health care system. By
participating in such a dialogue, mental health may finally establish itself as a vital
and integral part of overall health care and wellness.
Lastly, the increased use of design thinking methods has the potential to
revolutionize our increasingly fragmented health care system. In addition, this school
of thought and practice presents an exceptional opportunity to increase the

48. 41
understanding and awareness of mental health issues in our society as well as the
importance of mental wellness while also reducing stigma. This may just be the
disruptive 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 of
a research paper, I doubt I would have come to these same meaningful conclusions.
Instead I drew a tremendous amount of inspiration from behavioral health community
leaders we interviewed as well as the project group discussions with the advisors and
full-time students concerning topics such as Web 2.0, social media, design thinking,
and human-centered design to achieve socially innovative solutions. These
experiences led me to incorporate additional readings about these unfamiliar subjects
with my previously anticipated research on mental health and health care reform. As
a result, I feel that my project took a direction that I would not have considered had I
been left to my own devices while conducting traditional and solitary research for a
literature review based project. Luckily, I was able to participate as an active member
of a project team rather than simply as a passive consumer of information. This
expanded my horizons and opened me up to a new way of evaluating the current
systemic, 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 the
Scattergood Foundation, the goal has always been maintained that future MPH
students could participate in this project as it continues to evolve. Initially, it was
assumed that only full-time MPH students would participate as a part of their
yearlong CBMP. However, the opportunity fortuitously presented itself for me to

49. 42
contribute as an Executive MPH student in fulfillment of my Block VIII Independent
Study requirement. After having completed this project, I can conclude that this is
may serve as an exceptional opportunity for future Executive MPH students to
complete their Block VIII project and one that is ideally suited for someone who is
considering a career change or advancement after graduation. The aspects of this
project afford students the chance to meet many prominent professionals in the local
behavioral and public health communities. One is not as likely to receive this level of
exposure when completing the relatively solitary task of writing a traditional research
paper. By virtue of collecting qualitative data from behavioral and public health
professionals and implementing a design challenge with the same target audience in
mind as participants, future students may have several opportunities to engage with
such professionals on a remarkable level.
Since I believe students of public health should include behavioral health in all
aspects of their education, I may be biased in my willingness to promote working on
project that directly addresses behavioral health concerns of the region. However, it
is my opinion that the in-depth focus on social innovation and the usage of design
thinking techniques in this type of project will add a unique perspective and
unparalleled learning experience for Executive MPH students. I believe that the
application of design techniques to achieve socially innovative solutions is a
discipline that is still evolving and has yet to reach its full potential, particularly in the
field of public health. Therefore, this may serve as an ideal setting for Executive
MPH students at Drexel University to “get in on the ground floor” so to speak, expand
their skill set, and enable their public health career to advance in an exciting direction
they may have not previously considered.

50. 43
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APPENDIX A: INTERVIEW GUIDE
Introduction
[Introduce interviewers] Thank you for taking the time to speak with us. This
interview is taking place during the initial phase of our community-based Master’s
project at Drexel University. The purpose is to provide us with a birds-eye view of
the current climate surrounding behavioral health issues in the Southeastern PA
region. We are seeking your input on what kinds of problems exist in the regional
behavioral health system, which of these problems you consider most urgent, and
what kinds of opportunities you believe exist around these issues. We do have a set of
questions to ask you but encourage you to share any information or opinions that you
think are relevant. The information from the interview will be used to help inform the
development of an online design challenge [Hand out information brief on the
project].
Following this first round of key informant interviews, we will administer a survey to
a larger population of providers, academics and students. We will use the survey to
further explore themes that arose during the interviews. Ultimately, the purpose of
these 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 challenge
will foster innovative thinking and provide an online platform for engaging the
regional 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 behavioral
health issues)
We’d to like to start off just by hearing a bit about your “story” with regard to the
field of behavioral health. Can you speak a bit about some of the experiences that
have gotten you to this point in your career?
How would you describe the current level of interest and engagement about
behavioral health policy in our region?
How might we raise the level of interest, engagement and excitement about
behavioral health policy?
What specific issues or questions within behavioral health policy should we
prioritize?
Optional Follow-Up:
Who is affected?
How are they affected?
What kinds of barriers exist in addressing this issue?

58. 51
What ways could we engage more policymakers, providers, researchers and students
this 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 believe
should be involved?
Topic Area 2: Successful examples in the community
(Now we would like to explore what “success” in behavioral health policy means to
you.)
Can you give an example of a program, organization or policy in the region that you
believe 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 or
had?
Topic Area 3: Further Recommendations
(Lastly, we’d like to close out the interview by asking you for recommendations
about our project.)
Do you have any recommendations for other professionals or organizations that we
should consider including in our survey?
Do you have any recommendations for how we will advertise and recruit participation
in our online design challenge?
Are there any additional questions, concerns, or suggestions that you have for us?

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APPENDIX B: DESIGN BRIEF DRAFT
What is The Scattergood Design Challenge?
The Scattergood Design Challenge is a public web space dedicated to hosting
conversations about innovation in the behavioral health system. Inspired by human-
centered design methodology [see below], these design challenges will be primarily
driven 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 the
Design Challenge as a safe space for users to share ideas and inspirations so that we
can work together to cultivate innovative ideas about behavioral health in the region
and beyond.
What is human-centered design?
Human centered design is a process and set of techniques for generating innovative
solutions. It is comprised of three phases: hear, create, and deliver. The Hear phase
revolves around collecting inspiration from the people directly affected by the
problem. The Create phase utilizes a workshop format to translate these inspirations
into frameworks, prototypes, and/or solutions. In this phase, group members first
brainstorm many options (divergent thinking) and then work to eliminate them
(convergent thinking). The ideas that are selected to continue through the process are
those that exist in an overlap of three lenses: desirability, feasibility and viability. The
Design phase entails planning the transition from workshop to real world, through
cost modeling, assessments, and implementation planning for the ideas that were
emerged during Create.
Who is allowed to participate?
The Scattergood Foundation encourages all individuals or groups that have an
existing interest or growing curiosity about their community’s behavioral health to
participate in this design challenge.
How will challenges be structured?
The specific structure of each challenge will be built around the nature of the question
and will vary from challenge to challenge. However, all challenges will follow the
three 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 of
Southeastern Pennsylvania, we believe that the issues and discussions presented here
will have relevance in communities across the country and encourage users from all
over to participate. In addition, the behavioral health issues addressed within this
challenge will be examined through a public health lens in an effort to create solutions
that will generate system-wide changes for the targeted interventions and their
programs.

60. 53
Will Scattergood implement the winning ideas?
No, we envision the Challenge web space as a database of ideas. The larger scope of
this project hopes to see community organizations and policymakers borrow
inspiration from this database and take ownership of implementation. In addition, our
goal is to address behavioral health issues and concerns that are of particular
importance to community organizations and advocacy groups, and thus encourage
organizations to submit challenge questions. [Contact info for submitting challenges?]
What are the expected outcomes?
The Scattergood Design Challenge does not only create solutions to genuine
behavioral health problems but, also makes a positive impact in the field of behavioral
health by creating a conversation and fostering innovation around policy and system
issues. This challenge allows for community organizations, individuals, and other
groups to exercise their creative thoughts, promote and nurture growth of current
programs and initiatives, create new programs and initiatives, and attract positive
participation and discussion about behavioral health.
What does “success” look like?
Success will be gauged by the types of interaction and collaboration, the long-term
impact and influence, and community awareness and utility. The freshness of
material, amount and type of feedback provided, and the continual evolution is of
great importance to the project and will be tracked.

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APPENDIX C: LINKS FOR ADDITIONAL INFORMATION
For additional information about the organizations and programs mentioned, please
access the following links:
Thomas Scattergood Behavioral Health Foundation
http://www.scattergoodfoundation.org/
Department of Behavioral Health and Intellectual disAbility Services (DBHIDS)
http://dbhids.org/
DBHIDS: Philadelphia Launch of Mental Health First Aid
http://www.dbhids.org/dbhids-launches-mental-health-first-aid
Mental Health First Aid USA
http://www.mentalhealthfirstaid.org/cs/